尿道延伸术结合局部皮瓣治疗远端型尿道下裂.docVIP

尿道延伸术结合局部皮瓣治疗远端型尿道下裂[摘要]目的:探讨尿道延伸术结合局部皮瓣治疗远端型尿道下裂的疗效。方法:总结1年内收集的10例行尿道延伸术接使局部皮瓣治疗远端型尿道下裂患者的资料。年龄4～21岁,平均年龄12岁。结果:10例全部成功,术后随访6～12个月,阴茎外形满意,排尿通畅,无尿瘘及尿道狭窄。结论:尿道延伸术接合局部皮瓣适合于治疗远端型尿道下裂,具有手术成功率高,术后并发症少的优点。 [关键词]尿道延伸术;尿道下裂 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2010)10-1419-02 Urethral extension and reconstruct distal urethra with local skin flap for the repair of distal hypospadias DING Jian,LI Qiang,LI Sen-kai,ZHOU Chuan-de,LI Feng-yong,ZHOU Yu,HU Jin-tian,WANG Yan (The Tenth Department, Plastic Surgery Hospital,Chinese Academy of Medical Sciences, Chinese Peking Union Medical College, Beijing 100144,China) Abstract:ObjectiveTo observe the efficacy of urethral extension and reconstruct distal urethra with local skin flap for the repair of distal hypospadias. Methods From October 2008 to October 2009,10 cases of distal hypospadias were treated by the method of urethra extension and local skin flap.The patients aged from 4～21 years old with a median 12 years. The types of hypospadias include subcoronal(n=7),subglans (n=3). ResultsAll postoperative recoveries were uneventful.They were followed up for 3～12 months. All patients obtained satisfactory or improved results,without urethral stricture and urethral fistula. Conclusions Urethral extension and reconstruct distal urethra with local skin flap is suitable for treatment of distal hypospadias,its advantages are higher success rate and less postoperative complications. Key words:urethral extension;hypospadias 尿道下裂是小儿泌尿系统的常见畸形,其表现存在明显的个体差异性,如阴茎及阴囊的发育状态、内分泌水平、局部组织发育情况,以往手术治疗经过等。对不同的尿道下裂患者应选择个性化的手术方式,以期达到外形协调美观、功能良好、术后并发症少等目的。我科近年来采用尿道延伸术接合局部皮瓣治疗远端型尿道下裂共10例,全部成功,术后随访满意,现报道如下。 1资料和方法 1.1临床资料:自2008年10月～2009年10月,我科共收治10例远端型尿道下裂患者,其中冠状沟型7例,阴茎头下型3例。最小年龄4岁,最大年龄21岁,平均年龄12岁。10例患者阴茎、阴囊均发育良好,但存在明显的阴茎弯曲和包皮帽,8例患者阴茎下弯角度约30°,2例患者阴茎下弯角度30～40°。 1.2 手术方法 1.2.1 阴茎脱套、尿道延伸:患者取平卧位,采用全身麻醉,常规洗手、消毒、铺无菌巾单。3-0丝线横行贯穿阴茎头作为牵引线,人工勃起后检查阴茎下弯程度,尿道留置硅胶导尿管直达膀胱,作为再造远端尿道的支撑物。美蓝标记切口线,0.5%利多卡因局部浸润麻醉后,沿线于冠状沟下及尿道口下方0.5cm作环形切口,行阴茎皮肤脱套