CAJ | 학술논문

目的：评估唇黏膜镶嵌Ⅰ期尿道板纵切卷管成形术（TIPU）治疗尿道下裂修复术后各种并发症的可行性和安全性。方法2011年1月至2013年4月间，42例平均年龄19.2岁的病人，因尿道下裂术后各种并发症做重建手术，其中有尿道皮肤漏32例，尿道狭窄6例，尿道憩室4例。先前已做过尿道下裂修复术平均2.1次（1~5次）。所有病例本次重建手术的各种并发症和阴茎整形外观被回顾。结果42例中，29例（69.1%）做唇黏膜镶嵌Ⅰ期TIPU，13例（30.9%）尿道板过短和纤维化而横断，尿道板组织缺损，联合阴茎原基内翻皮瓣重建新尿道。联合阴茎海绵体背侧折叠术2例。平均手术时间为147min（70~135min）。镶嵌唇黏膜的大小平均为46.4mm×9.1mm，阴茎内翻皮瓣平均为47.7mm×10.9mm。所有病例达到阴茎伸直，尿道外口呈垂直裂隙状位于阴茎头正前方。平均随访12个月，无阴茎头裂开、新尿道狭窄、尿道憩室和阴茎屈曲发生，38例无并发症发生，总的手术成功率为90.48%。4例发生尿道皮肤漏（9.52%），其中阴茎阴囊交界处漏2例，阴茎中部漏和冠状沟处漏各1例。术后3个月尿漏自愈1例，瘘管切除修复成功1例。另2例尚待再手术修复。结论口腔唇黏膜是一种优良的组织，镶嵌唇黏膜Ⅰ期TIPU是有效的重建手术方法，并发症的危险性低，阴茎的整容外观满意，可被推荐为尿道下裂修复术失败后首选的再手术方法。
목적：평고진점막양감Ⅰ기뇨도판종절권관성형술（TIPU）치료뇨도하렬수복술후각충병발증적가행성화안전성。방법2011년1월지2013년4월간，42례평균년령19.2세적병인，인뇨도하렬술후각충병발증주중건수술，기중유뇨도피부루32례，뇨도협착6례，뇨도게실4례。선전이주과뇨도하렬수복술평균2.1차（1~5차）。소유병례본차중건수술적각충병발증화음경정형외관피회고。결과42례중，29례（69.1%）주진점막양감Ⅰ기TIPU，13례（30.9%）뇨도판과단화섬유화이횡단，뇨도판조직결손，연합음경원기내번피판중건신뇨도。연합음경해면체배측절첩술2례。평균수술시간위147min（70~135min）。양감진점막적대소평균위46.4mm×9.1mm，음경내번피판평균위47.7mm×10.9mm。소유병례체도음경신직，뇨도외구정수직렬극상위우음경두정전방。평균수방12개월，무음경두렬개、신뇨도협착、뇨도게실화음경굴곡발생，38례무병발증발생，총적수술성공솔위90.48%。4례발생뇨도피부루（9.52%），기중음경음낭교계처루2례，음경중부루화관상구처루각1례。술후3개월뇨루자유1례，루관절제수복성공1례。령2례상대재수술수복。결론구강진점막시일충우량적조직，양감진점막Ⅰ기TIPU시유효적중건수술방법，병발증적위험성저，음경적정용외관만의，가피추천위뇨도하렬수복술실패후수선적재수술방법。
Objective To evaluate the feasibility and safety of 1-stage tubularized incised plate urethroplasty(TIPU)with inlay labial mucosa graft in the treatment of patients with complications following failed hypospadias repair(s). Methods A total of 42 patients with average age of 19.2 years (ra2.5~47 years) who underwent reconstructive surgery from January 2011 to April 2013 were enrolled in the study, and ocurrenece of complications after hypospadias repairwere foundsuch as urethrocutaneous fistula(32), urethral stricture(6), diverticulum(4). The mean number of prior failed repair(s) was 2.1(range1-5).The medical records of all patients were retropectively reviewed with regard to complication rate and cosmetic appearance. Results Of the 42 cases, 29(69.0%) underwent 1-stage TIPU with inlay labial mucosa graft, 13(30.9%) received the neourethral reconstruction with penile rudimentary flip-flap due to shorter urethral plate resulting to urethral defects. 2 cases received the combined dorsal plication of the corpora cavernosa in the same sitting. The mean operative time was 147 min(range,70~315min). The mean length and width of inlay labial mucosa graft was 46.4mm×9.1mm, of penile flip-flap was 47.7mm×10.9mm. All patients got, the straight penis and a slit-like appearance at the glans tip of neomeatus. After 12 months following up, no patient had glans dehiscence, neourethral stricture, diverticula or residual chordee developed. Thirty-eight cases had no complications. Overall success rate of operation was 90.48%. The urethrocutaneous fistula were observed at penoscrotal junction(2 cases), penile shaft(1 case)and corona(1 case). For one case the fistula was healed spontaneously three months later, another was treated with fistula repair successfully. The othertwo cases waited revision resurgery. Conclusion Oral grafts harvested from lower lip are a versatil tissue. The 1-stage TIPU with grafting labial mucosa is an effective method for the reconstructive surgery with good cosmetic outcome and low risk of complications, may be recommented procedure for failed hypospadias.