联合口腔黏膜与阴囊皮瓣重建尿道一期修复尿道下裂

COMBINED BUCCAL MUCOSAL GRAFT AND SCROTAL FLAP FOR RECONSTRUCTION OF URETHRA IN PRIMARY HYPOSPADIAS REPAIR

目的总结联合口腔黏膜和阴囊皮瓣重建尿道一期修复尿道下裂的手术方法及临床效果。方法2002年3月-2007年12月,联合口腔黏膜和阴囊皮瓣重建尿道一期修复尿道下裂42例。年龄1岁6个月～18岁。阴茎阴囊型21例,阴囊型12例,会阴型9例。34例为既往尿道下裂修复手术失败,初次手术至该次手术时间为6～19个月,平均10个月;8例为初次手术。术中阴茎矫直后尿道缺损3～7cm,平均4.2cm。将大小为3.0cm×1.2cm～7.0cm×1.5cm的口腔黏膜移植于阴茎腹侧白膜,与大小为3.0cm×1.5cm～7.0cm×1.5cm的阴囊皮瓣对合形成完整尿道。结果38例术后切口Ⅰ期愈合,无并发症发生。4例术后7d分别于冠状沟及吻合口端出现尿瘘,其中1例尿瘘于术后2个月自行封闭,3例于术后6个月行尿瘘修补术后愈合。42例均获随访,随访时间3～48个月,平均18个月。术后排尿通畅,重建尿道口均位于阴茎头远端,无回缩,外形接近正常尿道外口形态。阴茎阴囊形态较满意,阴茎完全矫直。口腔形态、功能无异常。结论联合口腔黏膜和阴囊皮瓣重建尿道组织量充裕,形成尿道狭窄率低,是一期修复尿道下裂的有效方法之一。

Objective To investigate a method of repairing hypospadias by combining buccal mucosal graft with scrotal flap and its therapeutic effect. Methods From March 2002 to December 2007, 42 patients with hypospadias underwent primary urethral reconstruction using buccal mucosal graft and scrotal flap. The patients ranged in age from 18 months to 18 years. There were 21 cases of penoscrotal type, 12 cases of scrotal type and 9 cases of perineal type. Among them, 8 cases were at initial operation, and 34 cases suffered from＇the failure of hypospadias repair 6-19 months （average 10 months） after initial operation. During operation, the defect of urethra was 3-7cm（average 4.2cm） when the penis was straightened; the buccal mucosa （3.0cm×1.2cm—7.0cm×1.5cm） was transplanted to the tunica albuginea in the ventral aspect of the penis, and was paired with the scrotal flap （3.0cm×1.5cm—7.0cm×1.5cm） to repair urethra. Results The incision of 38 cases healed by first intention, and no complication occurred. At 7 days after operation, 4 cases had urinary fistula at either coronary sulcus or anastomotic stoma, one of which spontaneously closed 2 months after operation and the rest 3 recovered by repairing urinary fistula 6 months after operation. All patients were followed for 3-48 months （average 18 months）. Urination was smooth, the reconstructed urethral opening was at the tip of glans peins without retraction and with apperance similar to the normal urethral opening. The appearance of penis and scrotum was satisfying, and the penis was straightened completely. Conclusion Combined buccal mucosal graft and scrotal flap, with considerable tissue for uretha tract reconstruction and low incidence rate of urethral stricture, is one of the effective methods to repair hypospadias.