改良加盖岛状皮瓣尿道成形术治疗小儿尿道下裂  

Improved onlay island flap urethraplasty in the treatment of children with hypospadias

作　　者：牛志尚[1] 郝春生[1] 白东升[1] 叶辉[1] 邱颖[1] 宋晋秋[1] 

机构地区：[1]首都儿科研究所附属儿童医院泌尿外科,北京100020

出　　处：《河北医科大学学报》2016年第10期1123-1125,1130,共4页Journal of Hebei Medical University

摘　　要：目的探讨改良加盖岛状皮瓣(Onlay island flap法)尿道成形术在小儿尿道裂手术中的应用经验。方法回顾性分析应用改良Onlay island flap术式治疗尿道下裂患儿76例。Onlay island flap术式改良方法:包皮脱套后自阴茎海绵体上游离尿道板/尿道海绵体,利用其弹性矫正下弯;尽可能选用包皮内板作为岛状皮瓣与尿道板U形吻合。结果全组76例中成功保留尿道板73例(96.0%),阴茎伸直良好。包括行包皮脱套及阴茎腹侧肉膜松解后阴茎伸直的患儿4例,经游离尿道板/尿道后成功矫正下弯58例,加行背侧海绵体折叠11例(其中包皮退套、腹侧肉膜松解后残余阴茎下弯<30°者4例,残余阴茎下弯>30°者7例)。手术成功率88.2%(67/76例)。尿道瘘5例(其中经手术修补4例,自行闭合1例);尿道外口狭窄1例,行尿道扩张后痊愈。未发现尿道憩室、坏死、切口裂开等情况。结论采用游离尿道板/尿道海绵体矫正下弯、包皮内板作为岛状皮瓣的Onlay尿道成形术能明显增大该术式适应证,提高手术成功率,减少术后并发症,值得临床推广。Objectiwe To investigate the operation of modified onlay island flap urethroplasty in the treatment of pediatric hypospadias. Methods Retrospective analysis was performed in 76 cases who received the modified onlay island flap urethroplasty. The method of the modified onlay island flap urethroplasty, the corpus spongiosum/urethral plate was dissected intact from the corpora cavernosa after degllving and dartos excision, relying on elasticity of these structures to allow the penis to straighten. It is necessary to select the inner plate 0f prepuce as the flap to suture with the urethral plate. Results The urethral plate was preserved successfully in 73 cases of 76 patients（96.0%）： 4 cases had no ventral curvature after degloving and dissectiong of the ventral dartos; 58 cases were corrected after mobilization of the corpus spongiosum/urethral plate and urethra; 11 cases were corrected by an extra dorsal placation,inclucting 4 cases with less than 30-degree residual curvature, 7 cases with greater than 30-degree residual curvature. The operation achievement ratio was 88.2% （67/76 cases. 5 cases supervened with urinary fistula（4 cases were then cured by opreration, 1 cases healed naturally）, 1 case with meatal stenosis and cured by urethral sounding. There was no urinary diverticulosis, necrosis and dehiscence. Conclusion The modified onlay island flap urethroplasty by straightening ventral curvature by mobilization of the corpus spongiosum/urethral plate and selecting the inner plate of prepuce as the flap can significantly reduce the postoperative complication and improve the success rate of operation, which is worthy of clinical promotion.

关 键 词：尿道下裂 尿道成形术 儿童 

分 类 号：R695[医药卫生—泌尿科学]