改良Duckett术式预防儿童尿道下裂术后尿道狭窄的临床研究

A clinical study on the modified Duckett procedure for preventing postoperative urethral stricture in children with hypospadias

摘要

目的 总结儿童Duckett尿道下裂修复术的术中改良细节，分析其对术后尿道狭窄发生率的影响，为临床预防尿道狭窄提供参考。方法 回顾性分析2015年1月-2025年6月在华中科技大学同济医学院附属同济医院小儿外科接受Duckett尿道下裂修复术的775例患儿临床资料。按照时间顺序及是否对手术细节进行改良优化，将患儿分为传统组（390例）和改良组（385例）。手术改良细节包括：保留阴茎冠状沟处Buck筋膜，对阴茎头腹侧进行劈开、减容及重新成型处理；皮瓣卷管尿道时用较粗型号导尿管支撑，完成尿道成形后再换为较小型号导尿管留置；卷管尿道近端与原尿道行吻合斜面长度≥1.5 cm。比较两组患儿的术中指标（阴茎长度、阴茎头宽度、皮瓣成形的尿道长度、手术操作时间和术中出血量）、术后尿道狭窄发生率，以及狭窄发生后的临床处理情况（尿道扩张治疗效果和再次手术率）。结果 改良组的手术操作时间较传统组延长[（128.4±26.3）min对比（112.5±28.6）min，P＜0.05]，但两组术中出血量差异无统计学意义[（21.1±11.2）mL对比（20.6±10.4）mL，P＞0.05]。所有患儿均获得≥12个月的随访，改良组术后尿道狭窄发生率显著低于传统组[7.2%（28/385）对比13.1%（51/390），P＜0.05]。对于发生尿道狭窄的患儿，改良组行保守扩张治疗成功率显著高于传统组[89.3%（25/28）对比74.5%（38/51），P＜0.05]，而需再次手术的比例显著低于传统组[10.7%（3/28）对比25.5%（13/51），P＜0.05]。结论 联合导尿管优化选择、阴茎头及Buck筋膜改良处理和斜面长吻合口成型的Duckett术中的细节改良，可有效降低儿童尿道下裂术后尿道狭窄的发生率，值得临床推广。

Abstract

Objective To summarize the intraoperative refinements of the Duckett procedure for hypospadias repair in children, analyze their impact on the incidence of postoperative urethral stricture, and provide a reference for the clinical prevention of urethral stricture. Methods Clinical data of 775 children who underwent primary Duckett hypospadias repair during Jan. 2015 and Jun. 2025 were retrospectively analyzed. The patients were divided into the conventional group (n=390) and modified group (n=385) according to chronological order and whether the surgical details were modified and optimized. The refinements included preserving Buck's fascia at the coronal sulcus; splitting, debulking and reshaping the ventral glans; using a larger-caliber catheter as a stent during urethral tubularization and then replacing it with a smaller-caliber catheter for indwelling; constructing a spatulated anastomosis (≥1.5 cm) between the native urethra and the neourethra. The intraoperative parameters (penile length, glans width, neourethra length, operation time, blood loss), incidence of postoperative urethral stricture, as well as the clinical management after stricture onset (therapeutic effect of urethral dilation and reoperation rate) were compared between the two groups. Results The modified group had a significantly longer operation time than the conventional group [(128.4±26.3) vs. (112.5±28.6) min, P<0.05], whereas intraoperative blood loss did not differ significantly [(21.1±11.2) vs. (20.6±10.4) mL, P>0.05]. During the follow-up of at least 12 months, the incidence of postoperative urethral stricture was significantly lower in the modified group [7.2% (28/385) vs. 13.1% (51/390), P<0.05]. Among those who developed stricture, the modified group exhibited a significantly higher success rate of conservative dilation [89.3% (25/28) vs. 74.5% (38/51), P<0.05] and a significantly lower reoperation rate [10.7% (3/28) vs. 25.5% (13/51), P<0.05]. Conclusion Combined intraoperative refinements of the Duckett procedure, including optimized catheter selection, improved management of the glans and Buck's fascia, and long spatulated anastomosis, can effectively reduce the incidence of postoperative urethral stricture, which are worthy of promotion.

关键词

尿道下裂 / 改良Duckett手术 / 尿道狭窄

Key words

hypospadias / modified Duckett procedure / urethral stricture

参考文献

[1] RICHARD MA, PATEL J, BENJAMIN RH, et al. Prevalence and clustering of congenital heart defects among boys with hypospadias[J]. JAMA Network Open, 2022, 5(7): e2224152.

[2] SOCIETY FOR MATERNAL-FETAL MEDICINE (SMFM); SPARKS TN. Hypospadias[J]. Am J Obstet Gynecol, 2021, 225(5): B18-B20.

[3] ABU-ARAFEH W, CHERTIN B, ZILBERMAN M, et al. One-stage repair of hypospadias-experience with 856 cases[J]. Eur Uro, 1998, 34(4): 365.

[4] GHALI AM, EL-MALIK EM, AL-MALKI T, et al. One-stage hypospadias repair. Experience with 544 cases[J]. Eur Urol, 1999, 6(5): 436-442.

[5] CASTAGNETTI M, EL-GHONEIMI A. Surgical management of primary severe hypospadias in children: an update focusing on penile curvature[J]. Nat Rev Urol, 2022, 19(3): 147-160.

[6] BALTOGIANNIS N, FILI F, BALTOGIANNI IV, et al. Hybrid one-stage Snodgrass-Duckett urethroplasty for severe hypospadias. A five-year institutional experience[J]. Pediatr Med Chir, 2026, 48(1): 368.

[7] WU Y, GUAN Y, WANG X, et al. Repair of proximal hypospadias with single-stage (Duckett's method) or Bracka two-stage: a retrospective comparative cohort study[J]. Transl Pediatr, 2023, 12(3): 387-395.

[8] MONTI M, CAPUTO V, AUDRY G, et al. Sexual health and proximal hypospadias repair: patient-reported outcomes after Koyanagi, a survey-based study[J]. J Sex Med, 2026, 23(4): qdag080.

[9] COUSIN I, BASMAISON C, COUSIN E, et al. Complication rates of proximal hypospadias: meta-analyses of four surgical repairs[J]. J Pediatr Urol, 2022, 18(5): 587-597.

[10] XIAO Y. An insight of pathological anatomy of urethral stricture and surgical manipulations for children suffered from hypospadias[J]. BMC Urol, 2023, 23(1): 40.

[11] 田广超， 范应中， 苑思彤， 等. 尿道下裂Duckett术后并发吻合口狭窄的相关因素分析[J]. 临床小儿外科杂志， 2022， 21（5）： 445-451.

[12] 徐奥， 李雪， 曾莉， 等. 尿道下裂Duckett手术后吻合口狭窄的预防与治疗[J]. 临床小儿外科杂志， 2019， 18（2）： 147-150.

[13] HUANG L, GUO Y, GE Z, et al. A new modification of the Duckett technique for one-stage repairing urethral plate transected hypospadias: another option for severe hypospadias? [J]. Int Urol Nephrol, 2017, 49(12): 2091-2097.

[14] 刘鹏鹏， 张胜利， 赵祥， 等. 尿道缺损长度对一期Duckett术后并发症发生的预测价值研究及分期手术时机判定[J]. 中华小儿外科杂志， 2026， 47（3）： 244-249.

[15] LI J, LIU P, YANG Z, et al. Reoperation frequency after transverse preputial Island flap urethroplasty “Duckett's technique” in treatment of severe hypospadias: a single center study[J]. Front Pediatr, 2023, 10: 1030649.

[16] 茹伟， 徐哲明， 沈一丁， 等. 尿道板离断尿道成形术后尿道狭窄危险因素分析[J]. 中华小儿外科杂志， 2019， 40（11）： 976-980.

[17] 江志勇， 李学德， 何庆鑫， 等. 尿道板增宽阴茎头结合层面外科手术在尿道下裂合并小阴茎头治疗中的应用[J]. 现代泌尿外科杂志， 2023， 28（10）： 841-845.

[18] 林珊， 何少华， 许辉煌， 等. 尿道板纵切卷管尿道成形术中应用Buck's筋膜恢复尿道海绵体完整包绕的体会[J]. 中华小儿外科杂志， 2020， 41（8）： 733-738.

[19] 陈海琛， 唐耘熳， 徐延波， 等. 阴茎腹侧Buck筋膜重建在重度尿道下裂修复中的应用及近期疗效观察[J]. 临床小儿外科杂志， 2019， 18（2）： 130-135.

[20] 茹伟， 唐达星， 吴德华， 等. 尿道板纵切卷管尿道成形术术毕时更换支撑导尿管对术后尿道并发症的影响[J]. 中华泌尿外科杂志， 2019， 40（3）： 220-223.

[21] LYU Y, YU L, XIE H, et al. Comparison of short-term complications between Onlay and Duckett urethroplasty and the analysis of risk factors[J]. Int Urol Nephrol, 2019, 51(5): 783-788.

[22] 杨珍珍， 李佳义， 刘沛， 等. 一期Duckett与分期Bracka尿道成形术治疗非远端型尿道下裂术后并发症的Meta分析[J]. 临床小儿外科杂志， 2023， 22（2）： 168-179.

[23] RU W, FENG C, TIAN H, et al. A novel corporoplasty technique with a urethral plate flap in hypospadias repair[J]. Int J Urol, 2023, 30(8): 666-671.

[24] ARDELT PU, CEDERQUIST M, SCHOENTHALER M, et al. The glandular resection and central embedding modification (GRACE) in Duckett and Barcat hypospadias repair[J]. Urol Int, 2013, 90(3): 358-364.

[25] HAYASHI Y, KOJIMA Y. Current concepts in hypospadias surgery[J]. Int J Urol, 2008, 15(8): 651-664.

[26] 曹华林， 姜心诚， 叶惟靖， 等. 改良自制双套管尿道支架引流在尿道下裂手术中的应用[J]. 中华小儿外科杂志， 2024， 45（12）： 1092-1096.

[27] 李昌佩， 周维， 王翔， 等. 阴茎深筋膜联合改良游离包皮移植物卷管尿道成形术与Duckett术在近端型尿道下裂中的疗效比较[J]. 中华小儿外科杂志， 2023， 44（4）： 338-344.