联合包皮及阴囊带蒂皮瓣修复阴囊型尿道下裂

目的　总结带蒂岛状包皮瓣尿道成形术 (Duckett术 )加阴囊中隔带蒂皮瓣翻转尿道成形术 (中隔皮瓣术 )治疗阴囊型尿道下裂的体会。　方法　对 19例年龄 2～ 12岁 ,尿道缺损长度 5 .0～ 9.0cm的严重阴囊型尿道下裂患儿应用Duckett包皮瓣成形加阴囊中隔皮瓣成形手术方法修复 ,探讨手术应用、并发症预防及尿流改道方法的选择。　结果　 19例随访 6个月～ 4年 ,17例获一期治愈 ,2例并发尿瘘 ,无尿道狭窄并发症。　结论　联合手术方法治疗阴囊型尿道下裂效果满意 ,并发症少 ,双管法尿液引流充分 ,对尿道刺激小     

显微外科技术纵形带蒂岛状包皮瓣一期修复尿道下裂

目的 探讨显微外科技术纵形带蒂岛状包皮瓣修复尿道下裂的临床效果.方法 伴明显阴茎下弯的尿道下裂患者42例.年龄1～19岁,中位6.4岁.阴茎头冠状沟型6例、阴茎体型28例、阴茎阴囊型8例.4倍显微镜下采用纵形带蒂岛状包皮瓣术式33例,纵形带蒂岛状包皮瓣联合阴囊纵隔皮瓣成形9例.42例重建尿道平均3.6(2.5～6.0)cm. 结果 一次手术治愈38例(90.5%).术后出现尿瘘1例,行尿瘘修补治愈;尿道口狭窄2例,尿道吻合口狭窄1例,行尿道扩张后治愈.41例获随访9～52个月,平均27个月,患者均符合尿道下裂治愈标准. 结论 显微外科技术纵形带蒂岛状包皮瓣行一期尿道下裂修复手术成功率高,并发症少,值得临床推广.     

纵行带蒂岛状包皮瓣治疗尿道下裂44例报告

目的:总结近4年来应用纵行带蒂岛状包皮瓣一期尿道成形术治疗尿道下裂的临床经验,并评价其疗效.方法:本组44例患者中,阴茎型尿道下裂34例,阴茎阴囊型尿道下裂10例.均采用纵行带蒂岛状包皮瓣一期尿道成形术,平均重建尿道长度2.8 cm.结果:一期手术成功率90.9%(40/44例),尿瘘9.1%(4/44例).所有患者术后1个月复查1次,随访3个月以上,阴茎外观及排尿均良好.结论:纵行带蒂岛状包皮瓣一期尿道成形术对伴有阴茎下曲、尿道板发育不好的阴茎型及阴茎阴囊型尿道下裂患者治疗效果良好,并发症少.     

显微外科技术一期修复尿道下裂的临床评价

目的 总结显微外科技术一期修复尿道下裂的临床疗效. 方法 采用显微外科技术进行一期修复尿道下裂126例,其中尿道口成形术8例,游离包皮双面岛状瓣成形术72例,带蒂阴囊纵隔皮瓣尿道成形术46例. 结果 一期修复成功率96％,其中尿道口成形术成功率100％,游离包皮双面岛状瓣成形术成功率95.83％,阴囊纵隔皮瓣尿道成形术成功率95.65％,并发尿瘘4例,尿道狭窄3例. 结论 应用显微外科技术一期修复尿道下裂效果良好.     

应用显微外科技术修复尿道下裂

目的报道应用显微外科技术转移纵行带蒂阴茎背皮瓣及包皮内外板联合皮瓣一期修复尿道下裂的临床效果。方法根据阴茎背侧皮肤及包皮内外板的共同血供和解剖关系设计纵行联合带蒂矩形皮瓣。应用显微外科技术游离出血管蒂，并将皮瓣转移至阴茎腹侧与原尿道作显微吻合成新尿道修复尿道下裂21例。结果术后20例效果满意，阴茎外形良好，排尿功能正常，无并发症。1例发生术后尿瘘，经修补后治愈。远期效果均满意。结论应用显微外科技术转移纵行带蒂阴茎皮瓣及包皮内外板联合皮瓣是一期修复尿道下裂的有效方法之一。     

显微外科技术及带蒂包皮岛状皮瓣法在尿道下裂治疗中的应用

目的总结应用显微外科及带蒂包皮皮瓣一期修复尿道下裂的经验,提高手术成功率。方法回顾性分析38例一期尿道下裂修复手术及术后并发症。患儿年龄3～22岁,平均7．5岁。阴茎头冠状沟型12例,阴茎体型19例,阴茎根部型7例,其中6例曾在院外行阴茎下屈矫正术。应用显微外科技术,单纯选择带蒂包皮岛状皮瓣法一期修复尿道下裂32例,联合应用Duplay术式6例。结果随访3个月～2年,35例患儿术后阴茎外观满意,排尿通畅,无明显并发症:术后发生尿瘘2例,再次手术后治愈。1例术后3月出现尿道外口狭窄,经尿道扩张治愈。手术成功率为94．7％。结论应用显微外科及带蒂包皮岛状皮瓣一期修复尿道下裂,成功率高,并发症少,是治疗尿道下裂的良好方法。     

带蒂阴囊L形皮瓣转位一期修复尿道下裂

目的探讨重症尿道下裂成形术的新方法、新术式。方法利用显微外科行带蒂阴囊L形皮瓣一期尿道成形。术中注意皮瓣长度、宽度、厚度及皮下血管吻合支。横部皮瓣血管供应，因靠皮下取材不宜太长。结果经52例L型阴囊皮瓣成形尿道，术后尿瘘1例（1．9％），尿道狭窄2例（3．8％），手术成功率94．09％。结论显微外科带血管蒂L型皮瓣成形尿道，有效解决了重症尿道下裂皮瓣不足问题，防止皮瓣血管损伤，操作方便，是重症尿道下裂最佳术式。     

联合应用包皮与阴囊独立皮瓣一期修复尿道下裂的探讨

目的：探讨阴囊及会阴型尿道下裂患者一期修复重建尿道的新术式。方法：联合应用包 阴囊两独立带蒂皮瓣施行尿道重建术一期修复阴囊及会阴型尿道下裂患者１３例。结果：１１例获得成功。２例术后出现尿瘘,其中１例经尿道扩张治疗。３周后尿瘘愈合,另１例行二期尿道成形术后尿瘘痊愈。结论：联合应用包皮与阴囊两独立皮瓣重建尿道的优势明显,更我的集中了目前治疗阴囊及会阴型尿道下裂众多术式的优点。获得满意疗效。     

横行带蒂包皮瓣法与阴囊纵隔皮瓣法在一期修复尿道下裂中的疗效比较

目的对比评价横行带蒂包皮瓣法与阴囊纵隔皮瓣法在一期修复尿道下裂中的治疗效果。方法123例尿道下裂患者随机分为横行带蒂包皮瓣法组（63例）和阴囊纵隔皮瓣法组（60例），比较两组的手术时间、治愈率和术后并发症发生率。瞎呆横行带蒂包皮瓣法组平均手术时间多于阴囊纵隔皮瓣法组（P〈0.05）。随访1—14个月，横行带蒂包皮瓣法组治愈率高于阴囊纵隔皮瓣法组（P〈0.05），尿瘘的发生率较低（P〈0.05）。两组尿道狭窄发生率差别无统计学意义（P〉0.05）。结论横行带蒂包皮瓣法虽稍复杂，但是术后并发症发生率低。若包皮发育符合要求，可优先考虑采用横行带蒂包皮瓣法一期修复尿道下裂。     

显微外科技术在复杂性尿道狭窄手术中的应用

目的 探讨应用显微外科技术治疗复杂性尿道狭窄的手术效果. 方法 本院1997年6月-2011年3月采用显微外科技术施行阴囊后动脉为蒂的阴囊皮瓣尿道成形术治疗复杂性尿道狭窄86例.术中裁剪所需的带血管蒂的阴囊皮瓣,用16 - 18 F硅胶尿管作支架,围绕尿管形成带蒂的皮管,在手术显微镜下以5-0无创伤缝针间断缝合,并于尿道吻合,术后1个月拔出尿管. 结果 临床治疗86例,83例一次手术成功,术后排尿通畅,术后6个月,尿流率测定17.0～26.5 ml/s,成功率96.5％.其中2例术后1年并发尿道内毛发结石,结石发生率2.3％.术后发生尿瘘3例,发生率3.5％. 结论 应用显微外科技术施行阴囊后动脉为蒂的阴囊皮瓣尿道成形术对复杂性尿道狭窄进行修复,手术成功率高,尿道狭窄、尿瘘等术后并发症低,可获得良好的临床效果.     

尿道下裂的术式选择-会阴型和阴茎阴囊型

目的 总结会阴型尿道下裂和阴茎包皮岛状皮瓣一期修复阴茎阴囊型尿道下裂的最佳术式.方法 将2000年1月至2015年1月本院收治的38例尿道下裂患儿,其中阴茎阴囊型25例、会阴型13例,按照尿道下裂的不同类型进行阴茎包皮岛状皮瓣设计、移位和尿道成形修复手术.阴茎包皮岛状最长7.5cm,宽1.5～1.8cm.结果 术后11例发生尿瘘,其中会阴型5例,阴茎阴囊型6例,经修补后痊愈.本组患者术后阴茎外形正常,无扭曲或臃肿、尿道开口达到正常解剖部位,均能正常排尿或有很大改善接近正常.结论 阴茎包皮岛状皮瓣一期修复阴茎阴囊型和会阴型尿道下裂是一种较为安全有效的手术方法.     

显微外科复尿道下裂术后尿道皮肤瘘

目的 探讨应用显微外科技术修复尿道下裂成形术后尿道皮肤瘘的治疗效果。方法 按三种方式显微外科修复阴茎部尿道皮肤瘘３７例４９个瘘口,瘘口间断内翻缝合２３例,横向旋转的复盖１０例和带蒂阴囊皮瓣转移４例。结果 显微外科修复一次手术成功率达８９．８％（４４／４９）。３例得期僵。１例再次手术治愈。结论显微修复组织损伤小,一次手术率和累积成功率高,明显优于统属一宏观下瘘口修补。     

Folding and everting distal end of graft flap to reduce orifice stenosis following onlay urethroplasty

Aim: Orifice stenosis remained to be a common complication of hypospadias repair. We had modified the preputial island flap urethroplasty by folding and everting the distal end of the pedicle graft flap to prevent the neo-orifice from stenosis. Methods: Sixteen patients had undergone hypospadias repair using a modified onlay island flap technique. A urethral catheter was retained for 8 days to 10 days after operation. Results: Satisfactory results were seen in all the patients with a cosmetically fine appearance. One patient had a urinary tract infection and another,urethrocutaneous fistula and both were amply treated. No glanular adhesion or stenosis occurred. A long-term follow up of 6 months to 4 years (mean: 2 years) in 15 patients did not find any complication. Conclusion: The modified preputial island flap urethroplasty technique is an easy, reliable and effective approach to reduce orifice stenosis in hypospadias repair. ( Asian J Androl 2003 Jun; 5:159-161 )     

Treatment of proximal hypospadias with a tubularized island flap urethroplasty and the onlay technique: a comparative study

BACKGROUND/PURPOSE: The onlay island flap urethroplasty was first described in the repair of mid and distal penile hypospadias. Since then, this technique has been increasingly used in more severe cases of hypospadias, because of the complications of tubularized flaps, mainly megaurethra and proximal anastomotic strictures. The aim of this study was to compare the morbidity of these 2 techniques. METHODS: Between April 1994 and December 1998, 80 patients underwent surgical treatment for hypospadias. A tubularized island flap (Ducketttechnique) was performed in 42 cases, and the onlay island flap technique was used in 38 patients. The authors retrospectively compared the complication rate and type of these 2 procedures. RESULTS: Altogether, fistula was the most frequent complication without any significant difference between the 2 groups (21.4% for Duckett technique and 18.4% for onlay repair; P > .05). However, the anastomotic stricture was much more common in the tubularized flap group (7.14% v 2.63%; P < .05). Moreover, a megaurethra was found only in the Duckett technique group (4.7%). There was no case of chordee recurrence, but 6 patients (15.7%) treated with the onlay technique required urethrolysis including dissection of the chord behind the urethral plate, and in the other 3 patients of the same group (7.9%), a dorsal Nesbit plication also was necessary. In all these cases, the urethroplasty included an island cutaneous flap to provide ventral coverage to the neourethra. CONCLUSIONS: The authors conclude that both techniques present similar complications. However, proximal strictures and megaurethra are more common after the Duckett technique. This procedure is of choice in patients with scrotal hypospadias. Conversely, the onlay repair should be completed with other procedures (urethrolysis, dorsal Nesbit plication) to obtain good results in patients with severe degree of chordee.     

微创钨针在横形包皮岛状皮瓣法尿道下裂一期修复术中的应用

目的 总结微创钨针在横形包皮岛状皮瓣管状尿道成形法尿道下裂一期修复术的应用方法及术后效果。方法 我科2013年5月至2019年10月收治的其中226例尿道下裂患者,年龄6月~26岁（平均3.8岁）,其中阴茎体型119例,阴茎阴囊型83例,阴囊型及会阴型24例。术中应用微创钨针进行阴茎矫直、阴茎包皮脱套、横形包皮岛状皮瓣的切取及解剖等操作,将成形的横形包皮岛状皮瓣缝合成管状尿道,对各型尿道下裂进行一期尿道重建术。结果 术后7~8天拔除硅胶尿管排尿后,共发现12例伤口愈合不良、尿外渗及尿瘘形成。全部病例随访3月~2年,共发现尿瘘及尿道部分裂开24例,尿道外口狭窄2例,尿道（吻合口）狭窄3例,尿道憩室1例,阴茎下弯复发2例,总的并发症发生率为32/226（14.2%）。结论 在尿道下裂一期修复手术中,合理应用微创钨针的电切及电凝功能的优势特点,可精细分离解剖横形包皮岛状皮瓣,可安全有效获取尿道再造所需要的血运良好的包皮瓣等组织,有利于提高手术效率、减轻组织的损伤,可促进组织愈合、降低术后并发症。     

Scrotal dartos flap for the prevention of the urethrocutaneous fistula on hypospadias urethroplasty

BACKGROUND: Urethrocutaneous fistula is a common complication of urethroplasty for severe hypospadias, even when a microsurgical technique is applied. PATIENTS AND METHODS: From June 2001 to July 2003, we applied the scrotal dartos flap wrapping technique to prevent the occurrence of urethrocutaneous fistula in 14 patients with hypospadias. RESULTS: Hypospadias was repaired without fistula formation in all but one patient, who developed a tiny fistula which was later closed successfully by a simple procedure. CONCLUSIONS: We recommend the scrotal dartos wrapping technique for covering the neourethra with a well-vascularized flap because of fewer complications, although the procedure to obtain the vascularized flap may take longer.     

Preservation of the urethral plate in hypospadias repair: extended applications and further experience with the onlay island flap urethroplasty

The onlay island flap urethroplasty, a variant of the transverse preputial (tubularized) island flap, was originally described for repair of anterior hypospadias. However, many cases of mid and proximal hypospadias have a well developed urethral plate and exhibit little or no chordee after release of skin tethering. Patients with this combination of findings are ideal candidates for onlay island flap urethroplasty regardless of initial meatal position. During the last 5 years the onlay island flap has been used for repair of mid to posterior hypospadias in 31 patients (38% of the cases). These are variants that formerly would have required more extensive urethroplasty. Because of the technical advantages of the onlay island flap this alteration in technique selection has resulted in fewer complications. When applied to mid and posterior hypospadias the onlay island flap maintained a significantly lower complication rate (10%) compared to other standard techniques. Preservation of the urethral plate in hypospadias repair is a principle with significant implications to an extended variety of hypospadias.     

尿道下裂术后尿道瘘的处理

为了探讨尿道下裂成形术后尿道瘘的处理，对我院1975～1995年收治的251例尿道下裂患者术后发生尿道瘘的情况进行分析，结果术后发生尿道瘘60例，发生率为23．9％，其中28例行尿道瘘修补术，直接修补术15例，成功6例，带蒂皮瓣转移术4例，成功2例，瘘孔周围皮瓣横形Y－V成形术7例，均获成功，另2例重新施行尿道成形术亦获成功。认为只有提高尿道成形术的成功率，才能从根本上减少尿道瘘的发生；如发生尿道瘘，则应以瘘孔周围皮瓣横形Y－V成形术为主。