会阴型尿道下裂的矫形和尿道重建

Severe hypospadias repair:reconstructing penis,scrotum and urethra

目的探讨采用分期手术治疗会阴型尿道下裂,行阴茎、阴囊矫形、重建缺损尿道的临床效果。方法22例会阴型尿道下裂采用分期手术：一期手术将阴茎海绵体完全伸直,阴茎包皮内板和背侧皮肤预置于阴茎腹侧和阴囊裂缝凹陷处；二期手术重建阴茎尿道采用半环状阴茎皮岛+半环状膀胱黏膜丛行侧面缝合形成阴茎尿道,阴囊尿道采用一期预置的组织丛行卷曲侧侧缝合重建阴囊尿道,在两尿道的接合点端端吻合,同时施行阴囊矫形。结果22例会阴型尿道下裂矫形后几乎接近正常状态,重建阴茎尿道长度为4—9 cm,平均7 cm。手术的成功率为68%(15．／22),尿瘘发生率为32%(7/22),5例(5/22)发生阴茎阴囊尿道交界处狭窄,经尿道扩张治疗后痊愈。结论会阴型尿道下裂行分期手术治疗可以修复超过10cm长的缺损尿道,而且完成手术以后外形形态较好。

Objective To investigate the surgical technic of re-shape penis and scrotum, as well as construct urethra in severe hypospadias patients. Methods Twenty-two cases of perineal hypospadias with abnormal penis and scrotum were involved in operative repair. All the patients underwent two-stage of repair technic. The penic sponge were completely stretched out and uprighted in the first-stage. Foreskin and partial penis back skin was transferred into the ventral of penis and scrotum crack. At second-stage, urethroplasty was performed using bladder mucosa folded into half tube that sutured with urothra plate to reconstruct the urothra. The scrotum were re-shaped using foreskin and skinflap. Results The operation＇s successful rate was 68% （ 15/22 ）. There were 7 cases （ 32% ） suffered from urethrocutaneous fistula and recovered after repair. Five cases（23% ） occurred stricture of urethra and were treated by urethra dilatation. The appearance of penis and scrotum in 22 cases were satisfied. Conclusions The operative methods should be made according to the type of hypospadias and of scrotum. The technic were effective on severe hypespadias with abnormal scrotum, even for the patients who need more than 10cm urethra construct. The appearance of penis and scrotum were satisfied after following up.