尿道下裂TIP手术图解
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发布日期: 2006-11-05 20:36 文章来源: 丁香园 - 肾脏泌尿专业讨论版
关键词: 尿道下裂 TIP 手术图解 点击次数:

资料来源:BJU international 2005。
文献作者:WARREN T. SNODGRASS。
文献题目:Snodgrass technique for hypospadias repair。
A 5–0 polypropylene suture is place into the glans for traction and to later secure the
urethral stent. The initial skin incision depends upon whether the family prefers circumcision or foreskin reconstruction, as either can be performed. When circumcision is the desired result care is taken to preserve sufficient inner prepuce so that a so-called ‘mucosal collar’ can be approximated in the ventral midline after glansplasty. Then the penis is degloved to near the penoscrotal junction. If the foreskin is to be reconstructed the skin incision extends from the corners of the dorsal preputial hood to 2 mm proximal to the meatus. Ventral shaft skin is released until normal dartos tissues are encountered.
An artificial erection confirms the absence of ventral curvature, but if there is significant bending a midline dorsal plication is done using a single 6–0 polydioxanone suture placed in the tunica albuginea of the corpora cavernosa directly opposite the point of  maximum curvature.


Figure 2
Next, longitudinal incisions are made along the visible junction of the glans wings to the urethral plate. Proposed lines for incision are first infiltrated with 1 : 100 000 noradrenaline or a tourniquet is used around the base of the penis for haemostasis. After making the skin incision with the 69 Beaver scalpel, I prefer to complete the dissection and glans wings mobilization using tenotomy scissors, taking care both to preserve vascularity to the urethral plate and sufficient thickness for the wings to be securely approximated.


Figure 3
The key step in the procedure is midline incision of the urethral plate. This manoeuvre
is facilitated by counter-traction maintained by the surgeon and assistant along opposite margins of the plate. Using tenotomy scissors, the relaxing incision is made from within the meatus to the tip of the urethral plate. It should not be carried further distally into the glans. The depth of incision depends upon whether the plate is grooved or relatively flat, but in all cases extends down to near the corpora cavernosa. Figure 3c: A 6 F Silastic stent is passed into the bladder and secured to the glans traction suture. Then the urethral plate is tubularized beginning at the neomeatus, using 7–0 polyglactin suture. The first suture is placed through the epithelium at a point just distal to the midglans so that the meatus has an oval, not rounded, configuration. Tubularization is completed with a running two-layer subepithelial closure, turning all epithelium into the neourethral lumen.

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