[1]陈海琛,唐耘熳,徐延波,等.阴茎腹侧Buck筋膜重建在重度尿道下裂修复中的应用及近期疗效观察[J].临床小儿外科杂志,2019,18(02):130-135.
　Chen HC,Tang YM,Xu YB,et al.Application and immediate efficacy of Bucks fascia reconstruction on ventral aspect of penis for repairing severe hypospadias.[J].Journal of Clinical Pediatric Surgery,2019,18(02):130-135.
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阴茎腹侧Buck筋膜重建在重度尿道下裂修复中的应用及近期疗效观察

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第18卷 期数: 2019年02期 页码: 130-135 栏目: 论著 出版日期: 2019-02-25
Title:
Application and immediate efficacy of Bucks fascia reconstruction on ventral aspect of penis for repairing severe hypospadias.
作者:
陈海琛; 唐耘熳; 徐延波; 等.
1.厦门市妇幼保健院小儿外科（福建省厦门市，361003）; 2.四川省医学科学院.四川省人民医院、电子科技大学附属医院儿童医学中心小儿外科（四川省成都市，610041）
Author(s):
Chen HC; Tang YM; Xu YB; et al.
1.Department of Pediatric Surgery,Xiamen Maternal & Childrens Health Hospital,Xiamen 361003,China; 2.Department of Pediatric Surgery,Sichuan Academy of Medical Science,Sichuan Provincial People’s Hospital & Affiliated Children’s Medical Center,University of Electronic Science & Technology University,Chengdu 610041,China.
关键词:
尿道下裂;  尿道成形;  修复外科手术;  治疗结果
Keywords:
Hypospadias;  Urethroplasty;  Surgical Repair;  Treatment Outcome
分类号:
R726.9 R691.1 R699.6
文献标志码:
A
摘要:
目的探讨重度尿道下裂修复手术中阴茎腹侧Buck筋膜重建技术的应用及近期疗效。方法2016年6月至2017年12月厦门市妇幼保健院共收治43例重度尿道下裂患儿，年龄7个月至8岁2个月，中位年龄1岁4个月。初次手术40例,其中重度尿道下裂36例，包括阴茎阴囊型10例、阴囊型15例、会阴型11例；先天性短尿道4例。合并症情况：合并明显阴茎阴囊转位35例；阴茎显露不良21例；隐睾7例9侧；腹股沟斜疝3例。另外3例为尿道下裂外院手术后残留阴茎Ⅳ型下弯。术中用游离包皮内板卷管尿道成形后，采用阴茎腹侧Buck筋膜重建技术进行成形尿道的覆盖。观察患儿术后近期尿流率、并发症发生情况、HOSE评分。结果43例手术均一期完成，重建尿道2.5~7.5 cm，平均3.8 cm； 同时完全矫正阴茎阴囊转位、阴茎显露不良、隐睾和斜疝；患儿随访时间5~23个月，平均11个月。术后3个月随访阴茎伸直满意，阴茎阴囊转位均矫正，外观满意。28例完成尿流率检查，尿流率4.5~12.8 mL/sec，平均8.2 mL/sec。HOSE评分为13~16分，平均15.1分。一次手术成功率93%（40/43），术后发生尿瘘3例，1例术后1个月自行愈合，2例尿瘘患儿术后半年以上行尿瘘修补术获得成功；阴囊感染1例，切口引流后痊愈；无尿道狭窄、皮肤坏死、尿道憩室等并发症发生。阴茎显露不良3例。结论应用阴茎腹侧Buck筋膜重建技术治疗重度尿道下裂可获得良好的近期疗效。
Abstract:
ObjectiveTo explore the application and immediate efficacy of Bucks fascia reconstruction on ventral penile aspect during repairing of severe hypospadias.MethodsFrom June 2016 to December 2017,43 cases of severe hypospadias were treated.The average age was 16 (7-98) months.Forty primary operations were performed.Among 36 cases of severe hypospadias,the types were penile scrotal (n=10),scrotal (n=15) perineal (n=11).And there were 4 cases of congenital short urethra.The complications included penile scrotum transposition (n=35),penile exposure (n=21),cryptorchidism (n=7),indirect inguinal hernia (n=9) and indirect inguinal hernia (n=3).Three cases had residual penile Ⅳ type of lower curvature after external hypospadias surgery.The technique of Bucks fascia reconstruction was applied on ventral penile aspect for reconstructing urethra.Urethra was reformed with inner plate coil of free foreskin.And then we observed urinary flow rate,complications and HOSE grade during immediate postoperative period.ResultsFortythree cases were operated within one period.The average length of urethral reconstruction was 3.8(2.5-7.5) cm.And transposition of penile scrotal,penile exposure,cryptorchidism and oblique hernia were completely corrected.The average followup period was 11 (5-23) months.After 3month followup,penile extension appeared to be satisfactory and penile scrotum transposition was corrected with satisfactory appearances.Twentyeight cases received the examination of urinary flow rate.The maximal urinary flow rate was 4.5-12.8 ml/sec with an average of 8.2 ml/sec.The HOSE score was 13-16 points with an average of 15.1 points.The postoperative complications included urinary fistula (n=3),scrotal infection (n=1) and poor penile exposure (n=3).There was no onset of urethral stricture,skin necrosis or urethral diverticulum.The success rate of onetime operation was 93% (40/43).Two patients of urethral fistula were successfully repaired after over 6 months.ConclusionSevere hypospadias may be treated by Bucks fascia reconstruction with an excellent immediate efficacy.

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更新日期/Last Update: 2019-02-26