Duckett术式一期修复小儿尿道下裂

目的 探讨横裁包皮带蒂岛状皮瓣尿道成形术(Duckett术)一期修复先天性尿道下裂的优点及提高疗效的措施.方法 采用Duckett术式一期修复尿道下裂50例,其中6例联合应用以尿道外口为基底的阴囊矩形皮瓣尿道成形术(Duplay术式).结果 40例一期治愈;8例出现尿瘘,其中3例自愈,5例再经尿瘘修补术后痊愈.2例尿道狭窄,经扩张后痊愈.结论 Duckett术一期修复伴阴茎下弯尿道下裂,取材方便,皮瓣成活率高,并发症少,外形美观,适用于大部分类型的尿道下裂;娴熟的手术技巧是提高疗效的关键.     

采用"乳头法"防止尿道成形术后尿道外口狭窄

198 0年以来 ,我院共行尿道下裂尿道成形术 5 4 0例 ,术后发生不同程度的尿道狭窄 38例 ,占 7.0 %。为防止这一并发症 ,我们对 2 0例尿道下裂患者采用“乳头成形术”,取得明显效果。现报告如下。1　资料与方法1.1　一般资料　 2 0例中 ,年龄 1～ 2 5岁 ,平均 3.5岁。其中阴茎型尿道下裂 8例 ,阴茎阴囊型 9例 ,阴囊型 3例。1.2　手术方法　阴茎型尿道下裂采取 Duckett尿道成形术 [1 ] ;阴茎阴囊交界型与阴囊型采用阴囊中隔皮瓣成形术 ,在以上两种术式的基础上 ,将新成形尿道远端约 1cm向外翻 ,并用细线平均四周缝合固定 ,使其自然形成小乳头…     

横行岛状包皮瓣联合阴囊中缝皮瓣一期修复重度尿道下裂

横行岛状包皮瓣尿道成术(Duckett术式)是国内外修复伴有阴茎下曲畸形的阴茎体型尿道下裂常用的术式,但对阴茎下弯矫正后尿道缺损长的重度尿道下裂,用岛状包皮瓣不足以修复时,联合应用原位阴囊中缝皮瓣(Duplay式)或带蒂阴囊中缝皮瓣(Scrotal式),可以达到一期修复的目的.1999年1月～2008年12月作者采用Duckett联合Duplay术式和Duckett联合Scrotal术式修复伴有阴茎下曲畸形的重度尿道下裂26例,取得较好的效果,报告如下.     

Duckett术联合阴囊中缝皮瓣治疗严重型尿道下裂

目的:介绍在严重型尿道下裂修复中采用横行带蒂包皮内板与阴囊中缝皮瓣联合治疗的手术方法及特点.方法:对阴茎下弯矫正后,尿道缺损长的尿道下裂病例,采用倒"U"形阴囊中缝皮瓣尿道成形,与带蒂包皮内板尿道成形术(Duckett术)的联合手术方法,共修复8例严重型尿道下裂.患儿平均年龄5.5岁.术后随访6个月～2年.结果:一次手术成功6例,1例尿瘘,1例尿道吻合口狭窄,经尿道扩张3个月后治愈.随访阴茎外观及排尿良好.结论:横行带蒂包皮内板与阴囊中缝皮瓣联合的手术方法,对治疗包皮发育不佳的严重型尿道下裂效果良好,同时有助于阴囊对裂的矫正.     

Duckett联合Duplay术修复重度尿道下裂

目的 评价Duckett联合Duplay术式修复重度尿道下裂的疗效.方法 重度尿道下裂患儿70例,一次成型尿道,远端用Duckett岛状皮瓣缝合皮管,近端采用尿道口附近阴囊皮肤做Duplay成型尿道,与Duckett管相吻合.对其中28例术后随访0.5～3年.结果 70例手术中,一次手术成功65例,并发症尿瘘3例,尿道狭窄伴憩室2例.所有患儿术后阴茎外观正常,排尿成线,与既往采用阴囊带蒂岛状皮瓣治疗重度尿道下裂54例中治愈40例（74%）相比较,有显著性差异（P〈0.05）.结论 Duckett联合Duplay术式对修复重度尿道下裂效果良好,外形满意,并发症发生率低,除发生合并症外,不需Ⅱ期手术.     

小儿先天性尿道下裂手术方式与术后尿道狭窄的关系

目的:探讨尿道下裂各类手术方式与术后尿道狭窄之间的关系及防治措施.方法:回顾分析2005～2008年我院350例尿道下裂手术者临床资料,分析不同术式与术后尿道狭窄的关系.结果:尿道口前移、龟头成形术(MAGPI)无尿道狭窄发生,加盖岛状皮瓣(Onlay)法、尿道板纵切卷管(Snodgrass)法尿道狭窄发生率均较高,但多为尿道远端开口处狭窄,发生率各占20.8%;保留血管蒂岛状皮瓣(Duckett)法多发生于近端吻合口,发生率14.8%;U型皮瓣(Duplay)法加Duckett法尿道狭窄发生部位多在近端吻合口及两个吻合口之间,发生率60.0%.结论:对于阴茎头及冠状沟型尿道下裂应尽量采用MAGPI术式,阴茎体型采用Onlay及Snodgrass法,只对不离断尿道不足以矫正阴茎下弯者采用Duckett法,对于尿道缺损较长的尿道下裂利用尿道周围皮肤做Duplay管再联合Duckett法基本可解决问题.出现尿道狭窄后应尽早行尿道扩张,必要时留置导尿管.     

横行岛状包皮瓣联合阴囊中缝皮瓣一期修复重度尿道下裂

横行岛状包皮瓣尿道成术（Duckett术式）是国内外修复伴有阴茎下曲畸形的阴茎体型尿道下裂常用的术式,但对阴茎下弯矫正后尿道缺损长的重度尿道下裂,用岛状包皮瓣不足以修复时,联合应用原位阴囊中缝皮瓣（Duplay式）或带蒂阴囊中缝皮瓣（Scrotal式）,可以达到一期修复的目的。     

尿道下裂一期修复及并发症的处理（附120例报告）

目的：探讨尿道下裂不同术式的疗效及并发症的处理。方法：总结我院14年来120例尿道下裂的手术效果，观察局部皮肤尿管成形术，带蒂皮瓣尿管成形术二类术式的临床效果。结果：尿道下裂一期修复成功率：①无合并阴茎下弯者，采用MAGPI术式89．7％，Omnly加盖岛状皮瓣法84．6％；②合并阴茎下弯者，Duckett横行带蒂岛状皮瓣尿管成形术81．4％。采用Duckett Duplay79．5％。结论：尿道下裂一期修复需根据其不同类型及病者具体情况而决定采用不同术式，才能达到治愈目的，手术由专业医师专人操作，能有效减少并发症的发生。     

改良横裁包皮岛状皮瓣尿道成形术治疗中度小儿尿道下裂35例体会

目的探讨应用改良横裁包皮岛状皮瓣尿道成形术 (Duckett)治疗有阴茎下弯的尿道下裂手术疗效。方法 71例Ⅱ型中度尿道下裂患者随机分为治疗组 35例与对照组 36例 ,分别采取改良Duckett手术和Duckett手术。结果对照组手术成功率 5 2 .8% ,并发尿瘘 13例 (36 .1% ) ,尿道狭窄 3例 (8.3% ) ,尿道扩张 1例 (2 .8% ) ;治疗组成功率 77.1% ,并发尿瘘 7例 (2 0 .0 % ) ,尿道狭窄 1例 (2 .9% ) ,尿道扩张 0例 ,两组相比有显著性差异 (P <0 .0 5 )。结论Duckett改良术式可显著提高手术成功率。     

阴囊纵膈皮瓣在先天性尿道下裂治疗中的应用

目的探讨阴囊纵膈皮瓣尿道成形术治疗先天性尿道下裂的临床疗效及可行性。方法选择先天性尿道下裂患者53例,均行阴囊纵膈皮瓣尿道成形术治疗。首先切除阴茎腹侧纤维索带以松解伸直阴茎,再采用阴囊纵膈皮瓣形成新尿道,并随访6个月～4年。结果 53例患者中,一期尿道成形手术41例(77.4%),二期尿道成形术12例(22.6%)。手术时间2.5～4.5 h,平均3.5 h;术中出血20～100 mL,平均50 mL;阴囊纵膈皮瓣最小为2.0 cm×1.5 cm,最大为8.0 cm×2.0 cm;术后分别留置气囊尿管或自制多侧孔硅胶支架管7～21 d,平均12 d。53例患者获得随访6个月～4年。术后7例出现尿瘘须再次手术治疗,5例出现尿道狭窄行3～5次尿道扩张后正常排尿。年龄较大患者术后阴茎勃起正常,阴茎无明显弯曲,外观基本正常。结论阴囊纵膈皮瓣尿道成形术治疗先天性尿道下裂,材料充裕,血供丰富,手术成功率高。阴囊纵隔皮瓣是治疗尿道下裂尿道成形的理想材料。     

改良Duplay术和Duckett术在儿童中重度尿道下裂中的临床应用比较

目的 比较改良分期尿道板纵切卷管尿道成形术（改良Duplay术）和一期横形带蒂岛状包皮皮瓣尿道成形术（Duckett术）治疗儿童中重度尿道下裂的疗效。方法 收集81例中重度尿道下裂患儿的临床资料,根据术式不同分为改良Duplay术式组45例和Duckett术式组36例。比较2组的手术时间、出血量、住院费用、术后并发症和患儿家属对手术的满意度及治愈率。结果 与Duckett术式组比较,改良Duplay术式组的手术时间较短,尿道狭窄和尿道憩室的发生率较低（P均< 0.05）。2组的出血量、住院费用、尿瘘和龟头裂开的发生率和治愈率比较差异均无统计学意义（P均> 0.05）。Duckett术式组患儿家属对手术的满意度高于改良Duplay术式组患儿家属对一期手术的满意度（P < 0.05）,与改良Duplay术式组患儿家属对二期手术的满意度相近（P > 0.05）。结论 改良Duplay术治疗中重度尿道下裂手术时间短、尿道狭窄和尿道憩室的发生率低,其临床应用优于Duckett术。     

Changes in the presentation of intussusception.

Intussusception is most often diagnosed in well-nourished 7- to 10-month-old infants, but may be overlooked in older children. From 1985 to 1991, we treated 118 boys and 62 girls ranging in age from 2 months to 15 years (average, 22.6 months). Thirty-seven percent were older than 2 years, significantly more than in earlier experience at this institution. Overall, children with intussusception had a less than average weight (P < .05). The majority of intussusceptions in all age groups were idiopathic. Seventy-three percent of the patients were treated successfully by barium enema. The presence of air-fluid levels on the plain radiograph decreased the success rate of barium enema reduction from 81% to 49%. Barium enema reduction should nevertheless be attempted regardless of the age of the patient or the duration of symptoms, and routine surgical exploration is never recommended.     

尿道口前移龟头成形术（MAGPI）矫治短段型尿道下裂（附24例报告）

尿道口前移龟头成形术（ＭＡＧＰＩ）适用于矫治短段型尿道下裂，其特点是手术简便、并发症低、疗效好。我们自１９８８年起采用该术式共治疗２４例，结果满意，无并发症。现结合文献对该手术的适应症及并发症的防治进行讨论。     

Cooperative studies in the treatment of acute lymphoblastic leukemia in children in Austria--report of 10 years' experience

437 children with acute lymphoblastic leukaemia (ALL) have been treated at 9 different institutions in Austria utilizing common protocols and central registration between 1974 and 1984. 227 patients (132 boys and 95 girls, group I) were treated between 1974 and 1980 using 3 consecutive protocols (KMK, O 76, A 78), which were essentially derived from the Memphis studies VII and VIII. Patients with a high risk of relapse were treated according to the LSA 2-L2 protocol. 210 patients (112 boys and 98 girls, group II) were consecutively treated following the BFM protocols 76/79 and 81/83. In this group, treatment intensity was adjusted to the initially determined individual risk of relapse (BFM risk score or risk factor). To date, the life table analysis demonstrates that the probability of continuous complete remission for patients in group II is 60% after 5 and 3 years (BFM 76/79 and BFM 81/83, respectively), whereas group I reaches a level of 37.3%. The prognostic difference between risk and non-risk patients in both studies of group II was eliminated. Despite a higher morbidity and non-leukaemia-related mortality in group II, the therapeutic success can be attributed to the intensification of induction therapy.     

Corticosteroid treatment and functional improvement in Duchenne muscular dystrophy: long-term effect

OBJECTIVE: To determine and compare the long-term effects of prednisone and deflazacort on the functional status of children with Duchenne muscular dystrophy. DESIGN: A total of 49 boys with Duchenne muscular dystrophy, between the age of 12 and 15 yrs, who were observed over a 7-yr period were reviewed retrospectively. Eighteen had been treated with prednisone, 12 with deflazacort, and 19 had no drug treatment. All boys treated with steroids received medication for >2 yrs before losing their ambulation. Lower and upper limb motor functions, pulmonary function, prevalence of surgery for scoliosis, and side effects were compared. RESULTS: Boys in the steroid groups were significantly more functional and performed better on all tests than boys not treated (P < 0.05). There was no significant difference between the deflazacort- and prednisone-treated groups (P > 0.05). The number of boys having scoliosis surgery in treated groups was significantly less than nontreated boys (P < 0.05). The control group's pulmonary capacity was decreasing and significantly less than both prednisone- and deflazacort-treated boys. Both deflazacort and prednisone had beneficial effect on pulmonary function and scoliosis. Cataracts, hypertension, behavioral changes, excessive weight gain, and vertebral fracture were noted as serious side effects. CONCLUSIONS: Prednisone and deflazacort have a significant beneficial effect on slowing the disease progress. Their usage in Duchenne muscular dystrophy may prolong ambulation and upper limb function with similar potency. Both steroids also improve pulmonary function, in addition to delaying the need for spinal interventions, with similar therapeutic profiles.     

Successful treatment of whiplash-type injury induced severe pain syndrome with epidural stimulation: a case report

Chronic severe cervico-facial pain syndrome associated with a whiplash-type injury was successfully treated with epidural spinal cord stimulation. The patient had been in pain for 9 years, responding temporarily only to stellate ganglion blocks. The patient has now been painless for 18 months. We have been unable to find a similar case reported in the literature to date.     

Treatment of traumatic splenic rupture in children

The introduction of new techniques for reducing blood loss in operations on parenchymatous organs and of ultrasonography for screening the traumatized spleen and monitoring therapeutic management have made it possible to preserve this organ following injuries in childhood with increasing success over the past few years. An analysis of a sample of 48 children with splenic rupture (33 boys, 15 girls, aged between eleven months and four years) treated in our department between 1974 and 1989 illustrates this change of approach. 26 patients were splenectomized, in 14 cases the spleen was partly preserved, and 8 were just monitored.     

重型尿道下裂手术修复方式进展

针对重型尿道下裂手术修复方式，汇总近5年国内大部分相关文献以及同期国外代表性相关文献。根据这些资料描述和分析重型尿道下裂各种尿道成形术的特点和优缺点。最后基于分析结果讨论重型尿道下裂各种尿道成形术的适宜人群。重型尿道下裂手术修复方式多种多样，各有优势和劣势。国内较常用的是Duekett联合Duplay尿道成形术，其他手术修复方式包括Koyanagi尿道成形术、加盖岛状皮瓣尿道成形术、游离黏膜瓣尿道成形术和分期修复手术等。学界在重型尿道下裂手术修复方式的选择上仍具有争议，尤其是在应该选择一期修复手术还是分期修复手术的问题上，宜根据患者病情条件及术者技术水平慎重选择。     

内窥镜术中尿道内留置尼龙线防治男童外伤性后尿道狭窄

目的提高男童创伤性后尿道狭窄的防治水平.方法陈旧性后尿道外伤男童15例.后尿道狭窄段长度0.8～2.0 cm,平均1.5 cm.均行尿道内切开(TUR)治疗,术中尿道内留置尼龙线.留置尿管2～4周,拔除尿管后即行尿道内尼龙线引导下改良软尿道扩张器的尿道扩张.结果15例患儿经平均2.5个月、最长9个月的尿道扩张,排尿通畅后拔除尼龙线.随访6～36个月,排尿正常,无尿失禁.结论改良软尿道扩张器和医用尼龙线治疗后尿道狭窄效果显著,具有取材方便、简单、实用的优点.术中患儿耐受性好,易于配合,解决了男童尿道扩张问题,减少了因尿道狭窄复发而反复手术的次数,为男童创伤性后尿道狭窄的防治开辟了新法.