阴囊中缝带蒂皮瓣治疗尿道下裂的临床应用体会

目的 探讨带蒂阴囊中缝带蒂皮瓣转移覆盖技术在治疗尿道下裂病例多次手术后皮肤缺损中的适应证与疗效.方法 2014年2月至2015年1月,收集我院12例患儿,年龄5～15岁,平均8.4岁.均为外院多次尿道下裂术后失败患儿.为再次治疗入我院.所有患儿均接受口腔黏膜镶嵌尿道成形术一次完成手术.完成尿道重塑后,在阴囊皮肤血供解剖学的基础上,对于重度尿道下裂患儿经多次术后皮瓣遭严重破坏而不足的患儿,采用阴囊中缝皮瓣游离,转移覆盖于阴茎腹侧创面皮肤缺损处.结果 术后随访6～12个月,平均8.3个月,12例患儿全部获得随访,所有患儿皮瓣完全成活,无尿道瘘及尿道憩室,术后2周出现尿道狭窄1例.接受会阴尿道镜检查,确定为口腔黏膜与原尿道吻合口狭窄,扩张后治愈.长期随访患儿阴茎下弯矫正满意,尿道外口位于阴茎头正位,排尿通畅,无尿道瘘、尿道狭窄、尿道憩室等.阴茎及阴囊外观满意.结论 对于接受多次尿道下裂修补术后需要重新接受手术的患儿,由于多次手术对阴茎皮瓣破坏严重,再次行尿道下裂修补术时,我们选择游离带蒂阴囊中缝皮瓣覆盖新尿道,较传统上阴茎阴囊皮肤覆盖新尿道的张力较低,覆盖范围广并避免了皮肤的臃肿感.该手术方法简单,操作难度不高,成功率高,术后并发症少,外形美观,值得临床推广应用.

Efficacy of mid-scrotal fasciocutaneous flap for hypospadias repair

Objective To explore a novel way of hypospadias repair using mid-scrotal fasciocutaneous flap as a multifunctional coverage for priorly failed hypospadias repair.Methods From February 2014 to January 2015,12 cases of hypospadias were recruited.And their mean age was 8.4 (5-15) years.All their prior surgeries failed before.On the anatomic basis of scrotal skin blood supply,the mid-scrotal fasciocutaneous flap was liberated with a vascular fascia pedicle and transferred to vacancy in ventral penis.Results The mean follow-up period was 8.3 (6-12) months.There was no occurrence of diverticulum or urethral fistula.One case of urethral stricture under urethroscope was located at anastomotic stoma of buccal mucosa and original urethra at 2 weeks post-operation.And it was cured after dilatation.The long-term follow-up outcomes had no diverticulum,urethral fistula or stricture.All patients were satisfied with penile bending,urethral opening,voiding,penile appearance and scrotum.Conclusions For repeatedly operated patients,due to severe operative damage to flap in ventral penis,mid-scrotal fasciocutaneous flap is selected as a multifunctional coverage.Compared to ordinary ones,this method has the advantages of low tension,wider coverage and avoiding bloated feeling.It has decreased the hardness of redo surgeries.It deserves to be recommended because of its simplification,high rate of success,low rate of complications and pleasant cosmetics.