论文部分内容阅读
目的介绍一种Snodgrass尿道下裂修复中新尿道覆盖方法,并对应用结果进行评估。方法2003年4月至2006年2月收治尿道下裂患儿289例。年龄3个月～12岁,平均2．4岁。其中冠状沟型78例、阴茎体型136例、阴茎阴囊型36例、阴囊型16例、Ⅱ期手术和再手术23例。均应用自阴茎体两侧分别游离的血管蒂肉膜瓣皮下组织对Snodgrass法修复的新尿道进行交替覆盖。结果289例患儿随访3～24个月,术后出现尿瘘32例(11%),其中11例术后4周内自行愈合,实际尿瘘发生率为7%(21/289)。21例未愈尿瘘中,远端型尿道下裂(冠状沟和阴茎体型)的尿瘘发生率为5%(11/214),近端型(阴茎阴囊型和阴囊型)、Ⅱ期手术和前次手术失败再次手术者为13%(10/ 75)。无伤口裂开或尿道憩室病例,结合黏膜领技术可以在腹侧正中线上原位缝合阴茎皮肤。术后能获包皮环切术样满意外观者277例。结论阴茎两侧肉膜组织双层覆盖新尿道是一种防止尿瘘和伤口裂开的可靠方法,并能有效重建类似正常阴茎外观。
Objective To introduce a new method of urethral coverage in the repair of Snodgrass hypospadias, and to evaluate the application results. Methods From April 2003 to February 2006, 289 children with hypospadias were treated. Aged 3 months to 12 years old, average 2.4 years old. There were 78 cases of coronal type, 136 cases of penis size, 36 cases of penis scrotum, 16 cases of scrotum, 23 cases of stage Ⅱ operation and reoperation. The new urethra repaired by Snodgrass method were covered alternately with subcutaneous tissue of the flap pedicel flap which was free from both sides of the penis. Results 289 children were followed up for 3-24 months. 32 cases (11%) had fistula after operation. Among them, 11 cases self-healed within 4 weeks after operation. The actual incidence of urinary fistula was 7% (21/289). Among 21 untreated urinary fistulas, the incidence of urinary fistula was 5% (11/214) for distal hypospadias (coronal and penis), proximal (penis scrotum and scrotum), and stage Ⅱ surgery The number of failed surgeries was 13% (10/75). No wound dehiscence or urethral diverticulum cases, combined with mucosal collar technology can be in the ventral midline suture the penile skin. Postoperative circumcision can get satisfactory appearance in 277 cases. Conclusions The double urethra of mesentery tissue on both sides of the penis is a reliable method of preventing urinary fistula and wound rupture and can effectively reconstruct similar normal penile appearance.