带血管蒂组织瓣覆盖技术在预防尿道下裂术后尿道瘘中的应用分析

目的：探讨带血管蒂组织瓣覆盖技术在预防尿道下裂术后尿道瘘中的应用方法及效果。方法：2000年1月至2012年1月共行273例尿道下裂手术，其中174例分别采用3种带血管蒂组织瓣覆盖技术覆盖新尿道，其中采用带蒂精索外筋膜瓣法82例，带蒂背侧皮下组织瓣法67例，带蒂睾丸鞘膜瓣法25例。对是否应用带血管蒂组织瓣覆盖尿道病例的I期治愈率、尿道瘘发生率等进行统计学分析。结果：与对照组相比，应用带血管蒂组织瓣覆盖尿道者，包皮岛状皮瓣尿道成形术I期治愈率由78．2％提高到95．1％（P〈O．01），尿道瘘发生率由21．8％降到3．7％；阴囊中隔皮瓣尿道成形术I期治愈率由83．3％提高到94．0％（P〈O．01），尿道瘘发生率由16．7％降到4．5％。膀胱粘膜尿道成形术I期治愈率由71．4％提高到88．0％（P〈O．01），尿道瘘发生率由28．6％降到4．0％。结论：应用带血管蒂组织瓣覆盖尿道能增加新建尿道及吻合口的组织覆盖面及厚度，提供良好的血供，有效地提高尿道下裂I期治愈率，减少术后尿道瘘的发生。

The Effect of Vascular Pedicle Fascia Technique in Prevention from Urethral Fistula after Hypospadias Repairing

Objective from urethral fistula after h ： To review the usage and effectiveness of vascular pedicle fascia in prevention ypospadias urethra plasty. Method： Hypospadias repair was performed on 273 ca- ses, among which 174 patients＇ new urethras were wrapped with three types of vascular pedicle fascias. In all the cases above, pediculate external spermatic fascia flap technique was used in 82, dorsal dartos flap technique in 67 and tunica vaginalis flap technique in 25. A statistical analysis was performed to compare cure rate and complication between the patients who received routine surgery of hyposadia repair and those who underwent surgery of covering urethras with vascular pedicle fascias. Result： After the surgery of cover- ing urethras with vascular pedicle fascia, the single stage success rate of prepuce island flap urethroplasty in- creased from 78.2% to 95.1% { P〈0.01 }. The incidence of urethral fistula decreased from 21.8% to 3. 7%. The success rate of scrotal dartos flap urethroplasty increased from 83.3% to 94.0% （ P〈0.01 ） , and the incidence of urethral fistula decreased from 16.7% to 4.5%. The cute rate of bladder mucosa grafting urethroplasty increased from 71.4% to 88.0% （ P〈0.01 ） while the incidence of urethral fistula decreased from 28.6% to 4.0%. Conclusion： Using vascular pedicle fascia flap to cover the urethra could enhance success rate effectively in one-stage hypospadias repair and minimize urethral fistula after operation.