尿生殖窦成形技术在性发育异常中的应用

发布时间：2018-04-11 01:22

本文选题：尿生殖窦成形 + 性发育异常　；参考：《中国修复重建外科杂志》2017年09期

【摘要】：目的探讨尿生殖窦成形技术在性发育异常(disorder of sex development,DSD)患者外阴女性化修复治疗中的应用指征和疗效。方法回顾性分析2010年10月—2015年12月,行一期外阴女性化修复的22例DSD患者临床资料。患者年龄1岁2个月~21岁,中位年龄2岁1个月。患者外阴按照Prader分级标准:Ⅰ级7例,Ⅱ级6例,Ⅲ级8例,Ⅳ级1例。外阴女性化修复前均进行膀胱镜检查,示阴道高位汇入3例、低位汇入19例;尿生殖窦长度为0.5~3.0 cm,平均1.6 cm;注水状态下阴道长度3.5~5.5 cm,平均4.4 cm;16例阴道底部可见子宫颈样结构,6例阴道底部为盲端。所有患者采用相同阴蒂成形和阴唇成形方式;采用3种尿生殖窦成形方式,其中尿生殖窦切开术6例,会阴皮瓣嵌入式尿生殖窦成形术11例,部分性尿生殖窦游离术5例。结果手术均顺利完成,术后切口均Ⅰ期愈合。22例患者均获随访,随访时间12~74个月,平均30.5个月。术后6个月,参照Braga等的方式评估外阴形态,其中优13例(59.1%)、良6例(27.3%)、差3例(13.6%)。术后17例能自主排尿,均无尿失禁、膀胱残余尿、尿路感染及阴道尿道瘘发生。结论尿生殖窦成形技术是DSD患者外阴女性化修复治疗中的关键步骤,可在青春期前与阴蒂成形和阴唇成形同期完成。术前全面评估和准确选择手术方式,能取得良好术后外观。
[Abstract]:Objective to investigate the urogenital sinus abnormalities in forming technology (disorder of sex development, DSD) in patients with vulvar feminization in repairing treatment indications and curative effect. Methods Retrospective analysis of October 2010 to December 2015, for a period of the female repair of 22 cases of DSD patients with clinical data. Patients aged 1 years and 2 months ~21 years old, the median age was 2 years and 1 months. Patients with vulvar according to Prader grading criteria: Grade I in 7 cases, 6 cases of grade II, 8 cases of grade III, IV 1 cases. Of the female repair were performed before cystoscopy, 3 cases showed high into the vagina, low into the 19 cases of urogenital; sinus length is 0.5~3.0 cm, average 1.6 cm; under the condition of water vaginal length 3.5~5.5 cm, average 4.4 cm; 16 cases of vaginal bottom visible cervical like structure, 6 cases of vaginal bottom for the blind end. All patients with the same clitoris forming and shaping the labia; using 3 kinds of urogenital sinus forming, which Incision of 6 cases of urogenital sinus, perineal flap embedded urogenital sinus plasty in 11 cases, 5 cases of urogenital sinus free operation. Results the operations were completed successfully. The.22 patients were followed up for incision healing were one-stage surgery, followed up for 12~74 months, average 30.5 months. 6 months. Later, according to Braga's assessment of genital morphology, 13 cases (59.1%), good in 6 cases (27.3%), 3 cases (13.6%). 17 cases of postoperative micturition, no urinary incontinence, bladder residual urine, urinary tract infection and vaginal and urethral fistula. Conclusion the urogenital sinus forming technology is a key step in DSD repair in the treatment of female patients with vulva, be before puberty and the clitoris and labia forming. At the same time forming comprehensive preoperative evaluation and accurate choice of surgical approach can achieve good postoperative appearance.

【作者单位】：四川省医学科学院·四川省人民医院电子科技大学附属医院儿童医学中心小儿外科;
【基金】：四川省医学科学院·四川省人民医院院基金项目(30305030609)~~
【分类号】：R713

【相似文献】