阴茎阴囊组合皮瓣在尿道下裂再次手术中的应用

Application of combined penile and scrotum skin flap in reoperation for failed hypospadias repair

目的探讨阴茎阴囊组合皮瓣在尿道下裂失败病例再次手术中的应用。方法选择2013年1月至2015年12月广西医科大学第一附属医院采用阴茎阴囊组合皮瓣治疗尿道下裂失败的15例病例，年龄7～15岁，中位年龄10.2岁。其中第3次手术4例，第4次手术5例，第5次手术4例，第6次手术2例。采用加盖岛状皮瓣耦合尿道板纵切卷管尿道成形术（Onlay＋TIP）4例，基底皮瓣翻转耦合尿道板纵切卷管尿道成形术（Mathieu＋TIP）11例。新尿道采用F8或F10的硅胶气囊尿管作为支架管，术后每2～3 d更换外层敷料，6～8 d拆除外层敷料。结果全部病例获得术后随访，截止日期为2016年3月20日，随访4～26个月。全组手术成功率为86.7%（13/15例），其中采用Onlay＋ TIP手术3例成功，1例失败；采用Mathieu＋TIP手术10例成功，1例失败。手术成功病例阴茎外形美观，尿道口正位，排尿通畅，术后未发现尿瘘、尿道狭窄、尿道憩室。2例手术失败患儿术后出现阴茎头段尿道崩裂，尿道外口低位，术后1年再次做尿道成形手术。结论对于符合解剖条件的尿道下裂失败病例，利用阴茎阴囊组合皮瓣，采用Onlay＋TIP或Mathieu＋TIP手术方式，可能是一期完成再次手术的良好选择。

ObjectiveTo explore the application of combined penile and scrotum skin flap in the reoperation process for operation failure cases with hypospadias.MethodsA retrospective analysis was performed with the inclusion of 15 failure cases with hypospadias who received combined penile and scrotal skin flap treatment for reoperation from January 2013 to December 2015 in the First Affiliated Hospital of Guangxi Medical University.These cases aged from 7 to 15 years old, with a median age of 10.2 years old.Among them, a 3rd operation was performed in 4 cases, 4th operation in 5 cases, 5th operation in 4 cases, and 6th operation in 2 cases.The procedure of Onlay island flap urethroplasty＋ tubularized incised plate （Onlay＋ TIP） urethroplasty was performed in 4 patients, and the other 11 cases were treated with urethral mouth basal vascular skin tube urethroplasty （Mathieu）＋ TIP urethroplasty.F8 or F10 silicone balloon catheter were used as stent in new urethra, outer dressing after operation was replaced every 2 to 3 d, the outer dressing was demolished 6-8 d after operation.ResultsAll patients were followed up after surgery until March 20, 2016, the follow-up time was 4-26 months.In these 15 patients, the success rate of operation was 86.7%（13/15 cases）, among them, 3 cases were success and 1 case was failed in Onlay＋ TIP group, and 10 cases were success and 1 case was failed in Mathieu＋ TIP group.The patients with successful operation were with beautiful appearance of the penis, normal position of the meatus urinarius and normal urination.No peristome of urethra, urethrovaginal fistula or urethral diverticulum was found after surgery.However, urethral cracking of the glans of penis appeared in 2 operation failed patients, and the orificium urethrae externum was low-set, and urethroplasty was needed 1 year postoperatively.ConclusionsFor some failure cases with hypospadias showing suitable anatomy conditions, Onlay＋ TIP or Mathieu＋ TIP combined with penile and scrotal flap may be a good choice for the completion of reoperation.