陰莖根部推進皮瓣重建陰莖陰囊角治療尿道下裂

[摘要] 目的 探討陰莖根部推進皮瓣重建陰莖陰囊角治療各型尿道下裂的療效及美觀性。 方法 2014年2月—2016年2月，方便收集篩選該院50例無合并癥患兒，采用陰莖根部推進皮瓣重建陰莖陰囊角治療尿道下裂中陰莖體型42例，陰莖陰囊型7例，會陰型1例。均采用Duckett術，重度尿道下裂（陰囊型、會陰型） 采用Duckett+Duplay治療。 結果 術后皮瓣血運良好，皮瓣色澤正常，無皮下血腫，無皮瓣壞死及切口感染。皮瓣全部存活，存活率達100%。6例尿瘺，無一例出現尿道狹窄及尿道憩室等并發癥，手術成功率達88%。隨訪6個月～2年，陰莖體挺立、皮瓣規整、外形美觀，家長滿意度高。結論 陰莖根部推進皮瓣重建陰莖陰囊角治療各型尿道下裂的療效滿意，并發癥少，美觀性佳，操作簡單，實用性強。

[關鍵詞] 尿道下裂；皮瓣；陰莖陰囊角

[中圖分類號] R726 [文獻標識碼] A [文章編號] 1674-0742（2016）12（c）-0091-03

[Abstract] Objective To evaluate different surgical procedures and aesthetic sense for hypospadias repair which is treated by promoteing the skin flap of penile base to reconstruct angle of the penile ang scrotum. Methods Convenient collect and filitrate 50 uncomplicated cases to adopt promoting the skin flap of penile base and reconstructing angle of the penis and scrotum for different hypospadias repair from February 2014 to February 2016. 42cases were penile hypospadias， 7cases were penoscrotal hypospadias，1cases was the perineum type hypospadias.Duckett ' s operation is recommended for all hypospadias. Duckett and Duplay' s operation is recommended for severe proximal hypospadias. Results Good blood supply for flap. Skin colour and lustre is normal. No subcutaneous hematoma.No flap necrosis and infection of incisional wound. Flaps all survived and survival rate was 100%.Urinary fistula was found for six cases.No complications about the postoprative stricture and diverticulum. The success rate for operations was 88%. The follow-up period ranged from six months to two years. Shaft of penis upright，flap neat，pleasant cosmetics， high degree of satisfaction. Conclusion Curative effect is satisfied for promoting the skin flap of penile base and reconstructing angle of the penis and scrotum for different hypospadias repair.low rate of complications ，pleasant cosmetics， simplicity of operator， Curative effect is satisfied.

[Key words] Hypospadias；Flap；Angle of the penis and scrotum

尿道下裂是男性泌尿生殖系統中常見的先天性畸形，在臨床中，常用的手術治療方法多種多樣，各有特色，但由手術所引發的并發癥也較多。近年來，臨床中采用陰莖根部推進皮瓣重建陰莖陰囊角治療各型尿道下裂效果顯著，為進一步探討其療效，現選取該院于2014年2月—2016年2月收治的50例患兒為研究對象，現總結報道如下。

1 資料與方法

1.1 一般資料

2014年2月—2016年2月，方便選取該組50例患兒，年齡1～12歲， 平均3.1歲，中位年齡1.5～4歲。由于陰莖下彎程度與尿道口位置不成比例[1]，根據術中尿道開口位置分型中陰莖體型（Ⅱ型）42例，陰莖陰囊型（Ⅲ型）7例，會陰型（Ⅳ型）1例[1]。均為第1次行Ⅰ期尿道成形術，篩選的患兒均未合并其它畸形。……