口腔黏膜卷管分期修复幼儿期先天性尿道下裂  

Tubed oral mucosa for staged treatment of congenital hypospadias in infancy

作　　者：李养群 李森恺 刘晓吉 唐勇 陈文 杨喆 赵穆欣 

机构地区：[1]中国医学科学院整形外科医院,北京100144

出　　处：《中华整形外科杂志》2011年第1期4-7,共4页Chinese Journal of Plastic Surgery

基　　金：卫生部临床重点学科基金资助项目（20010409）

摘　　要：目的 探讨修复幼儿期先天性尿道下裂的手术方法.方法 矫直阴茎后,应用口腔黏膜卷管游离移植预制缺损段尿道,二期进行吻接,同时应用以阴囊动脉为蒂的阴囊筋膜皮瓣覆盖创面,皮瓣范围包括阴囊中缝区在内的阴囊区域.结果 2007年1月至2010年5月,于临床应用42例.手术过程顺利,应用口腔黏膜卷长3.0～4.0 cm,直径0.6～0.8 cm;阴囊筋膜皮瓣最宽1.5cm,最长3.0 cm.术后除2例患者出现阴囊皮瓣远端血运障碍而漏尿,术后1～2周内经换药后自行愈合外,其余患者均一期愈合.术后有26例获得随访,时间为6个月至3年,阴茎无弯曲,自行排尿通畅,无尿道狭窄及尿瘘,阴茎外形良好.结论 应用口腔黏膜卷管游离移植预制缺损段尿道,二期尿道吻接,同时应用血运良好的阴囊筋膜皮瓣覆盖创面,是一种修复幼儿期尿道下裂的良好方法.Objective To discuss the treatment of congenital hypospadias in infancy. Methods After correction of chordee, the tubed oral mucosa was used to prefabricate urethra in penis as free graft.The uretheral anastomosis was performed at the second stage. The scrotum fascia flap, pedicled with scrotal artery, was transferred to cover the penile defect. Results From Jan. 2007 to May 2010, 42 cases were treated. The tubed oral mucosa was 3.0-4.0 cm in length ,and 0. 6-0. 8 cm in diameter. The maximum size of scrotum flap was 1.5 cm × 3.0 cm. Uretheral fistula happened in two cases due to necrosis at the distal end of scrotal flap, which was healed spontaneously after dressing for 1-2 weeks. Primary healing was achieved in all the other cases. After operation, the 26 cases have been visited for 6 months to 3 years, no urethra fistula , narrow and the penis curved. There is an universal urinate for oneself and a good form.Conclusions The tubed oral mucosa can be used to prefabricate urethera, which is anastomosed at the second stage. The tubed oral mucosa combined with scrotal fascial flap which has a reliable blood supply,is very suitable for hypospadias in infancy.

关 键 词：先天性尿道下裂 幼儿 口腔黏膜卷 阴囊筋膜皮瓣 

分 类 号：R726.9[医药卫生—儿科]