尿道板旁筋膜联合背侧带蒂转移筋膜瓣多重叠加覆盖尿道在尿道板纵切卷管尿道成形术中的应用  

Application of multiple urethral overlaying with lateral fascia plate and dorsal pedicled transfer fascia flap during Snodgrass operation

作　　者：许海华[1] 徐国栋[1] 张富义[1] 陈子英[1] 王晓佳[1] Xu Haihua;Xu Guodong;Zhang Fuyi;Chen Ziying;Wang Xiaojia(Department of Urology,Municipal Children's Hospital,Tianjin 300074,China)

机构地区：[1]天津市儿童医院泌尿外科,300074

出　　处：《中华小儿外科杂志》2021年第2期114-117,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨尿道板旁筋膜联合背侧带蒂转移筋膜瓣多重叠加覆盖尿道在尿道板纵切卷管尿道成形术(Snodgrass术)中的效果。方法回顾性分析2016年1月至2018年5月就诊于天津市儿童医院泌尿外科的94例行Snodgrass修复手术尿道下裂患儿的临床资料。患儿年龄11月龄至4岁,中位年龄2岁5个月;冠状沟型下裂28例,阴茎体型下裂66例;伴有轻度到中度下弯,尿道板发育较好。所有患儿均采用尿道板旁筋膜左右折叠双重覆盖尿道后,联合背侧带蒂转移筋膜瓣再次左右叠加覆盖尿道,从而达到多重筋膜瓣覆盖尿道的目的。术中成形尿道长度为1.5~2.8 cm,平均2.1 cm。结果随访6~24个月,12例患儿术后出现腹侧皮瓣局部颜色暗沉、表皮脱落,其中逐渐愈合无尿瘘9例,出现尿瘘3例(3.19%)。结论在尿道下裂Snodgrass术中采用尿道板旁筋膜联合背侧带蒂转移筋膜瓣多重叠加覆盖尿道技术,明显增加了尿道覆盖层次,且就地取材,皮瓣血运良好,操作便捷,手术成功率较高,术后尿瘘发生率较低。Objective To explore the efficacy of fascia beside urethral plate plus dorsal vascular pedicle flap covering urethra during Snodgrass operation.Methods From January 2016 to May 2018,94 cases of hypospadias were repaired by Snodgrass approach.After covering urethra with double repetitions folded by lateral fascia beside urethra plate,fascia flap was combined with dorsal vascular pedicle flap for re-covering urethra so as to achieve multiple fascia flap covering urethra.The average age was 29(11-48)months.The types were coronary groove(n=28)and multiple(n=66).A mild-to-moderate inferior curvature was associated with a well-developed urethral plate.The average length of shaped urethra was 2.1(1.5-2.8)cm.Results During a follow-up period of 6-24 months,12 children showed local dark color and epidermal detachment on ventral flaps.There were gradual healing without urinary fistula(n=9)and urinary fistula(n=3).The incidence of urinary fistula was 3.19%.Conclusions During Snodgrass operation for hypospadias,the technique of multiple superposition covering urethra with fascia beside urethral plate plus dorsal vascular pedicle flap may be adopted for boosting the coverage level of urethra with a convenient local sampling.Such a flap has an excellent blood supply,convenient handling,a high success rate of operation and a low incidence of postoperative urinary fistula.

关 键 词：尿道下裂 外科皮瓣 尿道瘘 

分 类 号：R726.9[医药卫生—儿科]