摘要
目的:总结改良Mathieu手术在尿道下裂再次修复中的治疗经验。方法:应用改良Mathieu手术治疗尿道下裂失败病例24例。患儿年龄3~12岁,平均4.5岁。20例为第2次手术,4例为第3次手术。其中大型的冠状沟尿瘘13例,尿道外口退缩5例,前段尿道崩裂6例。手术改良包括尿道后壁正中纵切、阴茎背侧血管神经束下方紧缩海绵体白膜、双层带血管蒂肉膜组织覆盖等技术。结果:24例中19例手术一次成功,阴茎伸直良好,外形美观,排尿正常,成功率79.2%(19/24)。尿瘘4例,1例自愈,3例行尿瘘修补痊愈。尿道外口狭窄1例,行尿道外口扩大整形治愈。无尿道狭窄及尿道憩室病例。术后行尿道镜检2例,未发现尿道后壁正中纵切处瘢痕增生。结论:改良Mathieu手术适用3种情况的尿道下裂失败病例,即大型的冠状沟尿瘘、尿道外口退缩和前段尿道崩裂。手术改良包括尿道后壁正中纵切、阴茎背侧血管神经束下方紧缩海绵体白膜、双层带血管蒂肉膜组织覆盖等技术。
Objective: To review the indications,techniques and complications of reoperation for failed hypospadias repair using modified Mathieu urethroplasty. Methods: Using modified Mathieu urethroplasty,we treated 24 hypospadias patients aged 312( mean 4. 5) years for whom the first( n = 20) or the second hypospadias repair( n = 4) had failed,including 13 cases of large coronary sulcus urethrocutaneous fistula,5 cases of urethral meatus retraction and 6 cases of anterior urethra dehiscence. The modified procedure involved median longitudinal incision of the urethral posterior wall,dorsal tunica albuginea plication under the vascular and nerve bundle,and double dartos flap protection of the neourethra. Results: Of the 24 patients,19( 79. 2%) were successfully treated by the first operation,which achieved desirable straightness,good cosmetic appearance and normal urethral meatus of the penis, without postoperative complications. Small urethrocutaneous fistula developed in 4 cases,of which 3 were cured by fistula repair and 1 self-healed. Urethral meatus stenosis occurred in 1 case,which was restored by meatal dilation. Urethrocele and urethrostenosis were not found in any of the cases. Two cases received urethrascopy postoperatively,which revealed no hypertrophic cicatrix at the site of median longitudinal incision in the urethral posterior wall. Conclusion: Modified Mathieu urethroplasty can be applied to hypospadias reoperation,particularly in such cases as large coronary sulcus urethrocutaneous fistula,urethral meatus retraction and anterior urethra dehiscence. The modified procedure includes median longitudinal incision of the urethral posterior wall,dorsal tunica albuginea plication under the vascular and nerve bundle,and double dartos flap protection of the neourethra.
出处
《中华男科学杂志》
CAS
CSCD
2013年第10期923-926,共4页
National Journal of Andrology
基金
广西壮族自治区卫生厅计划课题(桂卫Z2013003)~~
