嚴重型尿道下裂應用三明治技術的重建整型手術

-彰化基督教醫院最近三十年的經驗分享

林介山^1,2,3、江恆杰¹、陳建廷¹、、王百孚¹、周明智²

彰化基督教醫院 外科部 泌尿科¹中山學大學 醫學研究所²

The Reconstruction of Severe Type Hypospadias with Sandwich Technique-Sharing the Experience of CCH in Recent 30 Years

Jesun Lin 1,2,3, Herng-Jye Jiang 1, Jian Ting Chen 1, Bai-Fu Wang 1, and Ming-Chih Cho

1,Division of Urology, Department of Surgery, Children Hospital, Changhua Christian Hospital, Changhua

2, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

3, Division of Pediatric Urology, Children Hospital, Changhua Christian Hospital

Purpose: Severe type hypospadias is tough to be handle in the reconstruction of hypospadias and chordee. The presenting problems are various. We would review our over 30 years experience in the management of this patients. The purpose of this article is presenting the management and study of events with various problems in patients and the outcome of consequent surgery.

Materials and Methods: This is a review article of our 1236 hypospadias patients between January1980 and January 2021. There are 46 peno-scrotal, scrotal, and perineal types hypospadias with severe chordee patients. We performed one stage surgical reconstruction of these patients. described. The basic frames of reconstruction for hypospadias are: TIP ( Tubulized incised urethral Plate) and Island Flap. The basic frames of reconstruction for chordee are: chordectomy, orthoplasty, and dorsal placation. We preserved the best vascularized skin flap for a new urethra. We used double -tube for urethra stent and urine catheterization. Mini-Vac vacuum for drainage of subcutaneous hemorrhage. We follow up the outcome of surgical consequences from 6months to more than ten years. 

Results: The number of redo-operations for their presenting problems ranged from 1 to 3 attempts. The successful surgery of the redo operation requires radical correction of all deformities of fistula, remaining chordee, and hypospadias.   

Conclusions: We have to correct them in a single stage preferably. In redoing this reconstruction, we should be proficient with virtually all the existing methods of hypospadias and chordee reconstruction and be able to apply them appropriately. We follow up these patients to more than their adolescence.