临床小儿外科杂志

目的探讨膀胱尿道镜检术在重度尿道下裂合并前列腺囊诊治中的必要性和临床经验。方法回顾性分析本院收治的47例重型尿道下裂合并前列腺囊患者临床资料,年龄1.2～15岁,平均年龄2.8岁。其中尿道开口于阴茎阴囊交界处18例,开口于阴囊15例,开口于会阴部14例。47例均于尿道成形术前行膀胱尿道镜检术,其中3例行前列腺囊切除术。记录所有患者的临床资料,包括B超检查、影像学检查以及膀胱尿道镜检查结果,并进行分析。结果 47例重型尿道下裂患者通过膀胱尿道镜观察到前列腺囊大小不一,长度0.3～3.6 cm,以会阴型的前列腺囊长度最长。通过B超发现前列腺囊31例(59.5%),通过VCUG发现前列腺囊3例(6.4%)。临床表现为反复尿路感染、附睾睾丸炎4例(8.5%),其中3例行腹腔镜下膀胱镜辅助前列腺囊切除术,术后随访临床症状消失,1例拒绝手术,随访中仍存在反复感染症状。结论膀胱尿道镜检术能准确发现尿道下裂患者的前列腺囊,并能测量前列腺囊的大小、位置。在前列腺囊切除术中,膀胱尿道镜辅助腹腔镜操作,能准确显示前列腺囊的位置,有助于精准完整地切除前列腺囊。

Objective To explore the necessity and application of cystourethroscopy in the diagnosis and treatment of hypospadias with prostatic utricle. Methods A total of 47 patients of severe hypospadias with prostatic utricle were recruited.The average age was 2.8(1.2～15)years.The locations of urethral orifice were at the junction of penis & scrotum(n=18),scrotum(n=15)and perineum (n=14).Prior to urethroplasty,cystourethroscopic examination was performed.Three of them underwent cystoscopic-assisted laparoscopic excision of prostatic utricle.Clinical data and results of ultrasound,imaging examinations and cystourethroscopic examination were recorded. Results Under cystourethroscope,the sizes of prostatic utricle varied greatly.The length was 0.3～3.6 cm and the length of perineum was the longest.Among them,31 cases of prostatic utricle were detected by ultrasound(59.5%).Three patients(6.4%)had prostatic utricle on voiding cystourethrography(VCUG).Among 4 patients(8.5%)with epididymitis,3 underwent cystoscopic-assisted laparoscopic excision of prostatic utricle and the symptoms disappeared during postoperative follow-ups.One case refused surgery and developed recurrent infection. Conclusion Cystourethroscopy may detect prostatic utricle in patients with hypospadias and it can measure the size and location of prostatic utricle while other examinations tend to miss its diagnosis.During cystoscopic-assisted laparoscopic excision of prostatic utricle,cystourethroscopic assistance may facilitate counter-traction movements and accurate dissections.

引言
1 材料与方法
2 结果
3 讨论

图1 膀胱尿道镜检术。A.在尿道中找到精阜; B.在精阜部位见前列腺囊开口; C.将镜子探入前列腺囊; D.镜子进入前列腺囊顶部,可以测量前列腺囊的大小; E.造影显示巨大前列腺囊,其近端与右侧射精管相通。<br/>Fig.1 Cystourethroscopy

图1 膀胱尿道镜检术。A.在尿道中找到精阜; B.在精阜部位见前列腺囊开口; C.将镜子探入前列腺囊; D.镜子进入前列腺囊顶部,可以测量前列腺囊的大小; E.造影显示巨大前列腺囊,其近端与右侧射精管相通。
Fig.1 Cystourethroscopy

图2 腹腔镜下膀胱尿道镜辅助前列腺囊切除术。 A.在腹腔镜下,根据输尿管镜的光源,精准找到前列腺囊顶部; B.牵拉前列腺囊顶部,游离前列腺囊; C.将前列腺囊与周围组织剥离分开; D.完整将前列腺囊剥离至尿道部位。<br/>Fig.2 Cystoscopic-assisted laparoscopic excision of prostatic utricle

图2 腹腔镜下膀胱尿道镜辅助前列腺囊切除术。 A.在腹腔镜下,根据输尿管镜的光源,精准找到前列腺囊顶部; B.牵拉前列腺囊顶部,游离前列腺囊; C.将前列腺囊与周围组织剥离分开; D.完整将前列腺囊剥离至尿道部位。
Fig.2 Cystoscopic-assisted laparoscopic excision of prostatic utricle

表1 47例重型尿道下裂合并前列腺囊患者临床资料<br/>Table 1 Clinical profiles of patients of severe hypospadias with prostatic utricle

表1 47例重型尿道下裂合并前列腺囊患者临床资料
Table 1 Clinical profiles of patients of severe hypospadias with prostatic utricle

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备注

引言

1 材料与方法

2 结果

3 讨论

期刊信息

备注

引言

1 材料与方法

2 结 果

3 讨 论

期刊信息

2 结果

3 讨论