预置"尿道板"的分期手术治疗严重尿道下裂

目的 评价分期手术治疗严重尿道下裂的效果.方法 2001年12月至2009年8月治疗27例严重尿道下裂患儿,年龄8个月至17岁,平均4.3岁.近端型伴重度阴茎下弯23例,既往手术失败组织挛缩4例.Ⅰ期手术:完全脱套包皮,切除阴茎腹侧纤维束带或瘢痕组织,完全伸直阴茎,游离带蒂岛状包皮内板转移至腹侧填补缺损,预置"尿道板",包皮内板缺乏侧取下唇口腔黏膜皮瓣.术后6个月Ⅱ期手术:手术方式采用尿道板纵切卷管尿道成形术.4例皮瓣与尿道板连接处出现瘢痕愈合,予瘢痕切除,口腔黏膜镶嵌后卷管成形尿道.结果 27例患儿中,无尿道狭窄、皮瓣坏死等发生,4例术后尿瘘,6个月后再修补.结论 严重尿道下裂病例采用预置"尿道板"的分期手术,单次的手术操作简化,充分结合了传统尿道板卷管术式的优点,成功率高,整形效果好.

Two-stage repair in the surgical treatment of severe hypospadias

Objective To evaluate the efficacy of two-stage repair in the surgical treatment of severe hypospadias. Methods From December 2001 to August 2009,29 patients with severe hypospadias underwent two-stage repair. Of the 29 patients,24 patients with proximal hypospdias complicated with serious penile curvature, and the other 5 had a history of failed previous surgery. At the first stage,orthoplasty was performed and the prepuce was repositioned ventrally, then free oral mucosal graft preplaced urethral plate. The second stage surgery was performed 6 months later,and tubularization of the replaced urethral plate was performed. Four patients underwent healing scar excision and inlay oral mucosal graft urethroplasty. Results No urethra stricture or "preplaced urethral plate" atrophy was noted. Fistula developed in 4 of 29 cases. Conclusions Two-stage repair is effective for severe hypospadias. Preplaced urethral plate at the first stage presents good clinical outcomes.