Kulkarni Bharati, Chaudhary Navin, Yadav Sunil, Oak Sanjay N
Department of Paediatric Surgery, L.T.M.G. Hospital, Sion, Mumbai - 400 022, India.
Pediatr Surg Int. 2002 Sep;18(5-6):559-62. doi: 10.1007/s00383-002-0777-4. Epub 2002 Jun 5.
We report a new method of repair of exstrophy-epispadias complex (EEC) at a second stage by using flaps from the skin between the penis and scrotum (the clitoris and labia majora in females) used in seven patients. The non-pigmented skin between the penis and scrotum in males or a band of skin between the clitoris and labia majora in female is mobilized in two flaps, which are rotated superiorly. Five patients were treated primarily by this method and two patients at the time of secondary reconstruction. There were six boys and one girl. Two patients were post-pubertal, one male and one female. Follow-up (6-12 months) revealed good cosmetic and functional results. If EEC is repaired in a single stage, the entire pelvic diaphragm is visualized from inside and the sphincters can be reconstructed around the bladder neck. This procedure gives better exposure of attachments of the corporal bodies to the pubic rami, allowing easier mobilization. The bulbospongiosus muscle can be reconstructed. A normal penoscrotal relation is achieved in male patients. The root of the scrotum, which is splayed out and wide, narrows. Rotation of the flaps superiorly normalizes the symphyseal area. In female patients the appearance of the mons pubis is satisfactory. In post-pubertal children the pubic hair distribution appears normal.
我们报告了一种二期修复膀胱外翻-尿道上裂复合畸形（EEC）的新方法，该方法使用阴茎与阴囊之间（女性为阴蒂与大阴唇之间）的皮肤皮瓣，应用于7例患者。男性阴茎与阴囊之间的无色素皮肤或女性阴蒂与大阴唇之间的一条皮肤带被制成两个皮瓣并向上旋转。5例患者采用该方法一期治疗，2例患者二期重建时采用。患者中有6名男孩和1名女孩。2例患者为青春期后，1名男性和1名女性。随访（6 - 12个月）显示美容和功能效果良好。如果EEC一期修复，可从内部观察到整个盆底肌，并且可以围绕膀胱颈重建括约肌。该手术能更好地暴露阴茎海绵体与耻骨支的附着点，便于更容易地游离。球海绵体肌可以重建。男性患者可实现正常的阴茎阴囊关系。张开且宽阔的阴囊根部变窄。皮瓣向上旋转使耻骨联合区域恢复正常。女性患者阴阜外观满意。青春期后儿童的阴毛分布看起来正常。
