CAJ | 학술논문

目的探讨长隧道带蒂包皮内板尿道成形术治疗阴茎体型尿道下裂的疗效. 方法 2007年9月至2010年4月收治阴茎体型尿道下裂患儿28例,年龄1.5 ～6.0岁,平均2.0岁.均行长隧道带蒂包皮内板尿道成形术.尿道开口均位于阴茎体部,距离阴茎头顶端16 ～ 37 mm,平均25immn;分离尿道及纠正阴茎下曲后尿道缺损30 ～ 42 mm,平均38 mm.手术要点:沿尿道开口环形切开阴茎皮肤,分离至尿道板,横断尿道板,沿尿道板与海绵体之间分离隧道至阴茎头正中,隧道长度26～38 mm,平均33 mm.尿道开口至阴茎头之间全程由隧道贯通,尽量保持阴茎腹侧皮肤与组织完整,取带蒂包皮内板制作新尿道,将新尿道通过阴茎侧方深筋膜下通道转移至腹侧隧道进行吻合.术中人工勃起试验证实合并轻度阴茎下曲13例,无明显阴茎下曲15例. 结果 28例均一期修复成功,手术时间50～70 min,平均55min.随访时间6～31个月,平均20个月.28例患儿均排尿通畅,尿线粗直.尿道呈矢状开口于阴茎头正中,阴茎下曲纠正满意,外观好,未发生尿瘘或狭窄. 结论长隧道带蒂包皮内板尿道成形术适用于无或合并轻度阴茎下曲的阴茎体型尿道下裂,尤其适合年龄小或阴茎体细小患儿,手术简单,效果好,外观满意.
목적 탐토장수도대체포피내판뇨도성형술치료음경체형뇨도하렬적료효. 방법 2007년9월지2010년4월수치음경체형뇨도하렬환인28례,년령1.5 ～6.0세,평균2.0세.균행장수도대체포피내판뇨도성형술.뇨도개구균위우음경체부,거리음경두정단16 ～ 37 mm,평균25immn;분리뇨도급규정음경하곡후뇨도결손30 ～ 42 mm,평균38 mm.수술요점:연뇨도개구배형절개음경피부,분리지뇨도판,횡단뇨도판,연뇨도판여해면체지간분리수도지음경두정중,수도장도26～38 mm,평균33 mm.뇨도개구지음경두지간전정유수도관통,진량보지음경복측피부여조직완정,취대체포피내판제작신뇨도,장신뇨도통과음경측방심근막하통도전이지복측수도진행문합.술중인공발기시험증실합병경도음경하곡13례,무명현음경하곡15례. 결과 28례균일기수복성공,수술시간50～70 min,평균55min.수방시간6～31개월,평균20개월.28례환인균배뇨통창,뇨선조직.뇨도정시상개구우음경두정중,음경하곡규정만의,외관호,미발생뇨루혹협착. 결론 장수도대체포피내판뇨도성형술괄용우무혹합병경도음경하곡적음경체형뇨도하렬,우기괄합년령소혹음경체세소환인,수술간단,효과호,외관만의.
Objective To investigate the indications and results of long channel technique with pedicle inner preputial flap urethroplasty for middle hypospadias repair. Methods During September 2007 to April 2010,28 cases of middle hypospadias were include in this study.The average age was 2.0 years (1.5 -6.0 years).The orifice of urethra was opened in the shaft of penis,and the distance between the urethral meatus and the center of glans was 25 mm ( 16 - 37 mm).A pars-meatus skin incision was made,which was dissected deep to the urethral plate.The urethral plate was transected,and a long channel between the urethral plate and the corpora cavernosa was created.The neourethra was made from the inner prepuce,and transposed to the ventral tunnel through a tunnel between buck's fascia and albuginea of ventrolateral corpora cavernosa.The neourethra was anastomosed with the proximal urethra.The buck's and dartos fascia along the skin incision were brought together and sutured individually,covering the proximal neo-urethra and the anastomosis.Induced penile erection confirmed that 13 cases were with mild penile curvature,and the other 15 case were without penile curvature.The average length of the defected urethra and tunnel was 38 mm (30 -42 mm) and 33 mm (26 -38 mm). Results Success was achieved in all cases without fistula or urethral stricture formation with the average follow-up of 20 months (6 -31 months),and penile curvature was completely corrected.The urethra was opened in the apex of the glans with normal-looking circumcised penis. Conclusions Long channel technique with pedicle inner preputial flap urethroplasty can provide another option for repairing middle hypospadias without penile curvature or with mild penile curvature,especially for young children and those with small penis.This technique is simple,and the result is satisfied.