阴囊纵隔带蒂皮瓣尿道下裂一期矫治手术的改进(附23例报告)

The Improve of one – Stage Repair of Hypospadias Using Scrotal Septal Skin Flap (Report of 23 Cases)

目的手术矫治先天性尿道下裂目前仍是外科临床难题之一,其手术方法繁多,术后并发症亦多。本文探讨利用阴囊纵隔带蒂皮瓣对尿道下裂一期矫治手术方法的改进,旨在提高疗效,减少并发症。方法利用阴囊纵隔带蒂皮瓣对23例尿道下裂患者施行一期矫治手术作出改良,提出先原位利用阴囊纵隔皮瓣作尿道成形,尔后再作皮瓣游离,不必刻意保留阴囊纵隔血管丛。手术全部使用可吸收性合成线缝合,成形尿道内同时留置支架管和导尿管而不作膀胱造瘘尿流改道。结果本组23例当中除1例因感染发生尿瘘之外,其余均达到一期修复目的。结论资料表明这种术式只要落实防治感染等措施则极少出现尿瘘、尿道狭窄等常见术后并发症,同时还可达到儿童一期矫治、阴茎伸直、阴茎外观满意和良好的排尿功能以及成年后有性生活能力等现代尿道下裂矫治的要求。

Objective It’s still a problem that repair of hypospadias with surgery in surgical department, it’s surgical way was too much, it had much complication after surgery. To explore improve of one-stage repair of hypospadias using scrotal septal skin flap. Aim to improve the curative effect, to reduce the complication. Methods 23 hypospadia patients were treated by this method, using scrotal septal skin flap in urethroplasty in it’s position at first. Then, cut open the flap without retaining the blood vessels of scrotal septal. They were sutured with absorbing compound thread. Urethral tubes were inserted to the new urethra. Suprapubic diversion was not used for uring drainage. Results One stage healing was successfully achieved in 22 patients, one patient suffered from fistula because of being infected. Conclusion Patients seldom suffered from fistula and stenosis in this surgical method if they provided avoiding affected measure. One stage repair achieved in children. they had penile straighten, good penile appearance, normal urination, they will have normal sex life ability when they are adult. This surgical method is just the requirement of modern repair of hypospadias.