重度长段尿道缺如尿道下裂Ⅰ期修复20例.doc

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1、重度长段尿道缺如尿道下裂Ⅰ期修复20例作者：邹利文，吴学振，李伟，赵声龙，高明江，施宗伟，陈晓竹　［摘要］目的探讨重度长段尿道缺如尿道下裂Ⅰ期修复术式。方法采用近段尿道口基底蒂皮瓣翻转覆盖与保留的部分尿道板吻合成管加纵行带蒂岛状包皮瓣卷管成形尿道吻合即改良Onlay+Hodgson术式。20例重度长段尿道缺如尿道下裂伴阴茎弯曲者，尿道缺如以矫直阴茎后测量为8～12cm。成形尿道内留置多孔硅胶管支架引流尿液10天拔尿管排尿。结果20例患者18例Ⅰ期成功修复正位排尿，外观满意，无臃肿扭转，1例尿瘘6个月后修补尿瘘痊愈，1例尿瘘孔小3个月后自愈；

2、所有病例随访1年均无狭窄扭曲等并发症。结论此方法修复重度长段尿道缺如尿道下裂，因该术式设计合理，保证成形尿道的蒂皮瓣具有良好的血供、效果确切、外观满意等优点，是一种较好的改良术式。［关键词］尿道下裂；带血管蒂皮瓣；尿道成形术Urethralagenesisandhypospadiabythefirstphaseoperation:Areportof20cases［Abstract］ObjectiveToexploretheprocedureofthefirstphaseofrepairingurethracrackbycuttingdeep

3、andlongintourethra.MethodsAdoptedthemethodofjoiningoverturningsurgicalflapofnearbyurethralorificebaseandtheremainingurethralplatebyanastomosislongitudinalpreputialtubularflapurethroplastythatisameliorativeOnlay+Hodgsonoperationcarryouton20patientswhosufferedfromurethracrac

4、kwithclubbedpenisesbycuttingdeepandlongintourethra.Theoperationsstraightenpeniseslengthisbetween8~12cm.Acellularsilicegeltubesupportisimplantedandkeptintheformingurethratohelpdrainage.Tendayslater,thecathetercanbedrownandthepatientscanexcreteurinenormally.ResultsEighteenof

5、twentycasessucceededinthefirstphaseofrepairing.Thepatientscanexcreteurinenormally.Theappearanceoftheurethraissatisfactoryandnoturnscentorcrookhappened.Theother2patients,1withurethrastomarecoveredbyreparingurinaryfistula,theotherwithsmallurinaryfistulawascuredafter3months.T

6、herewerenoanyurethrostenosisorcrookcomplicated.ConclusionTheoperationisusedtorepairurethracrackbycuttingdeepandlongintourethra.Thedesignoftheoperationispractical.Theoperationguaranteestheformingurethralievascularpediclecansupplybloodnormallyandhasagoodandobviouseffectaswel

7、lastheappearanceissatisfactory.Inaword,themethodisarathergoodameliorativeoperationmethod.3［Keywords］hypospadia;surgicalflap;urethroplasty我院自2000年1月～2005年5月对收治的尿道长段缺如重度尿道下裂20例;采用自行设计改良的带蒂皮瓣Ⅰ期修复术。疗效确切,外观满意,现报告如下。1资料与方法1.1一般资料本组20例,年龄1.5～21岁。以尿道口位置分类,阴茎根部型15例,阴囊型4例,会阴型1例,合并隐睾

8、2例。20例病例均有不同程度的阴茎弯曲。1.2治疗方法12岁以下儿童采用全身麻醉，12岁以上采用硬膜外麻醉,显效后,阴茎头缝线牵引,于冠状沟处保留内板0.5cm环行切开包皮,沿B