组织瓣覆盖技术在尿道下裂手术及术后尿瘘修复中的应用

目的探讨组织瓣覆盖技术在尿道下裂手术及尿瘘修复手术的效果。方法1998年3月至2003年5月，73例尿道下裂手术及术后尿瘘修复手术中，采用5种组织瓣覆盖技术覆盖新尿道及尿瘘内口。尿道下裂组45例中采用带蒂背侧皮下组织瓣转移法27例，带蒂鞘膜瓣转移法3例，局部阴囊推进肉膜瓣法15例；尿瘘组28例中采用带蒂背侧皮下组织瓣转移法4例，局部X—V皮瓣法14例，局部U形组织瓣法10例。结果随访3～36个月，尿道下裂组45例术后3例出现尿瘘，尿瘘组28例均未再发尿瘘，成功率95．9％。结论尿道下裂手术及尿瘘修复手术中采用组织瓣多层覆盖技术，可提高手术成功率，降低术后尿瘘发生率。     

肉膜蒂阴茎阴囊联合皮瓣治疗重度或复杂性尿道下裂

目的：探讨重度或复杂性尿道下裂新尿道取材途径。方法：在单一皮瓣不够的情况下彩肉膜蒂阴茎阴囊联合皮瓣作新尿道。结果：47例中术后尿瘘2例。尿道狭窄1例。并发症发生率6.4%，结论：重度或复杂性尿道下裂可采用肉膜蒂阴茎阴囊联合皮瓣作新尿道。     

联合包皮及阴囊带蒂皮瓣修复阴囊型尿道下裂

目的　总结带蒂岛状包皮瓣尿道成形术 (Duckett术 )加阴囊中隔带蒂皮瓣翻转尿道成形术 (中隔皮瓣术 )治疗阴囊型尿道下裂的体会。　方法　对 19例年龄 2～ 12岁 ,尿道缺损长度 5 .0～ 9.0cm的严重阴囊型尿道下裂患儿应用Duckett包皮瓣成形加阴囊中隔皮瓣成形手术方法修复 ,探讨手术应用、并发症预防及尿流改道方法的选择。　结果　 19例随访 6个月～ 4年 ,17例获一期治愈 ,2例并发尿瘘 ,无尿道狭窄并发症。　结论　联合手术方法治疗阴囊型尿道下裂效果满意 ,并发症少 ,双管法尿液引流充分 ,对尿道刺激小     

阴囊纵隔皮瓣代尿道治疗尿道下裂45例报告

目的 探讨带蒂阴囊纵隔皮瓣Ⅰ期修复尿道下裂的方法及并发症的防治。方法 对45例应用带蒂阴囊纵隔皮瓣Ⅰ期修复尿道下裂术式治疗的患的资料进行了分析。结果 45例一次手术治愈43例，2例术后并发尿瘘，1例尿道外口狭窄，手术成功率95％。结论 带蒂阴囊纵隔皮瓣血运丰富，成形尿道愈合力强，合并症少，尿道口能达正位，能Ⅰ期完成手术。     

肉膜瓣覆盖在尿道板纵切卷管尿道成形术中的应用

目的:探讨肉膜覆盖在尿道板纵切卷管尿道成形术(TIP)中预防尿瘘的应用。方法:140例尿道下裂患者均行TIP术式修复,其中85例远端型尿道下裂采用纵行腹外侧阴茎肉膜瓣覆盖新尿道;55例近端形尿道下裂采用阴囊前动脉带蒂肉膜瓣覆盖新尿道。结果:12例患者出现尿道皮肤瘘,其中远端型尿道下裂患者7例;近端型尿道下裂5例。结论:远端型选择腹外侧阴茎肉膜瓣覆盖,近端型选择阴囊前动脉带蒂肉膜瓣覆盖,较少出现尿瘘的并发症,是TIP术中较理想的覆盖方式。     

显微外科技术纵形带蒂岛状包皮瓣一期修复尿道下裂

目的 探讨显微外科技术纵形带蒂岛状包皮瓣修复尿道下裂的临床效果.方法 伴明显阴茎下弯的尿道下裂患者42例.年龄1～19岁,中位6.4岁.阴茎头冠状沟型6例、阴茎体型28例、阴茎阴囊型8例.4倍显微镜下采用纵形带蒂岛状包皮瓣术式33例,纵形带蒂岛状包皮瓣联合阴囊纵隔皮瓣成形9例.42例重建尿道平均3.6(2.5～6.0)cm. 结果 一次手术治愈38例(90.5%).术后出现尿瘘1例,行尿瘘修补治愈;尿道口狭窄2例,尿道吻合口狭窄1例,行尿道扩张后治愈.41例获随访9～52个月,平均27个月,患者均符合尿道下裂治愈标准. 结论 显微外科技术纵形带蒂岛状包皮瓣行一期尿道下裂修复手术成功率高,并发症少,值得临床推广.     

横行带蒂包皮瓣法与阴囊纵隔皮瓣法在一期修复尿道下裂中的疗效比较

目的对比评价横行带蒂包皮瓣法与阴囊纵隔皮瓣法在一期修复尿道下裂中的治疗效果。方法123例尿道下裂患者随机分为横行带蒂包皮瓣法组（63例）和阴囊纵隔皮瓣法组（60例），比较两组的手术时间、治愈率和术后并发症发生率。瞎呆横行带蒂包皮瓣法组平均手术时间多于阴囊纵隔皮瓣法组（P〈0.05）。随访1—14个月，横行带蒂包皮瓣法组治愈率高于阴囊纵隔皮瓣法组（P〈0.05），尿瘘的发生率较低（P〈0.05）。两组尿道狭窄发生率差别无统计学意义（P〉0.05）。结论横行带蒂包皮瓣法虽稍复杂，但是术后并发症发生率低。若包皮发育符合要求，可优先考虑采用横行带蒂包皮瓣法一期修复尿道下裂。     

阴囊筋膜血管网蒂皮瓣重建尿道

目的探讨阴囊肉膜下筋膜血管网蒂皮瓣重建尿道的方法。方法1998年3月～2004年8月对先天性尿道畸形患者8例及尿道下裂术后并发多孔尿瘘、尿道狭窄和阴茎弯曲畸形23例，采用阴囊肉膜下筋膜血管网蒂皮瓣修复缺损的尿道。年龄6～34岁，平均20．3岁，皮瓣宽度：儿童为1．5～2．5cm，成人为2．5～3．5cm，长度可为宽度的1．5～2倍。其中尿道下裂阴茎型9例；阴茎阴囊型10例；阴囊型7例，其中3例为儿童伴阴囊分裂，尿道开口于阴囊分裂沟中；会阴型5例，为男性假两性畸形。结果术后皮瓣均成活，切口愈合良好，Ⅰ期愈合24例，Ⅱ期愈合7例。仅1例拔除支架管后发生尿瘘，嘱患者排尿时按压瘘口，2周后闭合。27例获随访1～4年，2例术后1年阴茎稍下弯，其余患者阴茎形态及功能良好。结论应用阴囊肉膜下筋膜血管网蒂皮瓣重建缺损的尿道疗效满意，是一种修复尿道下裂术后并发症较理想的方法。     

阴囊正中带蒂皮瓣一期尿道下裂修复术120例

目的:探讨尿道下裂一期手术的有效方法及效果。方法:对120例尿道下裂患者行阴囊中隔皮瓣一期尿道下裂修复术。结果:120例阴囊正中带蒂皮瓣一期尿道下裂修复术近期成功109例,发生尿瘘8例,皮瓣坏死3例。103例随访1~20年,尿道口狭窄2例。结论:只要严格、认真地处理好每一环节,阴囊正中带蒂皮瓣一期尿道下裂修复术是治疗尿道下裂的一种简单易行、成功率较高的手术方法。     

联合应用包皮与阴囊独立皮瓣一期修复尿道下裂的探讨

目的：探讨阴囊及会阴型尿道下裂患者一期修复重建尿道的新术式。方法：联合应用包 阴囊两独立带蒂皮瓣施行尿道重建术一期修复阴囊及会阴型尿道下裂患者１３例。结果：１１例获得成功。２例术后出现尿瘘,其中１例经尿道扩张治疗。３周后尿瘘愈合,另１例行二期尿道成形术后尿瘘痊愈。结论：联合应用包皮与阴囊两独立皮瓣重建尿道的优势明显,更我的集中了目前治疗阴囊及会阴型尿道下裂众多术式的优点。获得满意疗效。     

远端筋膜蒂第一跖背动脉皮瓣修复躅趾皮肤缺损

目的探讨远端筋膜蒂第一跖背动脉皮瓣修复蹰趾皮肤缺损的临床效果。方法回顾性分析2008年10月～2013年10月采用远端筋膜蒂第一跖背动脉皮瓣修复躅趾皮肤缺损患者9例,供区行中厚皮片移植。结果9例患者均获得随访,随访时间平均6（3～12）个月。皮瓣全部成活,皮瓣颜色、质地、厚薄与受区皮肤相近。1例皮瓣少许皮肤坏死,经换药3周后Ⅱ期愈合。供区植皮均Ⅰ期愈合。两点辨别觉为6～13mm,患者行走正常,皮瓣及供区植皮处皮肤无破溃。患者对外观、功能满意。结论相较于传统第一跖背动脉皮瓣,远端筋膜蒂第一跖背动脉皮瓣血管蒂长,转移覆盖范围增大,皮瓣血供更有保障,供区影响小,术后外形良好,是修复躅趾皮肤缺损的一种较好的方法。     

Mathieu's urethroplasty in surgery for hypospadia postoperative complications

The aim of the study was to report the results of meatal based flap urethroplasty called Mathieu urethroplasty, in failed preliminary surgery for hypospadias. PATIENTS AND METHODS: Fourteen boys aged three to 14 years underwent surgery using a meatal-based flap urethroplasty for the correction of prior hypospadia repair complications. The secondary procedure was performed for glandular or coronal urethrocutaneous fistula in ten cases, completely failed urethroplasty in three cases, and for severe meatal retraction in one case. The surgical technique was the same as that used for the primary Mathieu procedures. RESULTS: Only one meatal retraction occurred; the other 13 cases had satisfactory procedure of hypospadias repair failures. Despite the scar skin used for secondary meatal based flap, good results can be achieved specially in two favorite indications: juxta coronal urethrocutaneous fistula and meatal retraction.     

Perineal subcutaneous dartos pedicled flap as a new technique for repairing urethrorectal fistula

PURPOSE: Urethrorectal fistulas are rare, and the etiology is usually traumatic or iatrogenic (postoperative). Several operative approaches and techniques have been used for fistulous repair but no procedure has proved to be the best or universally acceptable. We present a new technique for repairing urethrorectal fistulas. MATERIALS AND METHODS: We successfully treated 12 male patients 7 to 65 years old who presented with urethrorectal fistula from 1990 to 1997 using the perineal subcutaneous dartos pedicled flap procedure. Urethrorectal fistulas resulted from crush pelvic injury in 6 cases and gunshot in 2, and developed after prostatectomy in 4. The fistula was associated with urethral stricture in 4 cases. A perineal approach was used in all cases of urethrorectal fistula and combined with the transsymphyseal approach in the 4 patients with posterior urethral stricture. We interposed a subcutaneous dartos pedicled flap as a vascularized tissue flap between the repaired rectum and urethra. RESULTS: The results of our technique were excellent in all cases. No leakage or perineal collection developed and there was no fistula recurrence. In 1 patient urethral stricture was managed by visual internal urethrotomy. Loss of the internal and external sphincters resulted in urinary incontinence in 4 cases, involving gunshot injury (2), crush pelvic injury (1) and prostatectomy (1). Followup ranged from 9 to 42 months. CONCLUSIONS: Our technique of a perineal subcutaneous dartos pedicled flap fulfills all principles of the successful repair of urethrorectal fistula. We consider it to be an ideal solution to this urological dilemma.     

成人阴茎段尿道缺损的修复

目的 总结成人阴茎段尿道缺损的于术修复方法及阴囊中缝区皮瓣的临床应用。方法 2000年1月～2005年11月，对不同原因的阴茎段尿道缺损患者26例，年龄18～40岁。应用局部阴茎皮瓣再造缺损尿道，其中先天性阴茎型尿道下裂16例；外伤性阴茎中段尿道缺损6例。远段尿道缺损4例。外伤1～4年，曾行尿道造瘘术，反复尿道外口开大。应用以阴囊前、后动脉为蒂的阴囊中隔岛状皮瓣进行刚茎腹侧再造尿道表面创面的覆盖，皮瓣范围在阴囊中缝区宽2．5cm，长5．5cm内。结果 术后除4例患者并发感染而漏尿，术后2～4周内自行愈合外，其余患者伤口均Ⅰ期愈合。术后随访7个月～4年，阴茎无弯曲，排尿无异常。结论 应用阴茎局部皮瓣再造尿道及阴囊中缝区带蒂岛状皮瓣覆盖创面，是修复青春期后阴茎段尿道缺损一种良好的方法，下术操作简便，皮瓣血运可靠，修复后阴茎外形及功能均良好。     

颞肌筋膜瓣与全厚皮片移植修复下睑凹陷性畸形

目的 探讨颞筋膜瓣或颞肌筋膜瓣与自体全厚皮片移植，在下睑凹陷性瘢痕畸形修复中的应用效果。方法 设计以颞浅动脉为蒂的颞筋膜瓣，对伴眶下壁骨缺损者同时行以颞浅、深动脉为蒂的颞肌筋膜瓣，并取耳后全厚皮片移植联合矫正下睑凹陷性畸形。结果 8例患者，术后组织瓣及皮片成活良好，凹陷处填充效果满意。随访6个月至1年，睑外翻矫正，瘢痕不显，颞部供区毛发生长良好。结论 应用颞筋膜瓣或颞肌筋膜瓣与全厚皮片移植，联合矫正下睑凹陷性畸形的方法，具有操作简便。且无明显的供区损害的特点，是修复下睑凹陷性瘢痕畸形较理想的方法。     

Congenital penile curvature (chordee without hypospadias)

We treated 30 patients aged six months to nine years with congenital penile curvature from 1988 to 1993. Twenty-four patients appeared to have a primary curvature with normal corpus spongiosum. In 12 of these 24 patients dissecting skin and dartos fascia were adequate to straighten the penis. In the other 12 patients, artificial erection demonstrated a varied degree of convexity of the penis after the skin and dartos fascia release, implying a disproportion of the corpora cavernosa bodies. We corrected this deformity using dorsal tunica albuginea plications (TAP). The remaining 6 patients presented with a primary curvature and hypoplastic urethra. In 5 of these patients we divided the hypoplastic midportion of the urethra leaving the meatus naturally on the glans and replaced the midurethral segment using a tubularized island flap. Of these 5 patients 2 required TAP for penile straightening. The final patient with a hypoplastic urethra was managed by preserving the urethral plate and applying an onlay island flap urethroplasty. Complications were one fistula and two mild ventral penile curvatures, presently not severe enough for reoperation (mean follow-up 2.6 years). We present a systematic approach for the repair of congenital penile curvature using intraoperative artificial erection, TAP, and the island flap urethroplasty when needed.     

包皮带蒂皮瓣尿道成形术

目的 :探讨包皮带蒂皮瓣在修复小儿尿道下裂中应用价值及注意事项。　方法 :对我院近十年来首次应用包皮带蒂皮瓣修复之 31例阴茎型尿道下裂进行回顾性分析。　结果 :4例因术后感染而失败 ,其余均获成功 ,外形满意 ,治愈率 87 1%。　结论 :修复阴茎型尿道下裂应优先考虑充分应用包皮带蒂皮瓣 ,术后常规行膀胱造瘘 ,放置尿道支撑管     

尿道口周蒂阴囊纵隔皮瓣一期修复尿道下裂

目的 探讨应用异位尿道口周肉膜蒂阴囊纵隔皮瓣一期修复尿道下裂的可行性。方法 1998年以来应用上述方法一期修复尿道下裂31例。结果 28例痊愈，2例无尿瘘，1例尿道狭窄，阴茎阴囊角正常，阴茎伸展自如。结论 该皮瓣血运良好，用于一期治疗尿道下裂疗效确切，阴茎、阴囊间无相互牵扯，操作比较简单，值得推广应用。     

应用阴囊筋膜血管网皮瓣的尿道再修复

目的：探讨阴囊筋膜血管网皮瓣在尿道下裂再修复中的应用。方法：阴囊皮肤存在多源性血供系统，4组血管终末支相互吻合，形成完整的动脉环路在肉膜内走行，通过筋膜层滋养皮肤。基于此项解剖学基础，术中设计不含知名动脉的阴囊筋膜血管网皮瓣，用于修复原已采用阴囊纵隔皮瓣或其他轴型皮瓣进行尿道下裂矫治而失败的病例。结果：本组20例患者，阴茎型5例，阴茎阴囊型8例，阴囊型7例。除1例出现尿瘘，经处理后痊愈，19例尿道重建成功，效果满意。结论：应用阴囊筋膜血管网皮瓣重建尿道是尿道下裂再修复较为理想的方法。     

Bhat's modifications of Glassberg–Duckett repair to reduce complications in management severe hypospadias with curvature

ObjectiveDisadvantages of two-stage hypospadias repair are the necessity of 2 or 3 surgeries, loss of time/money, complications like splaying of the stream, dribbling of urine or ejaculate and milking of the ejaculate due to a poor-quality urethra. The current article details our modifications of flap repair allowing to manage such patients in one stage and reducing the complications.Subjects and methodsTwenty one patients (aged 2–23 years, between January 2006 and June 2012 mean 11.5 years) of severe hypospadias were managed with flap tube urethroplasty combined with TIP since June 2006 and June 2012. Curvature was corrected by penile de-gloving, mobilization of urethral plate/urethra with corpus spongiosum and transecting urethral plate at corona. Buck's fascia was dissected between the corporeal bodies and superficial corporotomies were done as required. Mobilized urethral plate was tubularized to reconstruct proximal urethra up to peno-scrotal junction and distal tube was reconstructed with raised inner preputial flap after measuring adequacy of skin width. Both neo-urethrae were anastomosed in elliptical shape and covered with spongiosum. Distal anastomosis was done 5–8 mm proximal to tip of glans preventing protrusion of skin on glans. Tubularized urethral plate was covered by spongioplasty. Skin tube was covered by dartos pedicle and fixed to corpora. Scrotoplasty was done in layers, covering the anastomosis.ResultsType of hypospadias was scrotal 10, perineo-scrotal 5, penoscrotal 4 and proximal penile in 2 cases. Chordee (severe 15 and moderate 6) correction was possible penile de-gloving with mobilization of urethral plate with spongiosum after dividing urethral plate at corona 8, next 5 cases required dissection of corporal bodies, superficial corporotomy 5 and 3 cases lateral dissection of Buck's fascia. Length of tubularized urethral plate varied from 3 to 5 cm and flap tube varied from 5.5 to 13 cm (average 7.5 cm). Complications were fistula 2, meatal stenosis 1, and dilated distal urethra1 with overall success rate of 81%. None of them had residual curvature, torsion, splaying or dribbling urine in follow up of 10–36 (average 18) months.ConclusionsTIPU with spongioplasty of proximal urethra and dartos cover on skin tube reconstructs functional urethra. Distal end skin sutured to glans mucosa 5–8 mm proximal to the tip of glans reconstructs a cosmetically normal looking meatus. An exact measurement of the width and length of the stretched dartos, fixation of the skin tube to the corpora and covering the skin tube with dartos helps in prevention of diverticula. Elliptical anastomosis covered with spongiosum prevents fistula and stricture at anastomotic site.