CAJ | 학술논문

目的：探讨“前型”尿道下裂手术在“口腔粘膜”重建尿道、去皮肤的肉膜覆盖成形尿道等各操作步骤的要点．方法将40例“前型”尿道下裂患者中有阴茎下弯的纠正后，然后所有患者用口腔粘膜移植于阴茎腹侧前三分之一处白膜表面，固定，增加尿道的宽度，选择适宜大小的尿管后成形尿道．阴茎背侧皮肤转移至阴茎腹侧，将带蒂皮瓣去皮肤后，保留皮下肉膜层，完整的加盖于尿道卷管成形处（包括阴茎龟头海绵体切开两冀下方），再成形龟头．结果40例“前型”尿道下裂成形术中，无1例出现尿道狭窄，术后2月行输尿管镜检示：“移植的口腔粘膜均存活”，且位于阴茎龟头海绵体切开两冀下方加盖的皮下肉膜层粘连满意，未见龟头切口处裂开．有2例发生尿瘘，均术后半年行尿瘘修补术成功．1例转移皮瓣坏死，换药后愈合．术后40例患者阴茎外观均满意．结论遵循“前型”尿道下裂各步骤操作的要点，手术成功率明显提高，整形效果好，术后并发症明显减少．
목적：탐토“전형”뇨도하렬수술재“구강점막”중건뇨도、거피부적육막복개성형뇨도등각조작보취적요점．방법장40례“전형”뇨도하렬환자중유음경하만적규정후，연후소유환자용구강점막이식우음경복측전삼분지일처백막표면，고정，증가뇨도적관도，선택괄의대소적뇨관후성형뇨도．음경배측피부전이지음경복측，장대체피판거피부후，보류피하육막층，완정적가개우뇨도권관성형처（포괄음경구두해면체절개량기하방），재성형구두．결과40례“전형”뇨도하렬성형술중，무1례출현뇨도협착，술후2월행수뇨관경검시：“이식적구강점막균존활”，차위우음경구두해면체절개량기하방가개적피하육막층점련만의，미견구두절구처렬개．유2례발생뇨루，균술후반년행뇨루수보술성공．1례전이피판배사，환약후유합．술후40례환자음경외관균만의．결론준순“전형”뇨도하렬각보취조작적요점，수술성공솔명현제고，정형효과호，술후병발증명현감소．
Objective To explore the operation points of the steps of"front-type"hypospadias operation in oral mucosa urethroplasty and scrubbed shaped urethra with meat membrane covering.Methods After correction of chordee of penis of 40 patients with "Front -type" hypospadias, oral mucosa was transplanted and fixed on albuginea surface at the one-third of ventral penile for all the patients to increase the width of the urethra and form the urethra with the selected appropriate size ureter. The skin of dorsal penile was transferred to ventral penile. After clearing the pedicled skin flap, the subcutaneous layer of meat was kept down, and stamped wholly on forming place of urethral reel (including both sides inferior of cut-off cavernous body of glans penis),forming the glans again.Results There was no ankylo-urethria among the 40 "front-type" hypospadias operation, ureteroscopy examination after two months of the operation showed that "all the transplanted oral mucosa survived", and the stamped subcutaneous layer of meat located at both sides inferior of cut-off cavernous body of glans penis adhered with satisfaction,no glans incision dehiscence,there occurred 2 cases of urinary fistula which had been cured by neoplasty,there was 1 case of transferred flap necrosis which had been cured after dressing change.40 patients were satisfied with penis appearance after operation.Conclusion Following up the operation points of “front-type”hyospadias operation,the success rate of operation can be improverd obviously,the plastic effect is good,and the complications after operation can be reduced.stamped wholly on formed urethra.There is a small probability of incidence of urethral stenosis and urinary fistula after operation.