CAJ | 학술논문

目的探讨皮瓣法部分阴茎远段尿道成形在重度尿道下裂分期手术中的临床应用.方法 2004年10月至2014年8月,采用分期、分节段尿道重建的方法治疗25例重度尿道下裂,其中阴茎阴囊型4例,阴囊型8例,会阴型13例.一期手术行阴茎充分伸直术,同时采用横裁包皮皮瓣尿道成形,预置部分阴茎远段尿道;6～8个月后,采用尿道周围皮瓣皮管法尿道成形完成二期手术.结果 25例中15例行横行带蒂双面包皮皮瓣法,10例行仿Duckett法,术后无皮瓣坏死、感染等,成形的阴茎远段尿道通畅,尿道外口均位于阴茎头开口,阴茎下弯矫正后阴茎伸直满意.二期尿道周围皮瓣皮管法尿道成形术后随访6 ～72个月,平均24个月,手术成功19例(19/25,76％),出现尿瘘5例(5/25,20％),尿道外口狭窄1例(1/25,4％).5例尿瘘瘘口均发生于阴茎、阴囊交界处(远段尿道和近端尿道吻合口处),6～8个月后再次手术修补成功.结论采用皮瓣法部分阴茎远段尿道成形进行分期、分节段尿道成形术,术后成功率高,阴茎外观良好,是治疗重度尿道下裂的较好选择.
목적 탐토피판법부분음경원단뇨도성형재중도뇨도하렬분기수술중적림상응용.방법 2004년10월지2014년8월,채용분기、분절단뇨도중건적방법치료25례중도뇨도하렬,기중음경음낭형4례,음낭형8례,회음형13례.일기수술행음경충분신직술,동시채용횡재포피피판뇨도성형,예치부분음경원단뇨도;6～8개월후,채용뇨도주위피판피관법뇨도성형완성이기수술.결과 25례중15례행횡행대체쌍면포피피판법,10례행방Duckett법,술후무피판배사、감염등,성형적음경원단뇨도통창,뇨도외구균위우음경두개구,음경하만교정후음경신직만의.이기뇨도주위피판피관법뇨도성형술후수방6 ～72개월,평균24개월,수술성공19례(19/25,76％),출현뇨루5례(5/25,20％),뇨도외구협착1례(1/25,4％).5례뇨루루구균발생우음경、음낭교계처(원단뇨도화근단뇨도문합구처),6～8개월후재차수술수보성공.결론 채용피판법부분음경원단뇨도성형진행분기、분절단뇨도성형술,술후성공솔고,음경외관량호,시치료중도뇨도하렬적교호선택.
Objective To discuss the applicatioen of flap for the urethroplasty in the distal penile segment in the staged correction of severe hypospadias.Methods From Oct.2004 to Aug.2014, 25 cases with severe hypospadias were treated by staged urethroplasty for urethra reconstruction.The urethral meatus were located at peroscrotum in 4 patinets, at scrotum in 8 patients and at perineum in 13 cases.At the first stage, the urethral plate was divided and chordee was corrected.Then tubularized transverse island flap was used to prefabricate partial distal urethra.The defective urethra was repaired by using the Thiersch-Duplay principle at the second stage.Results All patients completed both stages of the operation.The follow-up duration was 6-72 months (average,24 months).In the first-stage, the modified tabularized transverse preputial island flap was performed on 10 patients, whereas the modified preputial double-faced island flap was performed on the other 15 patients.All of the prefabricated partial distal urethras had no evidence of stenosis or scarring.The result of the second-stage procedure was a complete penis with integrated urethral.All patients were satisfied with cosmetic and functional results.Neither stricture nor diverticula was observed.A good urinary stream during the urination was achieved in 19(19/ 25, 76％) patients.Five cases (5/25, 25％) developed urethrocutaneous fistula and one cases developed meatal stenosis (1/25, 4％) after the second stage repair.Conclusions Staged urethroplasty using flap is a good choice for severe hypospadias.The successful rate is relatively high with good cosmetic and functional results.