中华整形外科杂志
中華整形外科雜誌
중화정형외과잡지
CHINESE JOURNAL OF PLASTIC SURGERY
2012年
6期
440-443
,共4页
刘中华%范志强%皇甫雪军
劉中華%範誌彊%皇甫雪軍
류중화%범지강%황보설군
尿道下裂%舌黏膜%外科皮瓣%尿道成形术
尿道下裂%舌黏膜%外科皮瓣%尿道成形術
뇨도하렬%설점막%외과피판%뇨도성형술
Hypospadias%Lingual mucous graft%Surgical flaps%Urethroplasty
目的 总结21例舌黏膜尿道成形术治疗复杂性尿道下裂的经验与体会.方法 根据阴茎局部尿道皮肤和尿道缺损的程度,以及阴茎腹侧既往手术后瘢痕、阴茎皮肤张力情况,切取口腔舌黏膜游离皮瓣,宽1.5～2.0 cm、长2～9 cm,2010年11月至2011年10月临床应用21例,其中舌黏膜嵌入式即Dorsal inlay术式16例,舌黏膜管状法即Tube术式5例(其中Tube+ Duply术式2例),术后定期进行随访并进行尿流率检测观察排尿情况.结果 术后随访3～12个月,21例患者的舌黏膜游离皮瓣均存活,术后排尿通畅、尿线粗、无尿瘘、外形良好及尿流率测定正常者13例,占61.9％ (13/21)；并发症为尿瘘3例、尿道狭窄5例,占38.1％(8/21).舌供皮区均一期愈合,且未出现出血、麻木、舌活动受限、发声异常及味觉改变等.结论 舌黏膜尿道成形术是治疗复杂性尿道下裂较理想的术式,但Tube术式易发生尿道狭窄,应早期发现及定期尿道扩张；Dorsal inlay术式术后并发症发生率较低且效果良好,可优先考虑此术式.
目的 總結21例舌黏膜尿道成形術治療複雜性尿道下裂的經驗與體會.方法 根據陰莖跼部尿道皮膚和尿道缺損的程度,以及陰莖腹側既往手術後瘢痕、陰莖皮膚張力情況,切取口腔舌黏膜遊離皮瓣,寬1.5～2.0 cm、長2～9 cm,2010年11月至2011年10月臨床應用21例,其中舌黏膜嵌入式即Dorsal inlay術式16例,舌黏膜管狀法即Tube術式5例(其中Tube+ Duply術式2例),術後定期進行隨訪併進行尿流率檢測觀察排尿情況.結果 術後隨訪3～12箇月,21例患者的舌黏膜遊離皮瓣均存活,術後排尿通暢、尿線粗、無尿瘺、外形良好及尿流率測定正常者13例,佔61.9％ (13/21)；併髮癥為尿瘺3例、尿道狹窄5例,佔38.1％(8/21).舌供皮區均一期愈閤,且未齣現齣血、痳木、舌活動受限、髮聲異常及味覺改變等.結論 舌黏膜尿道成形術是治療複雜性尿道下裂較理想的術式,但Tube術式易髮生尿道狹窄,應早期髮現及定期尿道擴張；Dorsal inlay術式術後併髮癥髮生率較低且效果良好,可優先攷慮此術式.
목적 총결21례설점막뇨도성형술치료복잡성뇨도하렬적경험여체회.방법 근거음경국부뇨도피부화뇨도결손적정도,이급음경복측기왕수술후반흔、음경피부장력정황,절취구강설점막유리피판,관1.5～2.0 cm、장2～9 cm,2010년11월지2011년10월림상응용21례,기중설점막감입식즉Dorsal inlay술식16례,설점막관상법즉Tube술식5례(기중Tube+ Duply술식2례),술후정기진행수방병진행뇨류솔검측관찰배뇨정황.결과 술후수방3～12개월,21례환자적설점막유리피판균존활,술후배뇨통창、뇨선조、무뇨루、외형량호급뇨류솔측정정상자13례,점61.9％ (13/21)；병발증위뇨루3례、뇨도협착5례,점38.1％(8/21).설공피구균일기유합,차미출현출혈、마목、설활동수한、발성이상급미각개변등.결론 설점막뇨도성형술시치료복잡성뇨도하렬교이상적술식,단Tube술식역발생뇨도협착,응조기발현급정기뇨도확장；Dorsal inlay술식술후병발증발생솔교저차효과량호,가우선고필차술식.
Objective To review and summarize the experience of urethral reconstruction using lingual mucosal graft for the treatment of complex hypospadias.Methods We evaluated the methods using lingual mucosal graft for the treatment of complex hypospadias.The dorsal inlay graft method and the tube graft method were used in our study.Results From Nov.2010 to Oct.2011,21 cases were treated.All the cases had at least one failed hypospadisa surgery before.The dorasl inlay grafting technique was used for 16 patients,the tube grafting technique was carried out in 5 patients(2 cases received Tube + Duply method).The follow-up period ranged from 3 months to 12 months(by average 6 months).The success rate of the methods was 61.9％ with complications in 8 cases.Urethral fistula developed in 3 patients and urethral stricture developed in 5 patients.All cases who suffered stricture received the tube grafting technique.The fistula and urethral stricture were occurred at the site of the urethral termonoterminal anostomosis.Urethral stricture is the most common complication after the tube graft method for the treatment of the complex hypospadias.Conclusions Harvesting the lingual mucosal graft is feasible and easy to perform.The complex hypospadias repair technique using lingual mucosal graft method provides good results.There fore it should be one of the preferred techniques for complex hypospadias repair.The dorsal inlay grafting technique has lower complication rate than the tube grafting technique.Early and regular urethral sounding should be carried out when patients received the tube graft method.
