不同术式一期正位开口修复先天性尿道下裂：附114例报告

总结１１４例不同手术方式一期修复各种类型尿道下裂的经验。本组中阴茎型３０例，阴茎阴囊型６３例，会阴型２１例。阴茎型尿道下裂宜采用包皮内板转移皮瓣尿道成形术。阴囊型根据缺损尿道长短采用阴囊纵带蒂皮瓣术或包皮内板阴囊纵隔联合皮瓣尿道成形术。会阴型采用包皮内板阴囊纵隔联合皮瓣术或膀胱粘膜尿道造成形术本组一期手术的成功率为８４．８％。     

尿道下裂矫治术20年经验（附354例报告）

报告１９７５年１２月～１９９５年手术治疗先天性尿道下裂３５４例经验。手术方法在各个阶段不同。１９７５～１９８４年早期，５１例新尿道开口在冠状沟附近，全部行耻骨上膀胱造瘘，尿道留置多孔硅胶管引流；１９８５～１９９５年近期的３０３例中２７９例采用改进的正位尿道口带蒂皮瓣尿道一期成形术。改进要点：（１）经会阴尿道造瘘及置放新尿道支架管，（２）矫正下曲时由阴茎背侧开始绕向腹侧分离，（３）阴茎头打孔器行正位尿道口成形，（４）采用弧形带蒂阴茎阴囊联合皮瓣及阴囊中隔Ｌ形皮瓣行重度尿道下裂尿道成形，（５）阴茎全程皮下隧道埋藏新尿道行尿道再修复。手术成功率由早期７６４％升至９００％，近期达９８２％（Ｐ＜００１）。认为改进术式合理有效。     

尿道下裂合并阴茎阴囊转位肉膜蒂皮瓣一期矫治(附38例报告)

目的 探讨尿道下裂合并阴茎阴囊转位一期手术矫正方法。方法 根据阴茎及阴囊皮肤分布情况，采用保留轴心血管的阴茎或阴囊内膜蒂皮瓣尿道成形技术，先矫正阴茎下曲及尿道成形，然后同期行阴茎阴囊转位矫正。尿转流及新尿道分泌物引流采用会阴尿道造瘘及新尿道U型支架管引流技术。结果 本组38例术后阴茎阴囊外形美观，无尿瘘及尿道狭窄。结论 尿道下裂合并阴茎阴囊转位一期手术矫正完全可行。     

应用显微外科技术修复尿道下裂

目的报道应用显微外科技术转移纵行带蒂阴茎背皮瓣及包皮内外板联合皮瓣一期修复尿道下裂的临床效果。方法根据阴茎背侧皮肤及包皮内外板的共同血供和解剖关系设计纵行联合带蒂矩形皮瓣。应用显微外科技术游离出血管蒂，并将皮瓣转移至阴茎腹侧与原尿道作显微吻合成新尿道修复尿道下裂21例。结果术后20例效果满意，阴茎外形良好，排尿功能正常，无并发症。1例发生术后尿瘘，经修补后治愈。远期效果均满意。结论应用显微外科技术转移纵行带蒂阴茎皮瓣及包皮内外板联合皮瓣是一期修复尿道下裂的有效方法之一。     

会阴型尿道下裂的矫形和尿道重建

目的 探讨采用分期手术治疗会阴型尿道下裂,行阴茎、阴囊矫形、重建缺损尿道的临床效果.方法 22例会阴型尿道下裂采用分期手术：一期手术将阴茎海绵体完全伸直,阴茎包皮内板和背侧皮肤预置于阴茎腹侧和阴囊裂缝凹陷处;二期手术重建阴茎尿道采用半环状阴茎皮岛＋半环状膀胱黏膜丛行侧面缝合形成阴茎尿道,阴囊尿道采用一期预置的组织丛行卷曲侧侧缝合重建阴囊尿道,在两尿道的接合点端端吻合,同时施行阴囊矫形.结果 22例会阴型尿道下裂矫形后几乎接近正常状态,重建阴茎尿道长度为4～9 cm,平均7 cm.手术的成功率为68%（15/22）,尿瘘发生率为32%（7/22）,5例（5/22）发生阴茎阴囊尿道交界处狭窄,经尿道扩张治疗后痊愈.结论 会阴型尿道下裂行分期手术治疗可以修复超过10 cm长的缺损尿道,而且完成手术以后外形形态较好.     

一期正位开口修复尿道下裂

自1991～1995年,我们采用包皮带蒂皮瓣和阴茎背侧纵行带蒂皮瓣一期正位开口治疗16例阴茎型和阴茎阴囊型尿道下裂,取得较为满意的疗效,现介绍如下。1　资料与方法1.1　一般资料本组16例,年龄3～12岁,平均4.6岁。阴茎型尿道下裂9例,阴茎阴囊型7例。1.2　手术方法阴茎伸直:距冠状沟0.5cm作包皮内板环形切开,直达阴茎海绵体白膜。阴茎腹侧正中纵行切口,自冠状沟切口至原尿道外口,彻底切除阴茎腹侧及尿道口周围纤维组织。人工勃起方法检验阴茎伸直效果,并测量尿道缺损长度。尿道成形:首先测量包皮皮肤,如可达到形成新尿道的宽度及长度,即采用Duc…     

带蒂包皮双面皮瓣治疗小儿尿道下裂

目的 探讨带蒂包皮双面皮瓣尿道成形术(PPDIF)治疗小儿尿道下裂的适用范围和疗效.方法 尿道下裂患儿99例.年龄4个月～12岁,平均5.1岁.按Barcat分型:阴茎体型56例、阴茎阴囊型24例、阴囊型13例、会阴型6例.在Duckett术基础上,保留部分包皮外板皮肤连同成形尿道转移至腹侧,覆盖新生尿道. 结果 99例随访2年.术后发生尿瘘8例(8.1%)、尿道狭窄1例(1.0%)、皮瓣坏死1例(1.0%).手术总成功率89.9%(89/99).其中单纯应用PPDIF修复阴茎体型或阴茎阴囊型尿道下裂成功率91.2%(73/80),联合尿道口周围皮瓣(Duplay)术修复阴囊型或会阴型尿道下裂为84.2%(16/19). 结论 PPDIF适用于大多数小儿尿道下裂的治疗,术后外形美观.重度尿道下裂患儿联合Duplay矫正疗效肯定.     

阴茎背侧纵形带蒂皮瓣修复小儿尿道下裂38例临床分析

目的 总结阴茎背侧纵形带蒂皮瓣Ⅰ期修复小儿尿道下裂的经验.方法 1998年9月～2008年8月,对38例尿道下裂患儿采用阴茎背侧纵形带蒂皮瓣进行Ⅰ期修复手术,年龄2～12岁,平均（5.2±2.8）岁.其中阴茎型30例,阴茎阴囊型6例,阴囊型2例.结果 38例转移皮瓣全部成活,Ⅰ期治愈32例,治愈率84.2% 出现尿道瘘6例,其中1例为尿道外口狭窄并尿道憩室、吻合口瘘.出现并发症的6例患者中,阴茎型3例（10.00%）,阴茎阴囊型1例（16.67%）.会阴型2例（100.00%）.随访3～6月,阴茎外观满意,尿道开口正位,排尿功能良好.结论 阴茎背侧纵形带蒂皮瓣治疗小儿尿道下裂,手术设计合理,并发症少,术后阴茎外形美观,不臃肿,无扭转,是治疗阴茎型小儿尿道下裂较理想的手术方式.     

“?”形阴茎阴囊联合皮瓣一期修复重度尿道下裂

我院从1987年1月起采用自行设计“?”形阴茎阴囊带蒂转移皮瓣一期惨复阴茎阴囊型、阴囊型、会阴型尿道下裂共5例,效果满意,介绍如下。一、手术方法 1.早期做耻骨上膀胱穿刺造瘘,近期选用F_(8～10)硅胶管自尿道外口置入膀胱,作为新成形尿道的支架管并引流尿液。 2.矫正阴茎下曲:沿冠状沟下3mm处做环形切口,于阴茎腹侧正中向下绕过尿道外口,逐层切开达阴茎海绵体的白膜表面,彻底切除腹侧纤维索条,使阴茎充分伸直(附图1)。     

带蒂阴茎、阴囊纵隔联合皮瓣正位尿道开口Ⅰ期尿道下裂成形术

目的 :探讨带蒂阴茎、阴囊纵隔联合皮瓣正位尿道开口Ⅰ期尿道下裂成形术的临床应用。　方法 :对 14 9例不同类型尿道下裂病人分别行带蒂阴茎、阴囊纵隔联合皮瓣正位尿道开口Ⅰ期成形术 ,并改进了引流形式。　结果 :一次排尿成功 12 2例 ,出现漏尿、包皮水肿 2 7例 ,其中尿道皮肤瘘 3例。　结论 :该手术方式适用于严重阴茎头型、阴茎型、轻度阴囊型的尿道下裂。该术式操作简单 ,易于掌握 ,但应注意术后感染的预防及引流管的护理     

Combined buccal mucosa graft and local flap for urethral reconstruction in various forms of hyposapdias

PURPOSE: Hypospadias is one of the most common congenital deformities in the male urogenital system. Although there are more than 250 techniques for treating hypospadias, it is often difficult to repair severe hypospadias using conventional methods. MATERIALS AND METHODS: We combined a buccal mucosa graft with a local onlay flap for urethral reconstruction in cases of severe hypospadias or a failed previous operation. A total of 162 patients with hypospadias (glandular 11, penile 40, penoscrotal 49, scrotal 34 and perineal 28) were treated between July 2000 and November 2003. For patients whose urethral meatus was perineal 2 treatment steps were taken. First, we used the aforementioned method to construct the penile urethra, and then we constructed the scrotal and perineal urethra with a local flap. RESULTS: Of the 134 nonperineal cases 127 were managed successfully in 1 stage, and 26 of 28 perineal cases were managed successfully in 2 stages. Most patients had a satisfactory penile appearance. A urethral fistula resulted in 8 cases, of which 4 closed spontaneously within 1 month postoperatively. Meatal stenosis occurred in 1 case. CONCLUSIONS: This technique is simple, safe and reliable, especially in cases of failed previous operation or for salvage hypospadias repair with deficient local tissue.     

纵行带蒂岛状包皮瓣治疗尿道下裂44例报告

目的:总结近4年来应用纵行带蒂岛状包皮瓣一期尿道成形术治疗尿道下裂的临床经验,并评价其疗效.方法:本组44例患者中,阴茎型尿道下裂34例,阴茎阴囊型尿道下裂10例.均采用纵行带蒂岛状包皮瓣一期尿道成形术,平均重建尿道长度2.8 cm.结果:一期手术成功率90.9%(40/44例),尿瘘9.1%(4/44例).所有患者术后1个月复查1次,随访3个月以上,阴茎外观及排尿均良好.结论:纵行带蒂岛状包皮瓣一期尿道成形术对伴有阴茎下曲、尿道板发育不好的阴茎型及阴茎阴囊型尿道下裂患者治疗效果良好,并发症少.     

袖状蒂岛状环形包皮瓣尿道成形术一期修复会阴型尿道下裂

目的 探讨袖状蒂岛状环形包皮瓣尿道成形术一期修复会阴型尿道下裂的临床效果.方法 距冠状沟0.5 cm处环形切开包皮内板和尿道板,脱套以纠正阴茎下曲.沿尿道板两侧平行切开,近端绕尿道口后会合,呈U形,远端环绕包皮到背侧,使新尿道皮瓣呈环状.解剖供应皮瓣的深层皮下组织与阴茎皮肤,形成血管蒂.经纽扣样孔隙,转移环状皮瓣至腹侧.缝合岛状环形皮瓣的内、外缘,形成新尿道.术后尿液转流时间10～14 d,平均12.8 d.结果 1997年以来,于临床应用22例,一期手术成功18例(81.8%),尿瘘4例,均位于阴茎阴囊交界近端,其中伴尿道外口狭窄1例,经尿道扩张后治愈,另3例经再次修补后愈合.新尿道长度为3.50～18.00 cm,平均4.93 cm.术后随访6个月以上,外观的满意度为72.7%(16/22).结论 袖状蒂岛状环形包皮瓣具有血供丰富、尿道成形材料天然的优点,能一期纠正阴茎弯曲和尿道成形,特别适用于伴有阴茎严重弯曲或阴茎阴囊转位和阴囊分裂的会阴型尿道下裂患者.     

Folding and everting distal end of graft flap to reduce orifice stenosis following onlay urethroplasty

Aim: Orifice stenosis remained to be a common complication of hypospadias repair. We had modified the preputial island flap urethroplasty by folding and everting the distal end of the pedicle graft flap to prevent the neo-orifice from stenosis. Methods: Sixteen patients had undergone hypospadias repair using a modified onlay island flap technique. A urethral catheter was retained for 8 days to 10 days after operation. Results: Satisfactory results were seen in all the patients with a cosmetically fine appearance. One patient had a urinary tract infection and another,urethrocutaneous fistula and both were amply treated. No glanular adhesion or stenosis occurred. A long-term follow up of 6 months to 4 years (mean: 2 years) in 15 patients did not find any complication. Conclusion: The modified preputial island flap urethroplasty technique is an easy, reliable and effective approach to reduce orifice stenosis in hypospadias repair. ( Asian J Androl 2003 Jun; 5:159-161 )     

Hypospadias repair in an outpatient setting without proximal urinary diversion: experience with 113 urethroplasties

A total of 113 consecutive patients underwent surgical repair of hypospadias. None had previously undergone a repair procedure. The median age of the patients at the time of surgery was 24 months (range, 5 months to 13 years). A meatal-based flap modified Mathieu technique was used in 48 children and a single- or double-faced transverse preputial island flap was used in 58 children. Urinary diversion was not performed. A 7F silicone rubber urethral stent with multiple perforations that drained freely was used in all cases. The stent was left indwelling for 7 days after meatal-based flap repairs and for 12 days preputial island flap repairs. Seventy-nine patients (70%) were discharged from the hospital the day of the operation. The results were cosmetically satisfactory in all cases. A total of 23 patients developed complications. Sixteen (14%) developed a urethrocutaneous fistula, 2 developed a stricture (1.7%), and 5 developed a urethral diverticulum (4.5%). There were no fistulas and only one stricture in the meatal based flap repairs. For 20 patients who suffered complications, a single outpatient surgical procedure corrected the problem. The remaining 3 patients required more than two surgical procedures. All complications were resolved within 12 months of the hypospadias repair.     

尿道口前移-龟头成形术与尿道延伸术联合治疗尿道下裂

目的 探索一种治疗伴有严重阴茎下弯的冠状沟或冠状沟下型尿道下裂的新方法。方法 尿道口前移-龟头成形术与尿道延伸术联合治疗有严重阴茎下弯的冠状沟或冠状沟下型尿道下裂。在术中切除阴茎腹侧的纤维索带后，如阴茎下弯仍无法矫正，同时尿道海绵体发育好，则采用部分尿道海绵体游离延伸的方法使阴茎下弯得到矫正。结果 19例患儿，手术一期完成，均获成功。结论 尿道口前移．龟头成形术与尿道延伸术联合是一种治疗伴有严重阴茎下弯的冠状沟或冠状沟下型尿道下裂的有效的手术方式。     

改良Mitchell术式修复尿道上裂

目的 探讨治疗尿道上裂的新方法。方法 在Mitchell术式基础上采用肉膜蒂阴茎或阴囊中隔皮瓣尿道成形,经会阴部尿道“U”形支架管引流。结果 6例全部一次矫正成功,尿道正位开口,阴茎外观满意。结论 改良术式效果确实,成功率高。     

Severe hypospadias repair with meatal based paracoronal skin flap: the modified Koyanagi repair

PURPOSE: Various techniques have been reported to repair severe hypospadias. The Koyanagi repair uses a meatal based foreskin flap. We modified this procedure and reviewed the outcome of the repair of severe hypospadias. MATERIALS AND METHODS: The modified Koyanagi repair was performed in 151 children 7 months to 15 years old (mean age 3 years) with severe hypospadias. The records of these patients were reviewed. In all cases the meatus was at or proximal to the penoscrotal junction. Followup was 6 months to 16 years (mean 6 years). Flap design is the same as in the Koyanagi repair, although our modified technique requires removal of the subcutaneous tissue of the distal portion of the flap, which acts as a full-thickness free skin graft. RESULTS: A fistula developed in 19 patients (12.6%), meatal stenosis in 3 (2%) required meatoplasty and infection in 2 (1.3%) resulted in a regressed meatal position. Good cosmetic results were achieved in all except the latter 2 cases. CONCLUSIONS: Our modified Koyanagi repair affords an excellent cosmetic appearance. The complication rate is relatively low and compares favorably with that of other techniques.     

额肌筋膜复合体弓状悬吊治疗重度上睑下垂

目的 寻求更佳的治疗重度上睑下垂的手术方法。方法 在手术治疗上睑下垂时，通过制作出完整的额肌、皱眉肌、眼轮匝肌及SMAS复合体，弓形下移悬吊纠正上睑下垂，治疗47例患者，观察近、远期效果。结果 应用额肌筋膜复合体悬吊治疗上睑下垂47例54只眼，术后3个月内有不同程度闭合不全，后逐步好转，6个月闭合自然，外形美观，无复发现象。结论 该方法是一种可靠的治疗上睑下垂的方法，较传统方法更具优越性。     

Experience with single stage hypospadias reconstruction

Our experience with single stage primary hypospadias repair in 96 patients over a 12-month period is reviewed. The ages ranged from 7 months to 14 years with an average of 3.5 years. Seventeen patients were 18 months or younger at the time of operation. Meatal advancement and glanuloplasty (MAGPI) was performed in 46 patients mainly with coronal and glanular hypospadias. There was a fistula rate of 4%. The modified Mathieu and Mustarde operations were used for subcoronal and distal hypospadias. The transverse preputial island flap technique was found to be very versatile and was employed in 33 patients. The fistula rate was 18% and proximal urethral stricture rate 9%. These complication rates are considered quite acceptable in busy centers where surgeons in training are involved in these operations. It is concluded that by mastering a relatively limited number of techniques, single stage hypospadias reconstruction can be undertaken in almost all cases at the optimal time.