显微外科技术纵形带蒂岛状包皮瓣一期修复尿道下裂

目的 探讨显微外科技术纵形带蒂岛状包皮瓣修复尿道下裂的临床效果.方法 伴明显阴茎下弯的尿道下裂患者42例.年龄1～19岁,中位6.4岁.阴茎头冠状沟型6例、阴茎体型28例、阴茎阴囊型8例.4倍显微镜下采用纵形带蒂岛状包皮瓣术式33例,纵形带蒂岛状包皮瓣联合阴囊纵隔皮瓣成形9例.42例重建尿道平均3.6(2.5～6.0)cm. 结果 一次手术治愈38例(90.5%).术后出现尿瘘1例,行尿瘘修补治愈;尿道口狭窄2例,尿道吻合口狭窄1例,行尿道扩张后治愈.41例获随访9～52个月,平均27个月,患者均符合尿道下裂治愈标准. 结论 显微外科技术纵形带蒂岛状包皮瓣行一期尿道下裂修复手术成功率高,并发症少,值得临床推广.

One-stage urethroplasty for hypospadias by utilization of longitudinal preputial island flaps of dorsum penis and microsurgical technique

Objective To explore the effects of applying microsurgical technique in the one-stage urethroplasty for hypospadias with longitudinal preputial island flaps of dorsum penis. Methods Forty-two hypospadias cases with obvious phallocampsis were reviewed. The patients aged from 1 to 19 years (median, 6.4 years). Among them, 6 cases were of coronary suleus type, 28 cases of pe-nis body type, and 8 cases of penis and scrotum type. All patients went through the operative proce-dures by microscope with four-times magnification and microsurgical instruments. Longitudinal prepu-tial island flaps of dorsum penis was employed for the treatment of 33 cases of these patients, and 9 cases underwent longitudinal preputial island flaps of dorsum penis combined scrotal septal pedicle flaps. Results Thirty-eight cases were cured by one-time surgery (90.5%). One case with urethral fistula after operation was cured by surgical repair of urethral fistula. Two cases with urethral meatus stricture after operation and one with urethral stoma stricture were cured by dilatation. Patients were followed for 9 to 52 months (mean, 27 months). Conclusion Use of microsurgical technique with longitudinal preputial island flaps of dorsum penis in one-stage urethroplasty for hypospadias improved the success rate of surgery with few complications.