尿道下裂

Part two: Urethroplasty by using skin oversleeve with vesicomucosa to treat hypospadias.

为解决单独使用膀胱粘膜尿道成形术后并发症较多的问题，我们设计了皮肤袖套式膀胱粘膜尿道成形术治疗重型尿道下裂及部分首次手术失败的尿道下裂患儿，即用游离包皮内板或游离阴囊中隔皮片在尿道外口处做成一短段尿道，然后用游离膀胱粘膜形成全段人工尿道并从包皮内板或游离阴囊中隔皮片做成的尿道内穿出。

Objective To investigate the nursing intervention in preclusion of post-urethroplasty urinary fis-tula of hypospadia.Methods 70urethroplasty cases were randomly divided into2groups,the urethral stents were douched with0.9%N.S in the cotrol group,and the integrated nursing interventionwas applied in the treatment group,the INI includerays the use of10ml0.9%N.S plus80000units gentamicin for douche,swabbing genitals with nitrofurazone solution and infrared rays exposure of genitals.

目的 采用护理干预手段预防尿道下裂术后尿瘘的发生方法选择尿道下裂带蒂皮瓣正位开口期尿道成形术患者70例随机分 2组：一组是常规用生理盐水冲洗尿道支架管方法；另一组是生理盐水10ml加庆霉素8万U冲洗新尿道支架管，呋喃西林溶液擦拭外阴部以及红外线伤口局部照射的护理干预方法综合护理，观察尿瘘的发生率。

Methods: Selected 93 confirmed cases with hypospadias during May 2003 to Sep 2009. Patients in balanic type were treated with meatal advancement and glandularp lasty; patients with urethra orifice at 2/3 of corpus penis accompanied with slight chordee of penis were treated with Snodgrass method or Onlay method; patients with severe chordee of penis were treated with Duckett method; patients in scrotum or perineum type were treated with combination of Duplay and Duckett; severe hypospadia patients were treated with curved pedicle penis-scrotum and skin flap urethroplasty; patients with good outer plate of ventral prepuce and chordee of penis were treated with ventral pedicle hooded foreskin flap.

选取2003年5月～2008年9月期间收治的93例确诊尿道下裂患者，对阴茎头型患者采用尿道口前移、阴茎头成形法；尿道口在阴茎体外2/3段伴有阴茎轻度下弯者采用尿道板纵切卷管法或加盖岛状皮板法（Snodgrass术或On-lay术）；有严重阴茎下弯的所有阴茎体型采用横裁或纵裁包皮岛状皮瓣尿道成形；阴囊型或会阴型用阴囊中缝皮管加横裁包皮岛状皮瓣成形尿道（Duplay联合Duckett术）；对重度尿道下裂患儿采用弧形带蒂阴茎阴囊联合皮瓣尿道成形术；对腹侧包皮外板发育良好患儿及合并阴茎下曲的患儿采用腹侧带蒂帽状包皮皮瓣法。

Methods: Selected 93 confirmed cases with hypospadias during May 2003 to Sep 2009. Patients in balanic type were treated with meatal advancement and glandularp lasty; patients with urethra orifice at 2/3 of corpus penis accompanied with slight chordee of penis were treated with Snodgrass method or Onlay method; patients with severe chordee of penis were treated with Duckett method; patients in scrotum or perineum type were treated with combination of Duplay and Duckett; severe hypospadia patients were treated with curved pedicle penisscrotum and skin flap urethroplasty; patients with good outer plate of ventral prepuce and chordee of penis were treated with ventral pedicle hooded foreskin flap.

选取2003年5月～2008年9月期间收治的93例确诊尿道下裂患者，对阴茎头型患者采用尿道口前移、阴茎头成形法；尿道口在阴茎体外2/3段伴有阴茎轻度下弯者采用尿道板纵切卷管法或加盖岛状皮板法(Snodgrass术或Onlay术)；有严重阴茎下弯的所有阴茎体型采用横裁或纵裁包皮岛状皮瓣尿道成形；阴囊型或会阴型用阴囊中缝皮管加横裁包皮岛状皮瓣成形尿道(Duplay联合Duckett术)；对重度尿道下裂患儿采用弧形带蒂阴茎阴囊联合皮瓣尿道成形术；对腹侧包皮外板发育良好患儿及合并阴茎下曲的患儿采用腹侧带蒂帽状包皮皮瓣法。

Objective: To evaluate the pathological characteristics of tissues on the surface of cavernosa of ventral penis with ventral curvature and to investigate the etiology of congenital ventral coned hypospadias.

目的：探讨尿道下裂阴茎下弯畸形阴茎海绵体腹侧表面组织病理学特点，认识尿道下裂阴茎下弯形成机制，为临床治疗方案提供一定的依据。

Flatten uroflow curves were seen in all patients with marked meatal stenosis. A bell-shaped flow curve was obtained in most patients after urethroplasty using oral mucosa graft combined with a local flap. The peak flow was within the normal range. The flow curve was obviously flat in patients with urethral stricture. The maximum flow rate was low and the voiding time prolonged apparently.

尿流率曲线低平的患者，均伴有明显的尿道外口狭窄；口腔粘膜片移植与局部皮瓣耦合再造尿道修复尿道下裂的患者，多数恢复了接近正常的钟形尿流率曲线，最大尿流率在正常范围：尿道下裂术后尿道狭窄的患者排尿曲线明显低平，最大尿流率降低，排尿时间延长。

We concluded that uroflowmetry was a simple, non-invasive procedure which provided an objective evaluation of the uroflow in hypospadias. Urethral stricture after urethroplasty could be diagnosed with uroflowmetry. The low flow rate in congenital hypospadias was mainly due to meatal stenosis. Oral mucosa graft combined with a local flap for hypospadias repair provided satisfactory functional results.

我们推论：尿流率测定评价尿道下裂患者排尿功能，方法简便，准确可靠，对尿道下裂术后尿道狭窄具有诊断意义；先天性尿道下裂患者尿流率曲线多数呈平台形，最大尿流率降低，其主要原因为尿道外口狭窄；口腔粘膜片移植与局部皮瓣耦合组建尿道修复尿道下裂功能性效果良好。

Objective To evaluate the therapeutic effect of urethroplasty, this was operated by the utilization of longitudinal preputial island flaps of dorsum penis.

目的：评价阴茎背侧纵行带蒂包皮瓣尿道成形术在尿道下裂修复中的应用及疗效；方法：采用改进的阴茎背侧纵形带蒂包皮瓣尿道下裂修复术治疗26例有阴茎弯曲，背侧包皮丰富的中、近段尿道下裂。

objective to summarize the merit and surgical essentials of pedicled preputial flap urethral phase ⅰ to treathypospadias.methods 28 cases of hypospadias use pedicled prepuce phase ⅰ orthotropia gap to repair hypospadias.

目的 总结带蒂包皮皮瓣行尿道ⅰ期成形术治疗尿道下裂的优点及手术要领。方法对28例尿道下裂患儿采用带蒂包皮ⅰ期正位开口治疗尿道下裂。

Modified Duckeet urethroplasty provides an excellent procedure for severe proximal hypospadias, especially suitable for correcting penoscrotal and scrotal hypospadias with severe penis chordee.

Duckeet改良术式是一期修复重度尿道下裂的较好术式，尤其适用于伴有严重阴茎下曲的阴茎阴囊型以及阴囊型尿道下裂。

Do you know, i need you to come back

你知道吗，我需要你回来

Yang yinshu、Wang xiangsheng、Li decang,The first discovery of haemaphysalis conicinna.

1〕 杨银书，王祥生，李德昌。安徽省首次发现嗜群血蜱。