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目的探讨应用阴囊中隔飞鸟状皮瓣再造尿道,以减少尿道下裂修复术后尿瘘、尿道狭窄并发症的发生。方法2007年1月-2008年3月,收治30例尿道下裂患者。年龄2～20岁,中位年龄10岁。阴茎近端型13例,阴茎阴囊型12例,阴囊型5例。其中8例曾于外院手术治疗。术中切取大小为4.0cm×0.8cm～9.0cm×1.0cm的阴囊中隔皮瓣,结合两侧各5mm中厚皮片再造尿道。供区经“Z”字改形后缝合。结果术后皮瓣全部成活。1例因勃起频繁致切口愈合不良,经换药后切口愈合;其余患者切口均Ⅰ期愈合。供区切口愈合良好。术后18例获随访,随访时间6～12个月;其中2次手术者8例。患者均无尿道狭窄及尿瘘发生,再造尿道排尿通畅,阴茎伸直良好。其中2例稍感排尿无力,尿流有散射现象;1例阴茎阴囊外观欠佳。该3例均为2次手术者。结论应用阴囊中隔飞鸟状皮瓣再造尿道,综合了皮片与皮瓣再造尿道的优点,适用于一期矫治尿道开口于阴茎阴囊交界区附近的尿道下裂,可有效减少尿瘘、尿道狭窄等并发症。
Objective To explore the use of scrotal septum astronechial flap to reconstruct the urethra so as to reduce the incidence of urinary and urethral stricture complications after hypospadias repair. Methods From January 2007 to March 2008, 30 patients with hypospadias were treated. Age 2 to 20 years old, the median age of 10 years old. Penis proximal type in 13 cases, penis scrotum in 12 cases, scrotum in 5 cases. Eight of them had surgery outside the hospital. Intraoperative scalpel size of 4.0cm × 0.8cm ~ 9.0cm × 1.0cm scrotal septal flap, combined with 5mm thick skin on both sides of the reconstruction of the urethra. For the area by “Z ” after the word modified suture. Results All flaps survived. In 1 case, the incision healed frequently due to the erection, and the incision healed after the dressing change. The rest of the incisions healed in the first stage. The incision healed well. Eighteen patients were followed up for 6 to 12 months; 8 of them were operated twice. No urethral stricture and urinary fistula occurred, urethral reconstruction urethral patency, good penis straight. In 2 of them, the urination was weak and the urine flow was scattered. The appearance of penis scrotum was poor. The 3 cases were 2 surgeries. Conclusions The scrotal septum astronechial flap is used to reconstruct the urethra. It integrates the advantages of rebuilding the urethra with skin flaps. It is suitable for the treatment of hypospadias with a urethral opening near the junction of penis and scrotum, which can effectively reduce urinary fistula and urethral stricture complication.