中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2014年
8期
137-138,139
,共3页
潘永斌%高卫华%邱伟全%梁永雄%吴宁宇
潘永斌%高衛華%邱偉全%樑永雄%吳寧宇
반영빈%고위화%구위전%량영웅%오저우
重型尿道下裂%Koyanagi手术%睾丸鞘膜覆盖技术
重型尿道下裂%Koyanagi手術%睪汍鞘膜覆蓋技術
중형뇨도하렬%Koyanagi수술%고환초막복개기술
Severe hypospadia%Koyanagi operation%Technique of perididymis covering
目的：评价Koyanagi手术+睾丸鞘膜覆盖技术治疗重型尿道下裂的疗效。方法：30例尿道下裂患者行Koyanagi手术+睾丸鞘膜覆盖技术，年龄11个月~3岁，阴茎阴囊型16例，阴囊型9例，会阴型5例。全部病例均有不同程度的阴茎下弯。阴茎发育不良21例，术前均肌注hCG 1~2个疗程使龟头直径达1.2 cm，停药1个月后手术。合并阴茎阴囊转位18例，均一次矫正。手术时间平均2.5 h，10~12 d拔除5号引流管，带9号支架管排尿。一般3周左右支架管自行脱落。1个月后常规行尿道扩张1~3个月，每周1次。结果：30例均顺利实施Koyanagi术式，术后随访1~3年，冠状沟小尿瘘3例（10.0%），尿道狭窄2例（6.7%），狭窄继发尿道憩室1例（3.3%）。除1例不能定期尿扩尿瘘需二次修补外，其余均经规则扩张获治愈，避免二次修补。总治愈率96.7%，且阴茎外观满意，接近包皮环切外形，无阴茎下弯。结论：Koyanagi手术+睾丸鞘膜覆盖技术治疗重型尿道下裂，外观满意，并发症少，是较理想的手术方式。
目的：評價Koyanagi手術+睪汍鞘膜覆蓋技術治療重型尿道下裂的療效。方法：30例尿道下裂患者行Koyanagi手術+睪汍鞘膜覆蓋技術，年齡11箇月~3歲，陰莖陰囊型16例，陰囊型9例，會陰型5例。全部病例均有不同程度的陰莖下彎。陰莖髮育不良21例，術前均肌註hCG 1~2箇療程使龜頭直徑達1.2 cm，停藥1箇月後手術。閤併陰莖陰囊轉位18例，均一次矯正。手術時間平均2.5 h，10~12 d拔除5號引流管，帶9號支架管排尿。一般3週左右支架管自行脫落。1箇月後常規行尿道擴張1~3箇月，每週1次。結果：30例均順利實施Koyanagi術式，術後隨訪1~3年，冠狀溝小尿瘺3例（10.0%），尿道狹窄2例（6.7%），狹窄繼髮尿道憩室1例（3.3%）。除1例不能定期尿擴尿瘺需二次脩補外，其餘均經規則擴張穫治愈，避免二次脩補。總治愈率96.7%，且陰莖外觀滿意，接近包皮環切外形，無陰莖下彎。結論：Koyanagi手術+睪汍鞘膜覆蓋技術治療重型尿道下裂，外觀滿意，併髮癥少，是較理想的手術方式。
목적：평개Koyanagi수술+고환초막복개기술치료중형뇨도하렬적료효。방법：30례뇨도하렬환자행Koyanagi수술+고환초막복개기술，년령11개월~3세，음경음낭형16례，음낭형9례，회음형5례。전부병례균유불동정도적음경하만。음경발육불량21례，술전균기주hCG 1~2개료정사구두직경체1.2 cm，정약1개월후수술。합병음경음낭전위18례，균일차교정。수술시간평균2.5 h，10~12 d발제5호인류관，대9호지가관배뇨。일반3주좌우지가관자행탈락。1개월후상규행뇨도확장1~3개월，매주1차。결과：30례균순리실시Koyanagi술식，술후수방1~3년，관상구소뇨루3례（10.0%），뇨도협착2례（6.7%），협착계발뇨도게실1례（3.3%）。제1례불능정기뇨확뇨루수이차수보외，기여균경규칙확장획치유，피면이차수보。총치유솔96.7%，차음경외관만의，접근포피배절외형，무음경하만。결론：Koyanagi수술+고환초막복개기술치료중형뇨도하렬，외관만의，병발증소，시교이상적수술방식。
Objective:To explore the effect of koyanagi operation and technique of perididymis covering in the treatment of severe hypospadia. Method:A total of 30 cases with hypospadias were cured by koyanagi operation and technique of perididymis covering. Patients ages were from 11 months to 3 years old. Among the 30 cases there were 16 cases diagnosed as penoscrotal hypospadias and 9 cases with scrotal type of hypospadias and 5 cases with perineal hypospadias. All those cases had different degrees of chordee of penis. All 21 patients diagnosed as maldevelopment of penis were given intramuscular injection hCG for one or two course before operation in order to make the glans diameter be up to 1.2 cm,and the surgical procedure was done one month after the hCG course. All 18 patients combined with the penis and scrotum transposition were rectified successfully by one time. The average operation time was 2.5 hours,and the drainage tube was removed in 10-12 days after operation and the stent was placed in the urethra until it fall off automatically about 3 weeks after operation. One month after operation,the urethral dilatation was done once a week from 1 to 3 months. Result:The koyanagi operations of 30 cases were all successful. Follow-up 1-3 years after operation 3 cases small fistula in coronary ditch(10.0%),2 cases urethral stricture(6.7%)and 1 case urethral stricture secondary urethrocele were found. One patient need the secondary surgical operation,and others were all cured by expansion rules. Generally the total curing rate in the 30 cases reached 96.7%,and the cosmetic appearance of penis were satisfied and close to the circumcision appearance(without chordee of penis). Conclusion:The koyanagi operation and tunica vaginalis testis covering technique is an ideal treatment for severe hypospadias because of its satisfied appearance and without any complications.
