阴囊中隔平滑肌肉膜组织瓣在尿道缺损修复中的应用

The application of the septal scrotal musculocutaneous dartos flap in repair of urethra-defected diseases

目的探讨阴囊中隔平滑肌肉膜组织瓣在尿道缺损性疾病的临床治疗效果。方法回顾性分析2010年1月至2019年12月中国医学科学院整形外科医院整形2科收治的各种原因导致尿道缺损的82例患者的临床资料,包括成人50例,平均年龄21岁;未成年人32例,平均年龄8岁。其中先天性尿道下裂阴茎型28例,先天性尿道下裂阴茎阴囊型23例,外院修复失败31例。外院修复失败的31患者中,尿瘘21例(11例需要重建尿道,10例单纯行尿瘘修复术),尿道狭窄10例(均需要重建尿道)。对于需要重建尿道的患者和尿道下裂患者,采用分期口腔黏膜卷管重建尿道。于阴囊依据创面大小设计切取阴囊中隔平滑肌肉膜组织瓣,转移至阴茎腹侧覆盖创面。术后对手术效果进行评价。结果阴囊中隔平滑肌肉膜组织瓣大小3.0 cm×1.2 cm~7.5 cm×3.0 cm。全部组织瓣成活良好。5例患者出现腹侧切口处尿瘘,其中3例尿瘘于1个月后自行愈合,2例接受了进一步的治疗。其余患者排尿良好。4例患者出现了供区血肿,后自行消退。术后效果评价:差3例,一般7例,良好72例。患者术后随访7个月至4年,所有患者均对外观满意。结论阴囊中隔平滑肌肉膜组织瓣有弹性良好的皮下肉膜、稳定丰富的血液供应,有一定收缩功能,转移方式灵活,在尿道缺损疾病修复重建方面有良好的临床意义。

Objective To evaluate outcomes of the septal scrotal musculocutaneous dartos flap in the repair of urethral-defected diseases.Methods A total of 82 patients with urethral defects were treated at the Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from January 2010 to December 2019.Fifty patients were adults,and 32 were children or adolescents.Fifty-one patients had hypospadias:for 28 patients,the urethral meatus were in the penis and 23 in the peno-scrotum.Thirty-one patients were redo cases:21 had the urinary fistula(11 need urethral reconstruction and ten did not);ten had urethral stenosis.For hypospadias patients or those who need urethra reconstruction,we used the staged buccal mucosa graft method to reconstruct the urethra.Moreover,the septal scrotal musculocutaneous dartos flap was harvested to cover the wound.Results All flap survived well.Five patients had the urinary fistula,and three did not receive further treatment,while two receive operations.Four patients suffered from hematomas in donor sites but did not need additional management.The size of flaps ranged from 3.0 cm×1.2 cm to 7.5 cm×3.0 cm.The period of follow-up was seven months to four years.All patients were satisfied with the outcomes.Conclusions The septal scrotal musculocutaneous dartos flap is reliable,versatile,and flexible.It is an excellent resource to cover wounds in urethral-defected diseases.