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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 summarize the surgical methods and clinical effects of reconstructing the first stage of urethral hypospadias with oral mucosa and scrotal skin flap. Methods From March 2002 to December 2007, 42 cases of urethral hypospadias were reconstructed with the combined oral mucosa and scrotal flap. Age 1 year old 6 months ~ 18 years old. 21 cases of penis scrotum, 12 cases of scrotum, 9 cases of perineal. 34 cases of past urethral hymen repair surgery failed, the time from the first operation to the operation of 6 to 19 months, an average of 10 months; 8 cases were the first surgery. Intraoperative penile urethral defect 3 ~ 7cm, an average of 4.2cm. The oral mucosa with the size of 3.0cm × 1.2cm ~ 7.0cm × 1.5cm was transplanted into the ventral white conjunctiva of the penis to form a complete urethra with the scrotal flap of 3.0cm × 1.5cm ~ 7.0cm × 1.5cm. Results 38 cases of postoperative incision healed, no complications. Urinary fistula was found in 4 cases at 7th day after operation and at the anastomosis of the anastomosis. One case of urinary fistula occluded itself at 2 months after operation, and 3 cases recovered after urinary fistula repair 6 months after operation. Forty-two patients were followed up for 3 to 48 months with an average of 18 months. Postoperative urination patency, reconstruction urethra are located in the distal tip of the penis, no retraction, shape close to normal urethral orifice morphology. Penis scrotum morphology is more satisfactory, the penis completely straightening. Oral morphology, function without exception. Conclusions The combination of oral mucosa and scrotal flap to reconstruct the urethral tissue is plentiful, and the rate of urethral stricture formation is low. It is an effective way to repair hypospadias in one stage.