应用阴囊中隔翻转-折叠-推进瓣I期修补阴茎阴囊交界处的巨大尿瘘

目的探讨应用阴囊中隔翻转一折叠一推进瓣I期再造尿道、防水层及被覆修补阴茎阴囊交界处巨大尿瘘的有效性。方法自2011年1月至2012年7月，共收治30例阴茎阴囊处巨大尿瘘患者，尿瘘大小为1．0～2．0em。术中切取阴囊中隔，并将此瓣分为3个区域，其中A瓣翻转形成尿道；B瓣去表皮形成筋膜瓣折叠覆盖于A瓣切口上，形成防水层；C瓣推进覆盖创面。结果30例患者术后随访6～12个月，均无尿道狭窄及尿瘘发生，再造尿道排尿通畅，阴茎伸直良好。术后皮瓣29例成活，均为I期愈合；1例C瓣因静脉回流较差，术后出现肿胀，皮瓣发黑，最终干性坏死，创面痂下愈合，严密观察至术后15d，排尿通畅，未见尿瘘形成；3个月后返院复查，C瓣区域瘢痕形成，自觉排尿可，无尿道狭窄。有2例患者自觉阴茎阴囊外形欠佳。结论应用阴囊中隔翻转一折叠一推进瓣I期修补阴茎阴囊交界处的巨大尿瘘，即应用一个筋膜皮瓣I期同时再造尿道、防水层及被覆，其方法简单可靠，供区破坏小，效果满意。

Application of modified scrotal-septal flap in repair of huge urethrocutaneous fistula at the penoscrotal junction

Objective To investigate a useful method for repairing a huge urethrocutaneous fistula （UCF） at the penoscrotal junction with modified scrotal-septal flap. Methods Thirty patients with huge UCF at the pe- noscrotal junction were treated from January 2011 to July 2012. A scrotal-septal flap was divided into three zones： A, B and C. Zone A was flipped over to form the urethra ; Zone B was folded over to cover the incision of Zone A to form waterproof layer; and Zone C was extend to cover the wound. Results All the patients were followed up for 6 to 12 months. Urination was smooth, and no fistula formation was observed. All scrotal-septal flaps survived except for one case with swelling and black flap because of the bad venous return which ended with dry necrosis. Three months later, there was scar formed in the Zone C with automatic urination and no urethral stricture. Two patients were unsatisfied with the appearance of penis and scrotum. Conclusion Use of a scrotal-septal overtur- ning, folding and advanced flap for primary repair of a huge UCF at the penoscrotal junction, namely one fascio- cutaneous flap was used to reconstruct the urethra, create a waterproof layer, and effectively cover the junction. The procedure is simple and reliable, results in minor damage to the donor site, and the results are satisfactory.