Wu Min,Ye Weijing,Lv Yiqing,et al.Redo surgery of failed hypospadias: single stage repair using buccal mucosa graft over pedicled external spermatic fascia flap urethroplasty[J].Journal of Clinical Pediatric Surgery,2020,19(04):317-320.[doi:10.3969/j.issn.1671-6353.2020.04.007]
精索外筋膜联合唇黏膜移植一期修复尿道下裂修复失败的初步报告
- Title:
- Redo surgery of failed hypospadias: single stage repair using buccal mucosa graft over pedicled external spermatic fascia flap urethroplasty
- Keywords:
- Hypospadias; Spermatic Cord; Fascia; Buccal Mucosa; Transplantation; Reconstructive Surgical Procedures
- 分类号:
- R726.9;R695;R628
- 摘要:
- 目的 通过预置精索外筋膜改良唇黏膜移植的方法，同期联合局部皮瓣尿道成形一期修复术治疗手术修复失败的尿道下裂，并评价其疗效。方法 2014年12月至2017年4月作者采用预置精索外筋膜移植床一期治疗13例修复手术失败的尿道下裂患儿，年龄2.5~6岁，患儿至少经历1次失败的尿道下裂手术，阴茎体与睾丸大小、质地均尚可，术前合并不同程度阴茎弯曲。沿原手术切口暴露原手术建立的尿道，人工勃起试验均提示存在阴茎体下弯（弯曲15°~45°）。自腹侧弯曲最显著处完全离断原尿道海绵体，深达阴茎海绵体白膜后完全伸直阴茎，剔除白膜表面原手术后瘢痕组织，尿道缺损长度2.2~4.9 cm；于一侧睾丸鞘膜表面自睾丸底部到腹股沟管处解剖长段精索外筋膜后，将其转移覆盖于白膜表面尿道缺损处，取同等长度的下唇黏膜移植于精索外筋膜表面，固定后游离局部带蒂阴茎皮肤加盖成型新尿道，一期完成重建手术。结果 13例患儿留置导尿管3周后拔除，随访12~40个月后，2例出现尿道瘘（1例位于冠状沟、1例位于阴茎根部），均再次行手术修补；1例阴茎头裂开未予处理，1例尿道外口狭窄行尿道外口扩张后治愈。所有患儿阴茎勃起时无下弯，患儿家长对其术后阴茎体外观满意。结论 通过预置精索外筋膜可增加唇黏膜的获取率，有效避免移植物挛缩的问题，可一次性完成尿道重建手术。
- Abstract:
- Objective To report the outcomes of using buccal mucosa graft placed over pedicled external spermatic fascia flap plus onlay adjacent penile skin flap for single-stage correction of children with unsuccessful re-operative hypospadias.Methods Between 2014 and 2017,13 re-operative hypospadias children underwent correcting penile curvature by transecting adjacent scarred urethral plate or keloid and anastomosing unilateral external spermatic fascia flap to ventral surface of corpus cavernosum for dorsal penile urethral defect.A buccal mucosa graft was placed directly on the top of flap and an onlay adjacent penile skin flap employed for one-stage urethroplasty.A urethral catheter was inserted for 3 weeks and then removed.Results Repair was successful in all cases.During a mean follow-up period of 12-40 months,penile cosmetic appearance was decent.There was no residual chordee.For two cases of postoperative urethrocutaneous fistula,one case presented with obstructive pattern uroflowmetry due to meatal stenosis while another child developed glans dehiscence.Conclusion In this preliminary clinic report,failed hypospadias repair has been successfully managed with single-stage correction using buccal mucosa graft over pedicled external spermatic fascia flap plus onlay adjacent penile skin flap urethroplasty.More studies are necessary for further elucidating the role of grafting over flap in the correction of failed re-operative hypospadias.
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备注/Memo
收稿日期:2018-08-16。
基金项目:上海市科学技术委员会（编号：14411950403）
通讯作者:陈方,Email:doctorchenfang@126.com