前尿道游离和尿道口前移术治疗尿道下裂

目的：提高冠状沟及冠状下型尿道下裂的手术成功率。方法：对5例冠状沟及冠状沟下型尿道下裂患儿行改良的前尿道游离和尿道口前移术治疗。结果：5例全部成功，随访1－3年，阴茎外观满意，尿道功能正常，无术后并发症。结论：采用改良的前尿道游离和尿道口前移治疗冠状沟及冠状沟下型尿道下裂，手术成功率高，术后并发症少。     

尿道松解延长龟头尿道口成形术治疗轻型尿道下裂

目的减少尿道下裂手术后并发症的发生，提高手术成功率，取消尿道代用物。方法选择尿道下裂Ⅰ型和部分Ⅱ型患者。26例行尿道松解延长电头尿道口成形术，14例行尿道松解延长电头隧道法尿道口成形术。24例留置尿管，16例尿流改道，二种方法术后均于1wk拔管。结果40例术后阴茎龟头畸形完全矫正，恢复后外观正常，仅1例因感染引起漏尿，2例尿道口狭窄。结论尿道松解延长龟头尿道口成形术为自身尿道的延长，成功率高，不需尿道代用物，恢复快，明显减少术后并发症，对于轻型尿道下裂是种理想的手术方法。     

尿道下裂一期尿道口正位成形术

尿道下裂一期尿道口正位成形术王忠曹安贵辜福贤（广元市人民医院泌尿外科６３８４００）我院自１９９０～１９９７年收治尿道下裂４１例，行一期尿道下裂成形术３８例，手术一次成功率８４％，６例尿瘘患者施行修补成功５例现报告如下。１临床资料３８例年龄最小１３个月...     

双皮瓣对合成形尿道治疗尿道下裂

目的：总结双皮瓣对合成形尿道治疗尿道下裂的经验，方法：对36例尿道下裂患者II期行双皮瓣对合成形尿道的尿道成形术，其中阴茎体型10例，阴茎阴囊产界型24例，阴囊型2例，术后尿道支架管留置5－7天，结果：36例皮瓣均成活，随访6－12个月，阴茎外观正常，排尿通畅，尿道外口狭窄1例，尿瘘3例，均已修补成功，结论：双皮瓣对合成形尿道行尿道下裂II期成形术，皮瓣血供丰富，手术简单，成功率高。     

带蒂阴囊隔皮瓣正位尿道口一期尿道下裂成形术

我院自 1 991年起采用带蒂阴囊纵隔皮瓣正位尿道口一期尿道下裂修复术 ,使尿道口达生理位 ,外形美观 ,效果满意。现报告如下。1　临床资料本组 6 1例 ,年龄 3～ 2 6岁 ,平均 5岁 ,其中阴茎型 1 2例 ,阴茎阴囊型 43例 ,阴囊型 6例 ;5例无阴茎下曲 ,尿道缺损长度为 2 .5～ 6 cm,平均 4cm,全部置尿管作支架及引流尿液。治愈标准为阴茎无下曲 ,尿道外口为正位 ,排尿通畅 ,无尿漏。2　手术方法阴茎头横缝牵引线 ,放置导尿管并调节好位置 ,小儿用 F8导尿管或硅胶管 ,成人用 F1 6 导尿管。 1矫正阴茎下曲切口 ,沿冠状沟下约 0 .5 cm环形切口 ,环形…     

游离前尿道治疗尿道下裂15例体会

尿道下裂是男性泌尿系统较常见的先天性畸形,手术方式多达200余种,但术后并发症尤其是尿瘘发生率高,故至今尚无一种理想的术式[1].1997年3月～2002年3月,我们采用游离和延伸前尿道(UM)治疗远端型尿道下裂15例,效果满意,报道如下.     

尿道板纵切卷管尿道成形治疗尿道下裂临床疗效分析

目的 评价尿道板纵切卷管尿道成形治疗尿道下裂临床疗效以提高尿道下裂矫治的成功率.方法 先天尿道下裂患者265例,年龄1～17岁,平均2岁.冠状沟型25例,阴茎体型163例,阴茎阴囊型55例,阴囊型22例.伴阴茎弯曲261例.采用尿道板切开卷管成形法,75例阴茎头向下弯曲者采用阴茎背侧白膜折叠术纠正.结果 随访6月至2年,TIP术中244例手术一次成功.结论 TIP术手术操作简单,治疗效果好,术后阴茎外形美观,是尿道下裂修复术的首选方法.     

尿道下裂修复术中的龟头和尿道口成形

目的　探讨尿道下裂治疗方法 ,提高治疗效果。方法　在进行尿道下裂修复的同时 ,一期将尿道外口做到龟头顶端 ,并同时进行龟头尿道口成形。结果　尿道下裂修复术 5 0例中 43例龟头和尿道口成形 (另 7例无明显龟头畸形者仅行尿道口移位 ) ,手术后尿道口位于龟头顶端 ,龟头形态良好。 2例并发尿瘘 ,1例并发尿道口狭窄 ,经治疗后痊愈。 15例经 1a以上的随访未见异常。结论　尿道下裂修复时应行一期龟头尿道口成形 ,改善形态和功能应作为治疗的重要步骤。     

保留尿道板一期尿道成形治疗尿道下裂

目的探讨尿道板在尿道成形中应用价值。方法对20例尿道下裂患者施行保留尿道板一期尿道成形术。结果总成功率为90%.术后1例出现尿瘘,一例尿道外口狭窄,全部病例随诊3-12月,阴茎外观均接近正常,无下弯,尿道开口于阴茎头部排尿通畅。结论保留尿道板成形术操作相对简单,易掌握,成功率高。适用于阴茎体型及阴茎下弯较轻的尿道下裂患者。     

Preserved urethral plate urethroplasty for failed hypospadias repair: report of 249 cases

Hypospadias is one of the most common .abnormalities of the external male genitalia but is very difficult to repair. Hypospadias reoperation is also a common practice for pediatric urologists, though repair of hypospadias at reoperation is much more difficult. The surgical technique involves using the well-vascularized ventral penile skin strip as a neourethral plate, and choosing surgical procedures according to the penile conditions. Tubularized incised plate urethroplasty （TIP）, first presented by Snodgrass in 1994, is widely accepted due to the ease of operation and satisfactory postoperative penis appearance. It can be used in most primary hypospadias cases, as well as in reoperations following failed surgery. Many satisfactory results of TIP have been reported in failed hypospadias repair. In this study, we used TIP and the Duplay technique for failed hypospadias repair in patients with the same penile conditions, and obtained similar, satisfactory results with both methods. Under suitable conditions, it is preferable to use a well-vascularized flap to repair failed hypospadias cases, and we therefore performed some Onlay island flap urethroplasties with good results.     

尿道下裂术后尿道狭窄细胞生物学基础研究

目的：模拟3种手术方式（TIP、Mathieu、Onlay）对尿道下裂动物模型进行尿道重建,探讨尿道瘢痕转归,为尿道下裂术后尿道狭窄并发症的防治提供理论依据。方法：26只大白兔,分为TIP、Mathieu与Onlay 3个实验组（每组各8只）和对照组（2只）。切除部分尿道腹侧全层,形成尿道下裂模型,分别采用TIP、Mathieu与Onlay术式进行尿道重建。分别于术后5 d、14 d、6周、3月每组各处死2只,肉眼观察有无尿道瘘及尿道狭窄,组织标本行石蜡切片HE染色、Masson胶原三色染色,免疫组织化学检测TGF-β1、α-SMactin细胞阳性表达情况。结果：全部实验兔无伤口感染及尿道狭窄,仅在Onlay组中出现1例尿道瘘。HE染色光学显微镜下观察发现,TIP组术后5 d尿道板及尿道腹侧创面已完全上皮化。Masson胶原三色染色提示Mathieu组与Onlay道腹侧胶原增生显著,增生明显强于TIP组。各组TGF-β1阳性表达以术后14 d、6周最强,组内各期比较差异并无统计学意义;各组α-SMactin阳性表达,以术后5 d最弱,6周、3月最强,组内比较差异有统计学意义;TIP组与Mathieu和Onlay组比较,术后6周、3月TGF-β1与α-SMactin明显减弱。结论：尿道愈合过程中,成纤维细胞和肌成纤维细胞均长时间保持较强活性,可能是尿道下裂术后尿道狭窄形成及加重的病理基础。TIP术式尿道板切口完全上皮化愈合,且尿道腹侧瘢痕增生较Mathieu及Onlay术式少,其重建尿道更符合正常解剖组织结构,是一种较为理想的手术方式。     

尿道板纵切卷管尿道成形术治疗尿道下裂32例临床分析

目的:探讨尿道板纵切卷管尿道成形术治疗尿道下裂的适应证、手术技巧、并发症。方法:对32例尿道下裂患者进行尿道板纵切卷管尿道成形术,其中冠状沟型3例,阴茎体型27例,阴茎阴囊2例。首次手术29例,采用尿道板正中切开卷管;再次手术3例,采用残余尿道板或阴茎皮肤正中切开卷管。卷管长1～9 cm,新尿道采用F6～F10号的多侧孔胃管作为支架管,术后10～14 d拔除。结果:随访0.5～2年,32例中27例一次手术成功,阴茎外观接近生理形态,排尿正常,成功率84.4%。尿瘘4例,均行尿瘘修补术痊愈;尿瘘并尿道狭窄1例,尿道扩张后狭窄改善,尿瘘待手术。结论:尿道板纵切卷管尿道成形术操作简单,治疗效果好,术后阴茎外形美观,是尿道下裂修复术的较好方法。     

Initial experience with lingual mucosal graft urethroplasty for anterior urethral strictures

Background

To present the feasibility of lingual mucosal graft urethroplasty in anterior urethral strictures and appraisal of donor site morbidity.

Methods

From November 2007 to December 2010, 14 patients underwent dorsal onlay lingual mucosal graft urethroplasty for anterior urethral strictures. Lingual mucosal graft was harvested from the lateral and undersurface of the tongue. Check micturating cystourethrograms were done 2 weeks after catheter removal and uroflowmetry after 3 months. Success was defined as normal uroflowmetry rates at 3 months in the absence of any postoperative instrumentation. Tongue was assessed for any residual pain, taste disturbances or restricted movement at 3 months.

Results

Four patients had submucosal fibrosis of the oral cavity and their buccal mucosa was unfit for grafting. Mean (range) stricture length was 5 (3–16) cm and the operation time 170 (140–210) min. Graft width averaged 1.6 cm. Average length of harvested graft was 6.5 cm. Mean duration of follow-up was 12.8 months. Two patients developed stricture at the proximal anastomotic site. There were no donor site complications.

Conclusions

Lingual mucosal graft harvesting is simple, gives graft lengths comparable to buccal mucosa and is associated with negligible donor site morbidity.     

尿道外口成形术治疗女性尿道综合征——附40例报告

[目的 ]探讨女性尿道综合征的治疗方法 .[方法 ]给 40例女性尿道综合征病人施行了尿道外口成形术 .[结果 ]40例病人中 ,随访 34例 ,其中治愈 2 0例 ,好转 10例 ,无效 4例 ,总有效率为 88% .[结论 ]尿道外口成形术是治疗女性尿道综合征的有效方法     

Initial experience with lingual mucosal graft urethroplasty for anterior urethral strictures

Background

To present the feasibility of lingual mucosal graft urethroplasty in anterior urethral strictures and appraisal of donor site morbidity.

Methods

From November 2007 to December 2010, 14 patients underwent dorsal onlay lingual mucosal graft urethroplasty for anterior urethral strictures. Lingual mucosal graft was harvested from the lateral and undersurface of the tongue. Check micturating cystourethrograms were done 2 weeks after catheter removal and uroflowmetry after 3 months. Success was defined as normal uroflowmetry rates at 3 months in the absence of any postoperative instrumentation. Tongue was assessed for any residual pain, taste disturbances or restricted movement at 3 months.

Results

Four patients had submucosal fibrosis of the oral cavity and their buccal mucosa was unfit for grafting. Mean (range) stricture length was 5 (3–16) cm and the operation time 170 (140–210) min. Graft width averaged 1.6 cm. Average length of harvested graft was 6.5 cm. Mean duration of follow-up was 12.8 months. Two patients developed stricture at the proximal anastomotic site. There were no donor site complications.

Conclusions

Lingual mucosal graft harvesting is simple, gives graft lengths comparable to buccal mucosa and is associated with negligible donor site morbidity.     

尿道板在尿道成形术中的应用

尿道下裂是男性小儿泌尿系常见先天畸形，治疗难度大。尿道板血运丰富，在一期尿道成形术中重要价值日益受到重视，现将保留尿道板的手术方式及其意义作一探讨。     

耻骨下缘部分切除辅助后尿道吻合术在男性骨盆骨折后尿道离断修复中的应用

目的: 总结耻骨下缘部分切除技术辅助后尿道吻合术治疗男性骨盆骨折后尿道离断(pelvic fracture urethral distraction defect, PFUDD)的临床效果并分析其技术要点。方法: 回顾性分析采用耻骨下缘部分切除技术辅助后尿道吻合术治疗的男性PFUDD患者63例,患者均以以下步骤完成后尿道吻合:(1)充分游离尿道海绵体球部,在尿道闭锁处切断尿道并切除瘢痕;(2)向远端适当游离尿道海绵体,劈开阴茎海绵体纵隔;(3)切除耻骨联合下缘,完成无张力吻合。结果: 63例患者的平均年龄(39.2±15.6)岁(15~72岁),平均尿道狭窄长度(3.85±0.91) cm (1.5~5.5 cm), 均采用耻骨下缘切除技术辅助完成后尿道吻合,手术时间平均为(160.2±28.1) min (110~210 min),术中估计失血量为(261.1±130.3) mL (100~800 mL),术后或术中输血者3例(4.8%)。术后并发症包括出血和泌尿系感染,均对症处理后治愈。患者的中位随访时间为23个月(12~37个月),术后平均最大尿流率为(23.7±7.4) mL/s (15.0~48.2 mL/s)。耻骨下缘切除技术辅助后尿道吻合治疗男性PFUDD的手术成功率为95.2%(60/63例)。结论: 耻骨下缘部分切除能够有效缩短远近端尿道间距离,辅助部分复杂PFUDD患者完成无张力吻合,技术要点包括阴茎海绵体纵隔切开充分暴露耻骨联合、游离结扎阴茎背静脉、充分切除耻骨骨质下方与尿道之间瘢痕组织暴露健康尿道近端。     

长隧道分期尿道成形术与传统分期手术的疗效比较

目的比较长隧道分期尿道成形术与传统分期尿道成形术在男性重型尿道下裂的治疗效果。方法 2010-2013年中山大学附属第一医院小儿外科收治重型尿道下裂患者82例,其中21例行长隧道分期术式,余61例行传统分期术式,比较两组手术时间、出血量、术后患者生殖器外观满意度、尿瘘发生率、尿道狭窄发生率、尿道憩室发生率、阴囊分裂纠正率以及阴茎阴囊纠正率。结果长隧道组二期手术时间(70±20)min低于传统组(110±25)min,差异有统计学意义(P0.05);术后随访长隧道组生殖器外观满意率(95.2%)及阴茎阴囊倒位纠正率(92.3%),高于传统组生殖器外观满意率(78.6%)及阴茎阴囊倒位纠正率(0.0%),差异有统计学意义(P0.05);长隧道组尿瘘发生率(0.0%)低于传统组(13.1%),差异有统计学意义(P0.05)。结论长隧道分期尿道成形术手术时间短,大大降低尿瘘的发生,可同时纠正阴囊分裂及阴茎阴囊倒位,生殖器外观改善满意,疗效优于传统术式。