带蒂阴囊中隔皮瓣加盖睾丸鞘膜尿道成形术在失败尿道下裂手术中的应用

Application of pedicled scrotal septum flap combined with tunica vaginalis in failed hypospadias repair

目的：评价带蒂阴囊中隔皮瓣加盖睾丸鞘膜尿道成形术在失败尿道下裂手术中的应用,了解其适应证、手术方法、术后并发症及远期效果。方法：回顾性分析2008年1月~2013年12月采用带蒂阴囊中隔皮瓣加盖睾丸鞘膜尿道成形术治疗的43例手术失败的尿道下裂病例及随访资料,描述手术适应证、手术方法,总结术后并发症及处理方法,评价远期效果。结果：平均手术时间110min。术后并发症发生率为14%（6/43）,其中尿道皮肤瘘3例,尿道憩室1例,尿道口狭窄2例。术后1年随访,阴茎外观满意率为90.7%（39/43）,通过随诊观察排尿评估尿道功能正常率为95.35%（41/43）。5例尿道镜检查无明显毛石形成。结论：带蒂阴囊中隔皮瓣加盖睾丸鞘膜尿道成形术是在失败尿道下裂修复术中有效的手术方式,手术方法相对简单,容易掌握,手术并发症较少,远期效果确切。

Objective：To evaluate the outcomes of pedicled scrotal septum flap combined with tunica vaginalis in failed hypospadias repair and to explore the indications,surgical method,postoperative complications and longterm effects of the operation.Method：Records of 43 cases with failed hypospadias repair undergoing pedicled scrotal septum flap combined with tunica vaginalis from January 2008 to December 2013 were reviewed.Surgical indications,procedure,complications and long-term results were summarized.Result：Average time of procedures was 110 minutes.The incidence rate of postoperative complications was 14%（6/43）.Three cases were found urethrocutaneous fistula,and one case was diagnosed with urethral diverticulum.Moreover,two patients suffered from meatal stenosis.All patients were followed up for 12 months.Satisfaction degree of penile appearance was90.7%（39/43）,and urethral function of urination was normal in 95.35%（41/43）.No hair-bearing urethral calculus was found through urethroscopy in five cases.Conclusion：Pedicled scrotal septum flap combined with tunica vaginalis is an effective technique for failed hypospadias repair because of easy procedures,fewer complications,and satisfactory long-term results.