包皮岛状皮瓣尿道板重建尿道成形术初步报告  

One-stage urethroplasty by tubularization of reconstructed urethral plate using preputial island flap in proximal hypospadias with severe chordee

作　　者：谢华[1] 陈方[1] 黄轶晨[1] 吕逸清[1] 余玲[1] 李晓溪[1] 孙莉[1] 徐展远[1] 陈艳[1] 

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院泌尿外科,200040

出　　处：《中华小儿外科杂志》2014年第5期370-373,共4页Chinese Journal of Pediatric Surgery

基　　金：上海市公共卫生体系建设三年行动计划

摘　　要：目的改良经典背侧包皮内板岛状皮瓣卷管尿道成形术，评价其治疗效果。方法2012年3月至2013年9月，15例阴茎严重弯曲的近端型尿道下裂采用包皮岛状皮瓣尿道板重建术进行尿道成形。患儿年龄7～23个月，阴茎伸直后阴茎长度2．5～4．0cm，尿道开口会阴部9例，开口阴茎阴囊交界处6例，尿道缺损4．046．0cm。术中横断尿道板伸直阴茎，将背侧包皮岛状皮瓣间置于尿道开口和阴茎头之间，使血供较丰富的皮瓣中心部分紧贴阴茎海绵体白膜，重建尿道板，同期卷管完成尿道成形。术后常规留置6Fr胃管2周。结果术后随访3～17个月，2例阴茎体部、1例冠状沟尿瘘，无尿道狭窄、尿道憩室发生。术后3个月尿流率Q=：7．2ml／s-11．5ml／s。13例患儿家长对术后外观满意。结论短期随访结果表明，应用包皮岛状皮瓣尿道板重建术进行尿道成形的患儿均未发生术后尿道狭窄，同时没有增加尿道瘘等其他并发症的发生率。Objective To explore the efficacies of a modified prepuce transverse island tube ure- throplasty for urethral stricture. Methods The procedure was conducted in 15 cases from March 2012 to September 2013 at our hospital. Their age range was 7-23 months. All cases had proximal hypospa- dias with small glans and severe penile chordee. The lengths of penis and urethral defect were 2. 5-4. 0 and 4. 0-6. 0 cm respectively. One-stage urethroplasty was performed. And a 6Fr gastric tube for uri- nary drainage was removed at Week 2 post-operatioru Results The follow-up period was 3-17 months. Urinary fistula occurred in 3 cases （coronary sulcus fistula, n = 1 ; penile fistula, n = 2）. There was no urinary stricture or diverticulosis. The maximal urinary flow rate ranged from 7. 2 to 11.5 ml/s at Month 3 post-operation. And 13 parents were satisfied with cosmetic appearance. Conclusions Ure- throplasty by tubularization of reconstructed urethral plate with preputial island flap for proximal hy- pospadias with severe chordee may reduce the incidence of urethral stricture without increasing the oc- currence of fistula.

关 键 词：儿童 尿道下裂 泌尿外科手术 

分 类 号：R726.9[医药卫生—儿科]