阴囊纵膈皮瓣在先天性尿道下裂治疗中的应用  

Application of Scrotal Septal Flaps in Treatment of Congenital Hypospadias

作　　者：李建昌[1] 柳建军[1] 许志坚[1] 

机构地区：[1]广东医学院附属医院泌尿外科,广东湛江524000

出　　处：《实用临床医学（江西）》2012年第5期27-29,共3页Practical Clinical Medicine

摘　　要：目的探讨阴囊纵膈皮瓣尿道成形术治疗先天性尿道下裂的临床疗效及可行性。方法选择先天性尿道下裂患者53例,均行阴囊纵膈皮瓣尿道成形术治疗。首先切除阴茎腹侧纤维索带以松解伸直阴茎,再采用阴囊纵膈皮瓣形成新尿道,并随访6个月～4年。结果 53例患者中,一期尿道成形手术41例(77.4%),二期尿道成形术12例(22.6%)。手术时间2.5～4.5 h,平均3.5 h;术中出血20～100 mL,平均50 mL;阴囊纵膈皮瓣最小为2.0 cm×1.5 cm,最大为8.0 cm×2.0 cm;术后分别留置气囊尿管或自制多侧孔硅胶支架管7～21 d,平均12 d。53例患者获得随访6个月～4年。术后7例出现尿瘘须再次手术治疗,5例出现尿道狭窄行3～5次尿道扩张后正常排尿。年龄较大患者术后阴茎勃起正常,阴茎无明显弯曲,外观基本正常。结论阴囊纵膈皮瓣尿道成形术治疗先天性尿道下裂,材料充裕,血供丰富,手术成功率高。阴囊纵隔皮瓣是治疗尿道下裂尿道成形的理想材料。Objective To explore the clinical efficacy and feasibility of scrotal septal flap urethroplasty in congenital hypospadias.Methods Fiftyo-three patients with congenital hypospadias underwent urethroplasty with scrotal septal flaps.Ventral fibrous band was firstly removed to straighten the penis.Then,scrotal septal flaps were used to form a new urethra.Patients were followed up for 6 month to 4 years.Results Among the 53 patients,one stage urethroplasty was performed in 41（77.4%） and two stage urethroplasty in 12（22.6%）.Mean operative time was 3.5 hours（range,2.5 to 4.5 hours）.Average blood loss was 50 mL（range,20 to 100 mL） in intraoperative.Scrotal septal flaps ranged from 2.0 cm×1.5 cm to 8.0 cm×2.0 cm.Average time of indwelling balloon catheters or self-made multi-side-hole silicone catheters was 12 days（range,7 to 21 days）in postoperative.53 patients were follodwe up for 6 month to 4 years.After urethroplasty,7 patients required reoperation for urinary fistula and 5 patients showed normal voiding after 3-5 times of urethral dilatation for urethrostenosis.Elderly patients showed normal rection and penis appearance without apparent bending.Conclusion Scrotal septal flap is an ideal and effective material for urethroplasty in the treatment of congenital hypospadias,with advantages of abundant source,rich blood supply and high success rate of surgery.

关 键 词：尿道下裂 阴囊纵膈皮瓣 尿道成形术 多侧孔硅胶支架管 自制 疗效 

分 类 号：R695[医药卫生—泌尿科学]