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。

Application of microdissection tungsten needle in transverse preputial island flap urethroplasty for one-stage hypospadias repair

Objective To summarize the application and result of microdissection tungsten needle in transverse preputial island flap and tube urethroplasty for one-stage hypospadias repair. Methods From May 2013 to October 2019, 226 patients with hypospadias underwent one-stage urethroplasty. The patients ranged in age from 0.5 to 25 years and the average was 3.8 years, including 119 penile shaft hypospadias, 83 penoscrotal hypospadias, 24 scrotal and perineal hypospadias. Microdissection tungsten needle was used for penis degloving, penis chordee resection and transverse pruputial island flap harvesting during the operation. Transverse prepuce island flap was performed to tube urethroplasty for all types of hypospadias one-stage repair. Results Twelve cases of poor wound healing, urinary extravasation and urinary fistula were found 7 to 8 days postoperatively. All patients were followed up for 3 months to 2 years. Twenty-four cases of urinary fistula and partial urethral dehiscence, 2 cases of urethral orifice stricture, 3 cases of urethral stricture, 1 case of urethral diverticulum, 2 cases of recurrences of penile curvature were found. The total complication rate was 32/226 （14.2%）. Conclusion Reasonable application of the advantages of microdissection tungsten needle, the transverse preputial island flap can be finely separated and dissected, and it can safely and effectively obtain good blood supply of transverse preputial island flap for urethroplasty, which is conducive to improving the operation efficiency, reducing tissue damage, promoting tissue healing and reducing postoperative complications.