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目的探讨采用横形包皮岛状皮瓣管状尿道成形术一期修复阴茎中段型尿道下裂的方法及临床效果。方法对自2010年1月至2014年12月收治的46例男性先天性阴茎中段型尿道下裂患者,行阴茎矫直、横形包皮岛状皮瓣管状尿道法一期尿道再造术。术中保护尿道口近端区域的肉膜组织,形成尿道口周蒂肉膜瓣;翻转肉膜瓣、覆盖尿道吻合口并固定,将皮瓣转移覆盖至阴茎腹侧的皮肤缺损。结果所有患者术后随访5~36个月,仅发现1例吻合口尿道瘘,1例阴茎腹侧部分皮肤血运欠佳而致切口瘢痕愈合,但无尿瘘发生,其余患者均愈合良好,无尿道裂开、皮瓣坏死、感染、尿道(口)狭窄、尿道憩室等并发症发生。结论采用横形包皮岛状皮瓣管状尿道成形术一期尿道再造治疗阴茎中段型尿道下裂,并采用尿道口周蒂肉膜瓣覆盖吻合口,是一种简单且可有效预防其吻合口尿瘘发生的较好方法。
Objective To investigate the method and clinical effect of using transverse circumcision island flap urethroplasty to repair the middle type of hypospadias. Methods From January 2010 to December 2014, 46 cases of congenital subcutaneous hypospadias were treated with penile straightening and transverse preputial island flap urethral catheterization. Intraoperative protection of the proximal urethra area of the tissue membrane, the formation of periostitis pedicle flap; flip flap, urethral anastomosis covered and fixed, the flap transferred to cover the penile ventral skin defects. Results All patients were followed up for 5 to 36 months. Only one case of anastomotic urethral fistula was found. One case of the ventral part of the penis did not have good blood supply and caused scar incision healing. However, no case of urinary fistula was found, and the rest of the cases healed well. Urethral open, flap necrosis, infection, urethral (mouth) stenosis, urethral diverticula and other complications. Conclusions The first-stage urethroplasty of transverse circumcised island skin flap urethroplasty is a simple and effective method to prevent the occurrence of urinary fistula The better way.