睾丸鞘膜瓣在尿道修复中的应用

目的探讨睾丸鞘膜瓣覆盖技术在尿道畸形和尿道瘘修复中的效果。方法2002年起对38例尿道下裂手术和术后尿道瘘,采用睾丸鞘膜下组织蒂鞘膜瓣覆盖修复。结果术后随访半年至1年,除1例尿道上裂术后瘘修复后再次发生尿道瘘外,其余均获成功,未再出现尿道瘘或尿道狭窄,阴茎外观满意,勃起正常。结论采用该方法可有效防止尿瘘再发生,提高手术成功率且易于获取,对睾丸无不良影响。     

一期正位尿道下裂修复术：附342例报告

总结１９８６年７月～１９９５年１０月行一期正位尿道下裂修复术３４２例，手术成功率９５．６％。其中阴茎型１５６例，阴茎阴囊型１０２例，阴囊型６８例，会阴型１６例。采用阴囊纵隔血管蒂皮瓣成形尿道加阴茎头腹侧高位Ｖ形切口，将成形尿道口做到阴茎头顶端，对１８４例病人采用保留导尿替代传统的尿液转流。本法最适宜治疗阴茎型和阴茎阴囊型尿道下裂。由于皮瓣血供良好，皮管翻转固定后，其缝合面紧贴阴茎海绵体腹侧，极少发生尿瘘及尿道狭窄等术后常见并发症。     

双皮瓣法尿道成形术治疗尿道下裂28例

目的：总结双皮瓣法尿道成形一期手术治疗先天性尿道下裂的体会。方法：对28例1—12岁，尿道缺损长度2—7cm的患儿用双皮瓣法行尿道成形一期矫治，探讨手术要点及并发症的预防。结果：术后3例发生尿道外口狭窄，经尿道扩张治愈，无尿瘘发生。均一期治愈。所有病例术后随访0．5—7年，恢复良好。结论：该方法成功率高，适用于各种不同类型的尿道下裂，明显减少了多次手术的痛苦。     

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.     

阴囊前外侧岛状皮瓣再造尿道的解剖学研究及临床应用

目的 为阴囊前外侧岛状皮瓣的设计提供解剖学基础。方法 对20具成人男尸采用少量氨水经股动脉冲洗后，灌注红色乳胶逐段解剖阴部外动脉及其分支。结果 阴囊前外侧皮瓣的血供来自阴囊前动脉，阴囊前动脉的发起点恒定，血供范围大，故该皮瓣有充足的营养及较大的范围，也便于皮瓣的松解和转移。结论 利用此皮瓣重建尿道，适用于阴茎型尿道下裂病例。     

The association between caudal block and urethroplasty complications of distal tubularized incised plate repair: experience from a South China National Children’s Medical Center

BackgroundThe effect of caudal block (CB) on the incidence of urethroplasty complications in hypospadias repair remains controversial. The evidence is conflicting, and some confounding bias issues need to be addressed. We sought to study a more homogenous group of distal hypospadias patients undergoing primary tubularized incised plate (TIP) repair by a senior pediatric urology surgeon in the past 2 years to examine the relationship between urethroplasty complications and the use of CB.MethodsWe reviewed our database to identify consecutive patients who had undergone hypospadias repairs by a senior director surgeon at our Center between January 2018 and November 2020. To be eligible to participate in the study, patients had to meet the following inclusion criteria: (I) have distal hypospadias; (II) have undergone a primary TIP repair; and (III) have attended follow-up appointments for a minimum period of 6 months. The primary outcome was the development of urethroplasty complications during the follow-up period. The principal variable of interest was whether or not CB was used perioperatively. The patients were categorized into a CB group (general anesthesia combined with CB) or a control group (general anesthesia only). Other potential risk factors were analyzed, including patient age at operation, patient weight, glans width, and the length of the urethral plate defect.ResultsThirty (12.2%) of the distal patients developed postoperative surgical complications. The postoperative surgical complication rates were similar between the different anesthesia groups. Weight, the length of the urethral plate length, and glans width did not contribute to the risk. Age was the only independent risk factor for postoperative surgical complications, and the complication rates increased in older patients.ConclusionsOur data from consecutive TIP repairs in distal hypospadias patients indicated no association between the use of CB anesthesia and the postoperative urethroplasty complication rate. Patients who were older in age when they underwent surgery had a higher risk of complications.     

女孩尿道下裂的诊断和治疗(附5例报告)

探讨女孩尿道下裂的病因,临床症状,诊断和治疗。方法：1990－1997年收治5例女孩尿道下裂,Ⅰ型1例,Ⅱ例1例,Ⅲ3例,Ⅰ型行Leadbetter术＋双侧输尿管膀胱再植及锥状肌膀胱颈悬吊术;Ⅱ型行胃膀胱扩大,双侧输尿管胃膀胱再植,锥状肌膀胱颈悬吊及劈耻骨尿道紧缩术;Ⅲ型行阴道前壁粘膜尿道成形和膀胱颈折叠术。结果：Ⅰ型1例排尿满意;Ⅱ型1例排尿好转;Ⅲ型3例控尿正常,临床症状消失。结论：女孩尿道下裂不同分型宜采用不同的手术方法。     

Belt-Fuqua operation for penile hypospadias repair

Between 1983 and 1993, 41 patients underwent a first-stage Belt-Fuqua operation for penile hypospadias repair and 39 completed the second stage. Minor complications were observed after the first stage. The primary success rate following the second stage was 82%. Major complications noted after the second stage consisted mainly of fistula formation. The surgical technique is described and alternative methods are discussed.     

先天性尿道下裂患者SRY基因的检测

对４２例先天性尿道下裂患者外周血白细胞,采取ＰＣＲ方法,进行ＳＲＹ基因的检测。结果发现２例先天性尿道下裂患者ＳＲＹ基因缺失。我们认为先天性尿道下裂是一种性别发育异常综合症。尿道的缺失只是其性腺发育不全的表现之一;ＳＲＹ砂是决定性别的基因,ＳＲＹ基因的缺失或突变可能导致性发育一系列异常改变,ＳＲＹ基因是性别的主导基因。