阴茎背侧纵行带蒂包皮瓣在尿道下裂修复中的应用

目的:评价阴茎背侧纵行带蒂包皮瓣尿道成形术在尿道下裂修复中的应用及疗效;方法:采用改进的阴茎背侧纵形带蒂包皮瓣尿道下裂修复术治疗26例有阴茎弯曲,背侧包皮丰富的中、近段尿道下裂。结果:随访3个月～1年,26例患者手术后全部一次成功。术后排尿顺利,尿线正常,外形接近正常。一次手术成功率达100%。结论:阴茎背侧纵行带蒂包皮瓣尿道下裂修复术是有阴茎弯曲,背侧包皮丰富的中、近段尿道下裂理想的手术方式。     

Duckett术式一期治疗尿道下裂的临床研究

目的:探讨横裁包皮带蒂岛状皮瓣尿道成形术(Duckett术)一期治疗尿道下裂的临床效果。方法:回顾性研究我科2003年～2007年采用Duckett术式一期修复尿道下裂患者20例,年龄2～22岁,平均11.3岁,其中阴茎体型3例,阴茎阴囊型17例;另外收集同期行膀胱粘膜代尿道术尿道下裂30例,年龄7～34岁,平均16.1岁,其中阴茎体型10例,阴茎阴囊型16例,会阴型2例,阴囊型2例。膀胱粘膜术全部行膀胱造瘘及留置尿道支架管,Duckett术仅留置尿道支架管。结果:Duckett术:1次手术成功17例(85%),术后尿瘘2例(10%),尿道狭窄1例(5%),2例尿瘘术后6个月修补成功,人均手术次数为1.1次;膀胱粘膜代尿道术:手术均分二期完成,手术成功26例(86.7%),术后尿瘘3例(10%),尿道狭窄1例(3.3%),再次手术修补瘘口治愈,人均手术次数为2.1次。2例尿道狭窄行尿道扩张后基本痊愈。结论:Duckett术一期修复尿道下裂效果良好,手术成功率与其他术式相近、术后并发症低,与膀胱粘膜尿道成形术相比,术后阴茎外观更满意,主要优点是一次完成手术。     

不同术式一期修复男童尿道下裂

目的　评价不同术式一期修复男童尿道下裂的疗效。　方法　 1995年至 2 0 0 2年间共收治尿道下裂及其并发症 32 3例 ,其中年龄 <14岁 2 4 2例 ,除并发症病例外 ,施行尿道下裂成形手术2 0 5例。其中带蒂包皮皮管尿道成形术 (Duckett) 12 7例 ,原位阴囊皮管加带蒂包皮皮管 (Duplay加Duckett) 2 5例 ,膀胱黏膜代尿道 16例 ,阴茎原位皮管 16例 ,带蒂包皮皮瓣相嵌 (Onlay) 9例 ,尿道口近端带蒂皮瓣翻卷 (Mathieu) 7例 ,尿道口前移 (MAGPI) 5例。　结果　术后发生尿瘘 19例 ,尿道外口狭窄 1例 ,总成功率 90 .2 %。总并发症发生率 9.8%。其中Duckett术式并发症 7.8% (10 / 12 7) ,阴茎原位皮管 12 .5 % (2 / 16 ) ,Mathieu术 2 8.6 % (2 / 7) ,Duplay加Duckett术 16 .0 % (4/ 2 5 ) ,膀胱黏膜代尿道 6 .3% (1/ 16 ) ,Onlay 11.2 % (1/ 9)。　结论　严格掌握不同术式的适应证 ,根据患儿情况灵活选择术式可降低并发症发生率。     

不同方法治疗尿道下裂16年回顾

目的　探讨尿道下裂不同术式效果及特点。方法　回顾分析 16年 2 3 1例尿道下裂手术资料 ,分别采用游离移植物尿道成形术、带蒂包皮内板尿道成形术、前尿道延伸术和前尿道延伸术加带蒂包皮内板尿道成形术等术式 ,观察手术效果。结果　游离移植物尿道成形术 :膀胱黏膜尿道成形术 12 0例 ,成功率 83 .3 %;游离包皮内板尿道成形术 2 3例 ,成功率 78.2 %。带蒂包皮内板尿道成形术 3 0例 ,成功率 80 .0 %。前尿道延伸术 45例 ,成功率 95 .5 %。前尿道延伸术和前尿道延伸术加带蒂包皮内板尿道成形术 13例 ,成功率 69.2 %。结论　尿道下裂术式各具优缺点 ,应根据尿道缺损的长度及术者的经验选取术式     

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.     

不同术式一期正位开口修复先天性尿道下裂：附114例报告

总结１１４例不同手术方式一期修复各种类型尿道下裂的经验。本组中阴茎型３０例，阴茎阴囊型６３例，会阴型２１例。阴茎型尿道下裂宜采用包皮内板转移皮瓣尿道成形术。阴囊型根据缺损尿道长短采用阴囊纵带蒂皮瓣术或包皮内板阴囊纵隔联合皮瓣尿道成形术。会阴型采用包皮内板阴囊纵隔联合皮瓣术或膀胱粘膜尿道造成形术本组一期手术的成功率为８４．８％。     

应用显微外科技术预防尿道下裂术后尿瘘

目的：提高尿道下裂一期手术疗效，减少尿瘘等并发症发生。方法：应用显微外科技术，选择不同的术式一期修复尿道下裂17例，包括加盖带蒂包皮瓣尿道成形术(onlay island flap urthroplasty)4例，横形带蒂包皮瓣尿道成形术(Duckett术)8例，膀胱黏膜一期尿道成形术5例。结果：一期手术全部成功，无尿瘘、尿道狭窄、感染等严重并发症。结论：应用显微外科技术，能提高尿道下裂一期手术的成功率，减少尿瘘的发生。     

带蒂双面包皮皮瓣法治疗180例尿道下裂临床分析

目的为提高一期修复尿道成功率，总结应用带蒂双面包皮皮瓣尿道成形术（PPDIF）治疗尿道下裂的经验。方法1991—2006年间，应用单面皮瓣尿道成形术治疗尿道下裂140例，应用双面皮瓣尿道成形术治疗尿道下裂180例，对比分析单面、双面皮瓣尿道成形术的治疗效果。结果单面皮瓣尿道成形术治愈率75．0％、双面皮瓣尿道成形术治愈率89．4％，双面皮瓣手术成功率明显高于单面皮瓣。结论带蒂双面包皮皮瓣尿道成形术为临床提供了一种更好的治疗方法，一期修复尿道下裂成功率高，且成形后阴茎外形美观。     

不同方法治疗尿道下裂16年回顾

目的 探讨尿道下裂不同术式效果及特点。方法 回顾分析16年231例尿道下裂手术资料，分别采用游离移植物尿道成形术、带蒂包皮内板尿道成形术、前尿道延伸术和前尿道延伸术加带蒂包皮内板尿道成形术等术式，观察手术效果。结果 游离移植物尿道成形术：膀胱黏膜尿道成形术120例，成功率83．3％；游离包皮内板尿道成形术23例，成功率78．2％。带蒂包皮内板尿道成形术30例，成功率80．0％。前尿道延伸术45例，成功率95．5％。前尿道延伸术和前尿道延伸术加带蒂包皮内板尿道成形术13例，成功率69．2％。结论 尿道下裂术式各具优缺点，应根据尿道缺损的长度及术者的经验选取术式。     

自制多孔平行双支架管在尿道下裂手术中的应用

目的 探讨提高各型尿道下裂修复手术成功率的方法.方法 220例尿道下裂患者,均采用一期尿道成形术.阴茎伸直后,用带蒂包皮内板尿道成形术(Duckett术)195例;阴囊中隔+带蒂包皮内板联合成形术20例;膀胱黏膜游离移植尿道成形术5例.用自制带有多个侧孔的平行双硅胶管作为尿道下裂修复手术中新形成的尿道支架管.结果 术后随访1～8年,208例一期手术成功,排尿通畅;2例术后出现尿瘘;6例手术1个月后出现尿道吻合口狭窄,4例术后1个月尿道外口狭窄.结论 本组一期手术成功率达94.5%,自制带有多侧孔的平行双硅胶管作为尿道支架管,具有通畅引流、利于冲洗等优点,可减少感染、尿瘘、狭窄的发生率.     

尿道下裂手术方式的选择及并发症的预防

目的：评价一期膀胱粘膜或包皮内板在尿道下裂修复术中的应用和并发症的预防。方法：尿道下裂患者164例，年龄1.5-25岁，初次手术病例组138例，采用包皮内板尿道成形术47例，膀胱粘膜尿道成形术91例；再次手术病例组26例，全部采用膀胱粘膜尿道成形术。结果：术后随访6个月－7年。所有病例一次手术成功率（94.5%）。尿瘘9例都位于冠状沟下，初次手术组与再次手术组的成功率（94.9%：92.3%）差异无显著性意义。使用膀胱粘膜与包皮内板尿道成形术成功率（94.1%:95.7%）差异无显著性意义。结论：无论是那种类型的尿道下裂，正确应用包皮内板或膀胱粘膜尿道成形术能取得良好的疗效。手术成功的关键不在于手术的方法，而在于术者对术式掌握的熟练程度和术中以及术后对每个细微环节的认真处理。     

Treatment of severe scrotal hypospadias with onlay-type urethroplasty using mouth mucosa

Failure in repairing severe hypospadias complicated with fistula and cutaneous retraction is often associated with lack of subcutaneous tissue and skin providing protection to the neourethra. We report the results of treatment in 6 patients with scrotal hypospadias with severe deviation and scarce dorsal prepuce. A neourethra was created by the onlay technique applying an oral mucosa graft and preserving in all cases the dorsal preputial skin for the island cutaneous flap. All patients had hypospadias without previous repairs excepting one of them, who had had one first time hypospadias repair in other hospital. Patients age ranged between 2 years and 3 months, and 4 years (mean: 2 years and 9 months). In all cases, hypospadias was scrotal type with severe deviation and scarce dorsal prepuce. All patients had prior hormone stimulation with dehydrotestosterone 3%. Surgical repair was performed in one-stage. Urethroplasty included preservation of the urethral plate, oral mucosa graft to provide ventral coverage, and island cutaneous flap with the dorsal preputial skin. In all cases, the chord was dissected behind the urethral plate. In 3 patients a dorsal Nesbit plication was necessary to obtain a complete straighten penis. Results in all 6 cases were satisfactory. Only one patient had a small leakage at the previous neomeatus. The other five patients are asymptomatic. Follow-up ranges from 6 months to 2 years. We conclude that urethroplasty in association with a well vascularized island flap of dorsal preputial skin decrease the incidence of fistulae. In patients with severe hypospadias with scarce dorsal prepuce urethroplasty should be completed with oral mucosa grafts preserving dorsal preputial skin for the ventral cutaneous plasty.     

游离包皮内板或膀胱粘膜治疗尿道下裂(附56例报告)

目的：介绍采用游离包皮内板或膀胱粘膜治疗尿道下裂的方法及效果。方法：对56例尿道下裂患儿根据尿道缺损长度不同，42例采用包皮内板，14例采用膀胱粘膜行尿道成形术。结果：56例中一次手术成功49例（87.5%），7例尿瘘（12.5%），其中1例小尿瘘自行愈合，另6例分别于术后3个月行尿瘘修补术治愈，随访6个月－3年，疗效满意。结论：游离包皮内板或膀胱粘膜可以治疗各种类型尿道下裂，效果良好。     

手术治疗尿道下裂12年回顾

目的 :探讨尿道下裂修复术的手术方式与治疗结果的关系。　方法 :对 1989～ 2 0 0 1年尿道下裂修复术 9种方式和不同的取材特点进行回顾性分析。　结果 :除术者的临床经验外 ,手术方式和取材对治疗效果有重要影响 ,其成功率为 :隧道式管状法尿道成形术 86 .4 % ,带蒂包皮岛瓣法尿道成形术 83.3% ,膀胱粘膜法尿道成形术 83%。结论 :尿道下裂修复术 9种术式和不同的取材各具优缺点 ,值得进一步研究和改进。     

应用显微外科及带蒂皮管技术一期修复尿道下裂(附254例报告)

目的　提高尿道下裂一期手术疗效。　方法　应用显微外科技术 ,选择带蒂皮管法一期修复尿道下裂 2 54例。　结果　一期手术成功率 90 .2 % ,其中 <1岁者成功率 1 0 0 % ,1岁～者94 5% ,3岁～者 89.6% ,>1 4岁者 76.5%。　结论　应用显微外科技术 ,选择适宜的手术方法 ,提早接受手术治疗的年龄 ,能明显提高尿道下裂一期成形术的成功率     

The modified Koyanagi repair for severe proximal hypospadias

OBJECTIVE: To report the method and results of a modified one-stage Koyanagi repair (urethroplasty with a parameatal-based and fully extended circumferential foreskin flap) to preserve the vascularity to the peripheral portion of the neourethra, in the repair of severe hypospadias. PATIENTS AND METHODS: Using a skin-incision line as in the original Koyanagi repair, a circumferential incision is made approximately 5 mm proximal to the corona and the urethral plate incised as for repair of chordee. A U-shaped skin incision is then made surrounding the meatus, extended to the dorsal prepuce for approximately 8 mm and parallel to the first incision. The tissue between the prepuce and dartos is dissected on the dorsal side to fix the prepuce as a neourethra to the dartos and to maintain blood supply. After mobilizing the loop-shaped skin flap through the button-hole of the pedicle, the internal and external sides of the loop are sutured to construct a neourethra. Twenty patients (aged 10 months to 9 years) with severe proximal hypospadias underwent the one-stage modified Koyanagi repair. RESULTS: The repair was successful after the initial procedure in 14 patients, but urethrocutaneous fistulae developed in three and meatal stenosis in three. The overall success rate was thus 70%. CONCLUSIONS: There were fewer complications than reported with the original Koyanagi repair, suggesting that the attempted vascular preservation of the neourethra was effective.     

Yoke technique for severe proximal hypospadias

PROPOSED: Various techniques have so far been reported for the repair of hypospadias, however, a one-stage procedure for the repair of severe proximal hypospadias still remains difficult to perform. We recently have begun to use the Yoke hypospadias repair technique for the treatment of severe proximal hypospadias. PATIENTS AND METHODS: As the chief surgeon, I performed a one-stage hypospadias repair on 40 proximal hypospadiac patients with severe fibrous chordee between July 1992 and December 2004. During the early period, eleven patients underwent urethroplasty by the Transverse Preputial Island Flap techinique (TPIF). Next, 10 patients underwent One-stage Urethroplasty with Parameatal Foreskin flap technique (OUPF IV). Finally, the most recent 19 had their hypospadias repaired by the Yoke technique. RESULTS: With the TPIF technique in the early periods, only 6 out of 11 patients underwent a successful repair (54.5%). With the OUPF IV technique, the success rate was only 60.0% (6 out of 10 cases). In contrast, 17 out of 19 cases treated by the Yoke technique in the most recent period had a successful repair, although proximal urethrocutaneous fistula and urethral stenosis occurred in one patient, respectively. A relatively high success rate was therefore obtained using the Yoke technique for the repair of severe proximal hypospadias. CONCLUSION: The Yoke techniques for the repair of hypospadias is therefore considered to be a safe and effective technique for the repair of proximal hypospadias because of the continuous skin flap of the ventral urethral plate and the prepuce with a blood supply from the circumferential vascular pedicle. We consider this technique to be very useful for the treatment of severe proximal hypospadias.     

Onlay island flap urethroplasty: variation on a theme.

The onlay island flap urethroplasty is useful in patients with distal, mid shaft and proximal hypospadias who have a well developed urethral plate and exhibit little or no curvature after release of chordee. The technique described has 2 main features: 1) use of the entire inner prepuce of the foreskin facilitates its mobilization and protects the vascular pedicle, and 2) additional soft tissue coverage is gained by removing the excess preputial mucosa not used for the neourethra. This extra soft tissue covering of the suture lines should prevent fistula formation. During the last 4 1/2 years the onlay island flap has been used for repair of hypospadias in 61 patients. The complication rate (6%) is low and compares favorably with other techniques. Further refinements in the onlay flap hypospadias repair should decrease the complication rate and widen its applicability.     

尿道下裂术后阴茎部尿道瘘修补术式的比较

对１９７５～１９９５年间４３例尿道下裂术后阴茎部尿道瘘修补术的三种手术方式进行比较。初期１７例的术式为三层缝合法，失败率为３５．２９％，１９８９年后采用瘘口周围皮瓣横形ＹＶ成形法２１例，成功率达９５．２４％，另５例采用带蒂阴囊皮瓣转移法全部成功。认为瘘口周围皮瓣横形ＹＶ成形法成功率高，手术简便，特别适用于阴茎部尿道瘘。