阴囊中缝推进皮瓣在尿道下裂阴茎皮肤缺损的应用  

Scrotal midline raphe flaps for surgical repair of hypospadias with penile skin defects

作　　者：邓富铭 刘国昌 伏雯 贾炜 付凯 李忠民 DENG Fu-ming;LIU Guo-chang;FU Wen;JIA Wei;FU Kai;LI Zhong-min(Department of Urology,Guangzhou Women and Children's Medical Center,Guangzhou,Guangdong 510623,China)

机构地区：[1]广州市妇女儿童医疗中心泌尿外科,广东广州510623

出　　处：《中华男科学杂志》2021年第11期1006-1010,共5页National Journal of Andrology

摘　　要：目的:探讨阴囊中缝推进皮瓣在尿道下裂阴茎皮肤缺损覆盖手术中的疗效。方法:回顾性分析2017年1月至2019年7月收治的20例应用阴囊中缝推进皮瓣覆盖阴茎皮肤缺损的尿道下裂患者资料,年龄3~12岁,平均6.5岁。阴茎手术史0~4次,平均2.4次。尿道口位于阴茎体部或会阴部,无尿道瘘或尿道外口狭窄。手术方法为尿道板卷管尿道成形术(TIP),术中发现阴茎体部皮肤缺损明显,均采用阴囊中缝推进皮瓣覆盖。结果:本组20例患者,术后随访7~30月,平均18.4月。所有病例术后阴囊中缝推进皮瓣存活良好,无皮瓣坏死病例。18例1期治愈,2例在术后拔除尿管后出现尿道瘘,术后半年再次行尿道瘘修补术。所有患者排尿通畅,无尿道狭窄,术后半年行尿流率测定,5~9 ml/s,平均6.5 ml/s;无因外观不满意而要求再次手术患者或家长。结论:阴囊中缝推进皮瓣具有血供丰富、延展性好的特点,对于阴茎弯曲已矫正的患者,阴茎体皮肤缺损可以得到良好的覆盖。该手术方法具有取材方便、操作难度不高、并发症少等特点,在阴茎体皮肤缺损的尿道下裂修复中可以一期完成手术,避免分期手术,值得临床推广。Objective: To investigate the effect of the application of scrotal midline raphe flaps in surgical repair of hypospadias with penile skin defects. Methods: We retrospectively analyzed the clinical data on 20 cases of hypospadias with penile skin defects from January 2017 to July 2019. The patients ranged in age from 3 to 12(mean 6.5) years, with a history of 0-4(mean 2.4) times of penile surgery. The urethral orifice was located in the midshaft of the penis or perineum, without urethral fistula or narrowing of the outer urethral orifice. We performed ubularized incised plate(TIP) repair of the penile skin defects with scrotal midline raphe flaps and followed up the patients for 7-30(mean 18.4) months postoperatively. Results: The flaps survived well without necrosis in all the cases, and 18(90%) of the cases were cured in the first stage. Two of the patients developed urethral fistula after removal of the catheter, which was successfully repaired at 6 months after the first operation. All the patients achieved smooth urination with no urethral stricture. The urinary flow rate was 5-9(mean 6.5) ml/s at 6 months postoperatively. All were satisfied with the appearance of the penis and scrotum. Conclusion: The scrotal midline raphe flap, with rich blood supply and good ductility, is suitable for repair of penile skin defects. And TIP repair with the scrotal midline raphe flap, with the advantages of simple operation, few complications and good appearance of the penis and scrotum, is worthy of clinical application.

关 键 词：尿道下裂 阴茎皮肤缺损 阴囊中缝推进皮瓣 预后 

分 类 号：R699.6[医药卫生—泌尿科学]