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目的总结带蒂包皮岛状皮瓣在尿道下裂再次手术中应用的适应证、手术技巧及其并发症。方法 2005年9月-2009年12月本院应用带蒂包皮岛状皮瓣再次手术治疗尿道下裂再次手术患儿35例,年龄3～15岁。其中22例为第2次手术,9例为第3次手术,4例为第4次手术,所有病例尿道局部瘢痕增生明显或尿道板已被破坏。手术方式分为2种:应用加盖岛状皮瓣法(Onlay术式)24例,应用岛状皮瓣管状尿道成形法(Duckett术式)11例。带蒂包皮岛状皮瓣长度为1～4cm,新尿道采用F8或F10号的硅胶气囊尿管作为支架管,术后10～14d拔除。结果 35例中27例(77.1%)一次手术成功,阴茎伸直良好,外形美观,排尿正常,成功率为77.1%。术后并发症:尿瘘6例,5例已行尿瘘修补,痊愈,1例等待修补;尿道狭窄2例,1例先行尿道狭窄处尿道造瘘,然后再次行尿瘘修补,痊愈,另1例已行尿道造瘘等待修补。结论带蒂包皮岛状皮瓣可应用于尿道下裂再次手术,术后阴茎外形美观,但需注意根据手术适应证选择,而且手术操作较复杂,有一定的并发症。
Objective To summarize indications, surgical techniques and complications of pedunculated preputial island flap in reoperation of hypospadias. Methods From September 2005 to December 2009, 35 cases of reoperation with hypospadias were operated in our hospital from March 2003 to December 2009 with the age of 3 to 15 years. Among them, 22 cases were the second operation, 9 cases were the third operation and 4 cases were the fourth operation. The urethral plaque hyperplasia was obvious in all the cases or the urethral plate was destroyed. There were 2 types of operation: 24 cases were treated with the island flap method (Onlay procedure), and 11 cases were treated with Duckett operation. Pedicle foreskin island flap length of 1 ~ 4cm, the new urethra with F8 or F10 silicone balloon catheter as a stent tube, 10 ~ 14d after removal. Results Of the 35 cases, 27 cases (77.1%) were successful in one operation. The penis was straight, the appearance was good and the urination was normal with a success rate of 77.1%. Postoperative complications: 6 cases of urinary fistula, 5 cases of urinary fistula repair, healed, 1 case waiting for repair; urethral stricture in 2 cases, 1 case of urethral stricture Department of urethostomy, and then the line of urinary fistula repair and cure, and the other 1 case Urinary tract ostomy waiting for repair. Conclusion The pedicle island skin flap can be used for reoperation of hypospadias. The postoperative appearance of the penis is good, but care should be taken according to the choice of surgical indications. Moreover, the surgical operation is complicated and has some complications.