尿道口蒂皮瓣与口腔黏膜联合一期修复尿道下裂

ONE STAGE REPAIR OF HYPOSPADIAS USING MEATAL-BASED FLAP OVERLAPPING WITH BUCCAL MUCOSAL GRAFT

目的探讨尿道口蒂皮瓣与口腔黏膜对合重建尿道的方法。方法2002年3月～2004年5月,采用尿道口蒂皮瓣与口腔黏膜联合重建尿道21例,年龄14个月～8岁。切断挛缩尿道板,彻底矫直阴茎后,将口腔黏膜移植于阴茎腹侧白膜,尿道口蒂皮瓣翻转后与口腔黏膜对合,形成管状尿道。结果术后所有患儿均获3～18个月随访,平均7个月。阴茎弯曲完全矫正,尿道外口位于阴茎头前端,阴茎外形良好,排尿通畅。2例发生尿瘘,其中1例自愈,1例术后6个月再修补成功。结论尿道口蒂皮瓣与口腔黏膜联合重建尿道能彻底矫正阴茎弯曲,提高手术成功率和改善术后阴茎外形。

Objective To explore the feasibility of one-stage repair of hypospadias using the meatal-based flap overlapping with buccal mucosal graft. Methods From March 2002 to May 2004, 21 patients with hypospadias were treated with the meatal-based flap overlapping with buccal mucosal graft. Their ages ranged from 14 months to 8 years. The procedure were as follows：urethral plate at proximal corona was cut to correct glandular tilt and chordee; the buccal mucosa taking from inner cheek was then fixed on tunica albuginea of ventral shaft with suture; and the meatalbased flap was rotated distally and overlaid with buccal mucosal graft to repair urethra. Results All patients were followed up 3-18 months （7 months on average）. A cosmetic glans and a vertically oriented, normal appearing slit meatus were achieved. Two patients had fistulas on lateral corona. Fistula spontaneously healed in 1 case and the other one was repaired after 6 months. Conclusion The technique of meatal-based flap overlapping with buccal mucosal graft can completely correct glandular tilt and chordee, prove good cosmetic and functional glans and meatus.