游离移植物加盖式尿道成形在尿道下裂再手术中的应用：口腔黏膜与反脱套组合提供更优的修复策略

Use of free graft onlay urethroplasty in redo hypospadias repair: the combination of oral mucosa and retrograde degloving offers a superior strategy

摘要

目的 总结应用游离移植物加盖式（onlay）尿道成形术在尿道下裂再手术修复中的经验，并比较不同移植物来源及覆盖方式对疗效的影响。方法 回顾性分析2020年6月-2025年7月我院收治的52例尿道下裂再手术患者的临床资料，患者均应用游离移植物onlay尿道成形术进行修复，其中40例采用口腔黏膜游离移植（口腔黏膜组），12例采用阴茎皮肤游离移植（阴茎皮肤组）。比较两组患者的年龄、重建尿道长度、并发症发生率等指标，并分析覆盖方式（反脱套和Dartos筋膜）对治疗效果的影响。结果 口腔黏膜组平均重建长度为（57.3±23.4）mm，显著长于阴茎皮肤组的（19.2±7.3）mm（P＜0.001）。口腔黏膜组并发症发生率为5.0%（2/40），显著低于阴茎皮肤组的33.3%（4/12）（P=0.024）。多因素logistic回归分析显示，采用口腔黏膜游离材料是预防并发症风险的独立保护因素（OR=0.12，95%CI：0.02～0.71，P=0.018）。反脱套覆盖主要用于口腔黏膜修复长段缺损（77.5%），而Dartos筋膜覆盖更常用于阴茎皮肤修复（75.0%）。结论 对于无残留尿道性阴茎弯曲的尿道下裂再手术患者，应用游离移植物onlay尿道成形术可有效改善尿流率并保留良好外观。口腔黏膜游离移植在重建尿道长度和降低并发症方面均优于阴茎皮肤移植，尤其适用于长段缺损修复。反脱套技术可为长段修复提供更好的覆盖支持。

Abstract

Objective To summarize our experience with free graft onlay urethroplasty in hypospadias reoperation and to compare the outcomes of different graft materials and skin coverage methods. Methods A retrospective analysis was conducted on 52 patients who underwent hypospadias reoperation using free graft onlay urethroplasty during Jun.2020 and Jul.2025. Among them, 40 patients received oral mucosa grafts (oral mucosa group) and 12 received penile skin grafts (penile skin group). The two groups were compared in terms of age, reconstructed urethral length, complication rate, and effects of coverage methods (retrograde degloving vs. Dartos fascia). Results The mean reconstructed urethral length was significantly longer in the oral mucosa group than in the penile skin group [(57.3±23.4) mm vs. (19.2±7.3) mm, P<0.001], while the complication rate was significantly lower [(5.0%, 2/40) vs. (33.3%, 4/12), P=0.024]. Multivariate logistic regression analysis identified oral mucosa as an independent protective factor against complications (OR=0.12, 95%CI: 0.02-0.71, P=0.018). Retrograde degloving was primarily used for long-segment defects repaired with oral mucosa (77.5%), while Dartos fascia coverage was more commonly employed for penile skin repairs (75.0%). Conclusion For hypospadias reoperation without residual chordee, free graft onlay urethroplasty can effectively widen the urethra, leading to improved urinary flow rate and satisfactory cosmetic outcomes. Oral mucosa grafts demonstrate superiority over penile skin grafts in terms of both achievable reconstruction length and lower complication rate, particularly for long-segment defect repairs. The retrograde degloving technique provides superior coverage support for long-segment reconstructions.

关键词

尿道下裂 / 再手术 / 游离移植 / 口腔黏膜 / 阴茎皮肤 / 尿道成形术

Key words

hypospadias / reoperation / free graft / oral mucosa / penile skin / urethroplasty

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