带蒂包皮岛状皮瓣在尿道下裂再次手术中的应用

目的 总结带蒂包皮岛状皮瓣在尿道下裂再次手术中应用的适应证、手术技巧及其并发症.方法　2005年9月-2009年12月本院应用带蒂包皮岛状皮瓣再次手术治疗尿道下裂再次手术患儿35例,年龄3～15岁.其中22例为第2次手术,9例为第3次手术,4例为第4次手术,所有病例尿道局部瘢痕增生明显或尿道板已被破坏.手术方式分为2种:应用加盖岛状皮瓣法(Onlay术式)24例,应用岛状皮瓣管状尿道成形法(Duckett术式)11例.带蒂包皮岛状皮瓣长度为1～4 cm,新尿道采用F8或F10号的硅胶气囊尿管作为支架管,术后10～14 d拔除.结果　35例中27例(77.1%)一次手术成功,阴茎伸直良好,外形美观,排尿正常,成功率为77.1%.术后并发症:尿瘘6例,5例已行尿瘘修补,痊愈,1例等待修补;尿道狭窄2例,1例先行尿道狭窄处尿道造瘘,然后再次行尿瘘修补,痊愈,另1例已行尿道造瘘等待修补.结论　带蒂包皮岛状皮瓣可应用于尿道下裂再次手术,术后阴茎外形美观,但需注意根据手术适应证选择,而且手术操作较复杂,有一定的并发症.     

会阴、包皮联合岛状皮瓣一期尿道成形治疗会阴型尿道下裂

目的研究会阴型尿道下裂新手术方法的可行性。方法对16例会阴型尿道下裂,根据尿道缺损长度采用会阴正中岛状皮瓣、包皮横行岛状皮瓣一期尿道成形术。裁取带蒂会阴皮瓣约1.5cm×2.5cm～2.0cm×5.0cm,包皮皮瓣约1.5cm×3.0cm～2.5cm×4.0cm各制管道,成形尿道。结果16例病人14例痊愈,2例术后并发尿道瘘。6个月后尿道瘘修补成功。结论会阴、包皮联合岛状皮瓣一期尿道成形治疗会阴型尿道下裂具有能解决成形尿道材料不够,成形尿道血运好、术后并发症少、手术成功率高、安全可靠等特点。     

联合带蒂皮瓣尿道成形术一期治疗小儿会阴型尿道下裂

用会阴、阴囊、阴茎、包皮联合带蒂皮瓣手术治疗会阴型尿道下裂，成形尿道之皮管无吻合口、长度易调节、易存活，并且一期完成，外形美观。共治疗８例，效果良好。     

带蒂包皮岛状皮瓣卷管联合Dupluy皮管术治疗尿道下裂体会

先天性尿道下裂手术方式众多，本院近10年来采用带蒂包皮岛状皮瓣卷管联合Dupluy皮管成型尿道，对新成型尿道用血管蒂筋膜覆盖治疗，成功率较高，发生尿瘘及尿道狭窄少，现报告如下。     

带蒂管状岛状包皮瓣尿道成形术在尿道下裂修复中的应用

目的 评价带蒂管状岛状包皮瓣尿道成形术在尿道下裂病例修复中的应用.方法 回顾性总结2006年1月至2008年12月应用Duckett与Duckett+Duplay手术558例经验.患儿年龄1～8岁,平均年龄3.4岁.其中Duckett法457例,Duckett+Duplay法101例.结果 手术后随访12～36个月.Duckett手术457例,一次性手术成功336例,成功率73.5%,并发症121例:其中尿道瘘61例;尿道憩室42例;尿道狭窄10例;尿道瘘合并尿道憩室8例.行Duckett+Duplay手术101例,成功率73.3%,并发症27例:尿道瘘13例;尿道憩室5例;尿道狭窄6例;尿道瘘合并尿道憩室3例.以上两组手术结果比较差异没有统计学意义(P＞0.05).Duckett手术后并发症121例,有108例经一次修复痊愈,12例修复两次后痊愈,1例尿道狭窄经三次修复痊愈.Duckett+Duplay手术后并发症27例,18例一次修复痊愈,9例修复两次后痊愈.结论 带蒂管状岛状包皮瓣尿道成形术治疗尿道下裂效果比较满意.     

横裁岛状包皮皮瓣一期修复尿道下裂的经验

目的总结横裁岛状包皮皮瓣法修复先天性尿道下裂的经验。方法对1999年-2005年我科56例采用横裁岛状包皮皮瓣法进行尿道成形的尿道下裂患儿进行回顾性分析。其中5例加用尿道口为基底的阴囊矩形皮瓣作Duplay尿道成形。结果本组病例均获随访,时间3个月-4年,阴茎外观良好,阴茎下弯矫正满意,排尿通畅。一次手术成功49例,占89．3％;术后尿瘘5例,经第二次手术修补后痊愈,尿道狭窄1例,经尿道扩张后排尿改善。结论横裁岛状包皮皮瓣符合阴茎皮肤的解剖生理特点,设计合理,采用吻合口连续缝合,更加降低了尿瘘的发生率,避免耻骨上造瘘及带来的膀胱损伤。对多数尿道下裂尤其是有阴茎下弯的尿道下裂,采用横裁包皮岛状皮瓣法并灵活加用尿道口基底矩形皮瓣是一个很好的选择。     

阴茎阴囊皮瓣翻转埋藏法治疗各型尿道下裂的改进

目的：探讨保留尿道板与翻转阴茎阴囊皮瓣或皮管形成尿道法治疗各型尿道下裂的效果。方法：对我院１９８４年前采用的单纯阴茎阴囊皮瓣埋藏法进行改进，包括保留尿道板并与翻转阴茎阴囊皮瓣或皮管形成尿道，保证尿道正位开口，伴阴茎阴囊转位者一期矫正，取消膀胱造瘘等。结果：用改进术式治疗各型小儿尿道下裂３１２例，一期成功２６６例（８５．３％），因尿瘘、尿道狭窄等手术失败４６例（１４．７％）。结论：改进后的保留尿道板并与翻转之阴茎阴囊皮瓣或皮管形成尿道法是治疗本病较理想的方法，支架管替代膀胱造瘘和同时矫正阴茎阴囊转位不但简化了手术步骤，而且有利于手术一期成功     

游离膀胱粘膜或包皮内板尿道成形术治疗尿道下裂的评价

对一期膀胱粘膜尿道成形术和游离包皮内板尿道成形术治疗下裂的长期疗效进行评价。方法统计分析我院１９７７年１月－１９９７年１２月尿道下裂病例,共施行尿道成形术治疗１４岁以下小儿尿道下裂５７３例次。而运用一期膀胱粘膜尿道成形术或游离包皮内板尿道成形术治疗５６４例次,占同期尿道成形术的９８．４％。     

加盖包皮岛状皮瓣尿道成形术的临床应用和单因素分析北大核心CSCD

目的 通过分析加盖包皮岛状皮瓣尿道成形术（Onlay手术）治疗尿道下裂的临床疗效,探讨手术适应证范围和并发症特点.方法 回顾性分析2005年3月至2012年9月广西医科大学第一附属医院采用Onlay手术治疗的尿道下裂51例,年龄2～12岁,中位年龄4.3岁.其中首次手术43例,再次手术8例.采用单因素分析阴茎下曲程度、尿道缺损长度、手术次数、阴茎头大小对手术成功率的影响.结果 全组手术成功率82.4％（42/51例）,尿瘘7例,6例已经修补治愈,1例自行愈合.尿道外口裂开1例.阴茎下曲矫正不良1例.比较影响手术成功率的各种因素,其中轻中度阴茎下曲、尿道缺损长度、手术次数对手术成功率的影响差异均无统计学意义（x2=0.249、0.287、1.208,P均＞0.05）.阴茎头大小对手术成功率有显著影响（x2=3.393,P＜0.05）.结论 Onlay手术适用于大多数冠状沟型和阴茎体前端型病例,对于近端型明显下曲的病例需慎重考虑,因为可能导致术后阴茎下曲矫正不良.Onlay手术也适用于部分再次手术病例,但需要灵活设计岛状皮瓣.尿瘘仍然是Onlay手术最多见的并发症,尤其是阴茎头圆而小的病例.     

尿道下裂横裁带蒂包皮岛状皮瓣尿道成形术后近期并发症的危险因素分析

目的 探讨尿道下裂横裁带蒂包皮岛状皮瓣尿道成形术(Duckett术式)后发生近期并发症的危险因素,以期提高尿道下裂的治疗效果.方法 回顾性分析2018年12月至2019年12月首都医科大学附属北京儿童医院收治的首诊尿道下裂且手术方式为Duckett术式、分期Duckett术式或Duckett+Duplay术式患儿的临床...     

加盖带蒂包皮瓣一期尿道成形术修复小儿尿道下裂

目的：探讨加盖带蒂包皮瓣Ⅰ期尿道成形术修复小儿尿道下裂的手术要点和临床效果,提高手术技巧。方法对50例小儿尿道下裂应用onlay island flap术式（横裁带蒂岛状包皮瓣加盖法）行一期尿道成形手术。观察阴茎伸直和尿瘘、尿道狭窄的发生情况,总结和完善手术技巧。结果50例手术患儿获随访3个月至2年,均阴茎伸直满意,尿道位于龟头前端开口,外观良好。44例尿道下裂一次性手术成功,4例发生尿瘘;2例发生尿道外口狭窄,行尿道扩张后痊愈。结论加盖带蒂包皮瓣Ⅰ期尿道成形术修复小儿尿道下裂符合解剖生理,术后阴茎外形美观,并发症少,是一种修复阴茎下弯较轻的尿道下裂的理想术式。手术成功的关键在于保护皮瓣血管蒂的血供,掌握合理的尿道板皮条和岛状包皮瓣宽度及娴熟的缝合技巧。     

One-stage repair of severe hypospadias using modified tubularized transverse preputial island flap with V-incision suture

PurposeAlthough hypospadias repair for preserving the urethral plate is popular among pediatric urologists, applying this procedure to severe hypospadias is controversial. We report the outcome of applying additional modifications to the modified tubularized transverse preputial island flap (TPIF) procedure reported previously [Patel RP, Shukla AR, Austin JC and Canning DA. Modified tubularized transverse preputial island flap repair for severe proximal hypospadias. BJU Int 2005;95:901–4] for repairing severe hypospadias.Materials and methodsWe retrospectively evaluated our series of 22 patients (mean age 17.5 months) who underwent the modified TPIF with an additional simple modification of meatoplasty with V-incision suture. Patients were followed for a mean period of 18 months.ResultsAfter releasing the chordee, the hypospadiac orifice was retracted to become penile in five patients (22.7%), penoscrotal in six (27.3%), scrotal in nine (40.9%), and perineal in two (9.1%). The median length of the neourethra was 46 mm. One-stage repair was successful in 19 patients (86.4%) without any complications.ConclusionOur modified TPIF procedure yielded favorable outcomes functionally and cosmetically with a low postoperative morbidity rate. Such a procedure can be considered useful for repairing severe hypospadias when the urethral plate cannot be preserved.     

带蒂包皮双面皮瓣法联合DuplayⅠ期修复重度尿道下裂

目的 总结带蒂包皮双面皮瓣法(PPDIF)联合原位尿道板卷管(Duplay)治疗重度尿道下裂的方法及疗效.方法 1998年1月至2010年3月采用带蒂包皮双面皮瓣法加原位近端尿道板卷管(PPDIF+ Duplay)术式治疗重度尿道下裂72例,包括阴囊型50例,会阴型22例.结果 平均随访23个月,术后阴茎伸直及外观满意,尿道口位置正常.发生尿瘘10例(13.9％),尿道狭窄4例(5.6％),手术总成功率达80.6％.结论 PPDIF联合Duplay术式 Ⅰ期修复重度尿道下裂疗效肯定,具有术后外形美观,尿道狭窄、尿瘘等并发症少等优点.     

One-stage transverse preputial island flap in the management of maldeveloped short urethra

Chordee without hypospadias is found in a small number of patients. Surgical treatment differs according to the length of the urethra. Sometimes a maldeveloped short urethra requires transection to achieve good straightening of the penis. The authors present two such patients in whom a transverse preputial island-flap, as described by Duckett for the treatment of hypospadias, was used with good results.     

Dorsal tunica vaginalis graft plus onlay preputial island flap urethroplasty: Experimental study in rabbits

ObjectiveTo assess the use of tunica vaginalis graft plus onlay preputial island flap in urethral reconstructive surgery in rabbits through histopathology.Material and methodsWe developed an experimental model of urethroplasty that resembles one-stage complex hypospadias surgery with divided urethral plate. The tunica vaginalis graft is dorsally placed to recreate the urethral plate and the internal preputial island flap is placed onlay to complete the urethroplasty. Sixteen animals were divided into four equal groups and sacrificed at 2, 4, 8 and 12 weeks after surgery, the penis being sent for histopathological evaluation.ResultsThere were no deaths related to the procedure or wound breakdown; all rabbits voided spontaneously after surgery. Two urethrocutaneous fistulae were found. Microscopically, good tissue integration was observed, the tunica vaginalis mesothelium was gradually replaced by a more stratified epithelial lining, similar to the urothelial lining of the native urethra. The stratified squamous non-keratinized lining of the internal preputial island flap also changed into a thinner epithelial lining with only 4–5 cell layers. Two urethral diverticula were found.ConclusionA tunica vaginalis graft placed dorsally plus an onlay internal preputial island flap was shown to be a successful technique for urethroplasty in an animal model.