Successful use of tunica vaginalis grafts for treatment of severe penile chordee in children
Successful use of tunica vaginalis grafts for treatment of severe penile chordee in children
复制标题
DOI：
10.1097/01.ju.0000083694.44384.39
复制
发表时间：
2003-10-01
影响因子：
6.6
通讯作者：
Ribbeck, M
中科院分区：
文献类型：
--
作者：
Ritchey, ML;Ribbeck, M
目的：先前的报道表明，游离阴道膜移植治疗脊索的失败率和残余曲度较高。我们回顾了游离阴道膜移植治疗伴有阴囊和会阴尿道下裂的严重脊索的经验。材料与方法：回顾1996 ~ 2001年收治的25例伴有严重腹侧脊索的阴囊或会阴尿道下裂患儿行下体移植矫直阴茎的临床资料。其中5例因先前尿道成形术失败和残余脊索而再次手术。所有接受初次手术的患者术前均接受睾酮治疗。真皮3例，小肠黏膜下层3例，阴道膜游离移植19例。一名儿童在同一位置放置了2个膜移植物以纠正脊索。结果：患者年龄从5个月到16岁（中位8个月）。所有患者随访时间至少为1年，最长为5年。所有患者都完成了第二期尿道下裂修复术，在修复术中进行了人工勃起以检测残余的腹侧弯曲。只有1例先前尿道下裂修复失败的患者在阴道膜移植后出现复发性脊索。该患者在尿道成形术时进行了背侧手术。没有其他患者有残余或复发脊索的证据。结论：本组采用阴道膜移植术，取得了良好的效果。对于首次手术时需要广泛会阴解剖的患者来说，这是一种容易获得的材料。需要对这些儿童进行长期随访，直到他们进入青春期。
Purpose: Prior reports have suggested that tunica vaginalis free grafts for the treatment of chordee are associated with a high failure rate and residual curvature. We reviewed our experience with tunica vaginalis free grafts for the treatment of severe chordee associated with scrotal and perineal hypospadias.Materials and Methods: The records of 25 children with scrotal or perineal hypospadias associated with severe ventral chordee requiring a corporal graft to straighten the phallus treated from 1996 to 2001 were reviewed. Of the cases 5 were reoperative due to prior failed urethroplasty and residual chordee. All patients undergoing primary surgery received testosterone treatment preoperatively. Dermis was used in 3 patients, small intestinal submucosa in 3 and a free graft of tunica vaginalis in the remaining 19. One child had 2 tunica grafts placed at the same setting to correct the chordee.Results: Patient age ranged from 5 months to 16 years (median 8 months). All patients have been followed for a minimum of 1 year and a maximum of 5 years. All patients completed stage 2 repair of the hypospadias at which artificial erection was performed to detect residual ventral curvature. In only 1 patient with a prior failed hypospadias repair was there evidence of recurrent chordee after tunica vaginalis graft placement. This patient was treated with a dorsal plication at the time of urethroplasty. No other patient had evidence of residual or recurrent chordee.Conclusions: In our hands, tunica vaginalis grafting of the corpora has produced excellent results. It is a readily available material and easy to harvest in patients who require extensive perineal dissection at the first operation. Long-term followup of these children as they progress through puberty is needed.