微粒黏膜复合明胶海绵移植耦合局部皮瓣再造尿道  

URETHRAL RECONSTRUCTION USING GELATIN SPONGE AND MICRO-MUCOSA GRAFT COMBINED WITH LOCAL FLAP

作　　者：李鹏程[1,2] 李森恺[1] 赵穆欣[1] 石炳毅[2] 李强[1] 王永前[1] 陈文[1] 刘立强[1] 陈斌[1] 刘晓吉[1] 

机构地区：[1]中国医学科学院北京协和医学院整形外科医院南二病房,北京100144 [2]解放军总医院第二附属医院泌尿一科

出　　处：《中国修复重建外科杂志》2009年第3期313-315,共3页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：卫生部临床学科重点项目基金资助项目(20010409)~~

摘　　要：目的探讨明胶海绵复合微粒包皮内板黏膜或尿道板黏膜游离移植,并耦合局部皮瓣治疗阴囊型及阴茎阴囊型尿道下裂的手术方法及疗效。方法2006年4月-2007年12月,收治8例重度尿道下裂患儿,年龄8个月～3岁。阴囊型尿道下裂3例,余均为阴茎阴囊型尿道下裂。阴茎牵拉长度为2.5～4.5cm。应用明胶海绵复合微粒包皮内板黏膜或尿道板黏膜游离移植,并与大小为2.5cm×1.0cm～4.5cm×1.2cm的局部皮瓣耦合再造尿道。其中一期修复7例,二期修复1例。结果患儿手术时间为(150±35)min,术中测量修复尿道缺失长度为(3.38±0.79)cm。皮瓣均顺利成活。8例均获随访,随访时间2～24个月。无尿瘘和尿道狭窄并发症发生。患儿阴茎下弯彻底矫正,再造尿道口位于阴茎头部,能正常勃起和站立排尿,尿道顺应性良好。1例术后12个月出现轻度阴茎下弯,未行治疗。结论明胶海绵复合微粒包皮内板黏膜或尿道板黏膜游离移植耦合局部皮瓣修复阴囊型及阴茎阴囊型尿道下裂,具有减少局部皮肤应用、改善成形龟头外观、减少尿道并发症的优点,近期疗效较好。Objective To introduce an operative method of combining the complex of gelatin spongy and micro-mucosa from inner prepuce or urethral plate graft with the local ap in the treatment of scrotal hypospadias and penoscrotal hypospadias and to investigate its therapeutical effect. Methods From April 2006 to December 2007,8 cases of congenital hypospadias were treated,aging 8 months to 3 years. Three cases were scrotal hypospadias,the others were penoscrotal hypospadias. The length of penis was 2.5-4.5 cm. All cases were repaired with micro-mucosa which taken from inner prepuce or urethral plate,gelatin sponge and local ap. The size of the local ap was 2.5 cm×1.0 cm-4.5 cm×1.2 cm. Only one of the 8 cases underwent two-stage operation,and 7 cases underwent one-stage operation. Results The operation time was （150 ± 35） minutes. The length of repaired urethra was （3.38 ± 0.79 ） cm. All aps survived after operation. Eight cases were followed up for 2-24 months. All cases were successful without urethral stula and urethral stricture postoperatively. A vertically oriented,slit neomeatus was gained after operation and satisfactory voiding function. The appearance of penis resembled the appearance after prepuce circumcision. All the patients have normal urination and erection. Super cial penile curvature occurred in one case after 12 months postoperatively. Conclusion Gelatin sponge and micro-mucosa from inner prepuce or urethral plate graft combined with local ap can repair the scrotal hypospadias and penoscrotal hypospadias. The advantages are to decrease the utilization of local tissues,improve the appearance of glans and decrease the complication rates.

关 键 词：尿道下裂 明胶海绵 微粒黏膜 局部皮瓣 尿道再造 幼儿 

分 类 号：R699.6[医药卫生—泌尿科学]