唇黏膜耦合阴茎(阴囊)皮瓣治疗尿道下裂临床研究  

Urethralreconstruction by lower lip mucosa graft combined with ventrolateral vertical flap of penis and scrotum for treatment of hypospadias

作　　者：李学德[1] 江志勇[1] 何庆鑫[1] 汪中兴[1] 樊胜海[1] 贲晶华[1] LI Xuede;JIANG Zhiyong;HE Qingxin;WANG Zhongxing;FAN Shenghai;BI Jinghua(Department of Urology and Andrology,No.181 Hostpital of People＇s Liberation Army of China,Guilin 541002,Guangxi,China)

机构地区：[1]中国人民解放军第181医院泌尿男科,广西桂林541002

出　　处：《中国性科学》2018年第10期50-52,共3页Chinese Journal of Human Sexuality

摘　　要：目的:探讨下唇黏膜耦合阴茎(阴囊)腹外侧纵行皮瓣治疗阴茎体后型、阴茎阴囊交界型、阴囊型尿道下裂患者的手术方法及疗效。方法:2012年5月至2017年8月中国人民解放军第181医院收治的后段下弯类尿道下裂患者32例,阴茎体后型12例,阴茎阴囊交界型13例,阴囊型7例。年龄范围2. 3岁~12. 2岁,平均年龄4. 7岁。阴茎皮肤脱套并横断尿道板,阴茎伸直后,把龟头段尿道纵行切开并向两侧游离,切取宽约0. 6cm^0. 7cm下唇黏膜,长度与原尿道外口至龟头远端长度一致,把下唇黏膜缝合固定于阴茎海绵体腹侧正中,取一侧纵行阴茎皮瓣侧翻与下唇黏膜缝合包绕尿道支架成形尿道,缝合龟头两侧翼成形龟头。转移原有茎背侧皮肤覆盖尿道。结果:所有患者随访6个月~25个月,平均随访时间18个月。手术成功25例(78. 12%),发生尿道狭窄2例(6. 25%)、尿瘘4例(12. 50%)、尿道外口回缩1例(3. 12%)。2例尿道狭窄患者中,1例为尿道外口狭窄,行尿道外口裂开成为冠状沟型尿道下裂; 1例为重新留置尿道支架管1个月后自行排尿,4周好转。31例接近正常的阴茎外观。所有患者口腔言语、进食功能无影响,无口腔麻木、疼痛、外观不良等并发症。结论:对于下弯类后型尿道下裂,采用下唇黏膜耦合阴茎或加阴囊腹外侧纵行皮瓣尿道成形术,能有效解决阴茎皮肤相对不足、阴茎发育不良问题,并可一期修复尿道下道下裂,手术效果满意,术后外观良好。Objective： A discussion on improving surgical treatment technique and results forurethralreconstruction in hypospadias by lower lip mucosa graft combined withventrolateral vertical flap of penis and scrotum.Methods： From 2012. 5 to 2017. 8,32 patients with hypospadias treated with hypospadias by lower lip mucosa graft combined withventrolateral vertical flap of penis and scrotum. Of these cases,12 patients with ＂ post-type＂ penile hypospadias,13 patients with pennoscrotal hypospadias and 7 patients with scrotal hypospadias. Average age of patients from 2. 3 to 12. 2 years is 4. 7 years. In the surgery,penis skin were dgloved and urethral plate were cut off before Orthoplasty. Vertically cutting and laterally separating the glans penis section of urethral. 0. 6-0. 7 cm wide lower lip mucosa graft was resected,and the length is the same as the distance from urethral orifice to distal glans penis.Lower lip mucosa graft was sutured and fixed on the ventromediacorpus cavernosum. One side ventrolateral vertical flap of penis was cut off and turned over stiching to lip muscosa graft. Then Surrounding the urethral stent tube. Comleting balanoplasty by Stitching on both sides of the glans. At the last,covering new urethral with dorsal skin of the penis. Results： During 6 ~ 25 months following up,25 cases（ 78. 12%） were cured successfully,and other patients suffered from urethral stricture（ 2 case,12. 50%）,urinary fistula（ 4 cases,12. 50%）,and retraction of external urethral orifice（ 1 cases,3. 12%）. 1 case with external orifice stricturewere underwent second surgery into coronal hyposp-adias,1 case with indwelling urethral stenting for 1 month then voided well. 31 patients had normal-appering of penis. All patients had no any oral operative complication. Conclusions： urethroplastywith lower lip muscosa graft combined with ventrolateral vertical flap of penis and scrotum is effective for repairing＂post-type＂hypospadias combine with chordee.

关 键 词：尿道下裂 尿道成形术 口腔黏膜 

分 类 号：R699.8[医药卫生—泌尿科学]