發(fā)布時間：2018-04-11 01:22

  本文選題：尿生殖竇成形 + 性發(fā)育異常��； 參考：《中國修復重建外科雜志》2017年09期

【摘要】：目的探討尿生殖竇成形技術(shù)在性發(fā)育異常(disorder of sex development,DSD)患者外陰女性化修復治療中的應(yīng)用指征和療效。方法回顧性分析2010年10月—2015年12月,行一期外陰女性化修復的22例DSD患者臨床資料�；颊吣挲g1歲2個月~21歲,中位年齡2歲1個月�；颊咄怅幇凑誔rader分級標準:Ⅰ級7例,Ⅱ級6例,Ⅲ級8例,Ⅳ級1例。外陰女性化修復前均進行膀胱鏡檢查,示陰道高位匯入3例、低位匯入19例;尿生殖竇長度為0.5~3.0 cm,平均1.6 cm;注水狀態(tài)下陰道長度3.5~5.5 cm,平均4.4 cm;16例陰道底部可見子宮頸樣結(jié)構(gòu),6例陰道底部為盲端。所有患者采用相同陰蒂成形和陰唇成形方式;采用3種尿生殖竇成形方式,其中尿生殖竇切開術(shù)6例,會陰皮瓣嵌入式尿生殖竇成形術(shù)11例,部分性尿生殖竇游離術(shù)5例。結(jié)果手術(shù)均順利完成,術(shù)后切口均Ⅰ期愈合。22例患者均獲隨訪,隨訪時間12~74個月,平均30.5個月。術(shù)后6個月,參照Braga等的方式評估外陰形態(tài),其中優(yōu)13例(59.1%)、良6例(27.3%)、差3例(13.6%)。術(shù)后17例能自主排尿,均無尿失禁、膀胱殘余尿、尿路感染及陰道尿道瘺發(fā)生。結(jié)論尿生殖竇成形技術(shù)是DSD患者外陰女性化修復治療中的關(guān)鍵步驟,可在青春期前與陰蒂成形和陰唇成形同期完成。術(shù)前全面評估和準確選擇手術(shù)方式,能取得良好術(shù)后外觀。
[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.

【作者單位】： 四川省醫(yī)學科學院·四川省人民醫(yī)院電子科技大學附屬醫(yī)院兒童醫(yī)學中心小兒外科;
【基金】：四川省醫(yī)學科學院·四川省人民醫(yī)院院基金項目(30305030609)~~
【分類號】：R713

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1 張文同,劉月忠;女性尿生殖竇畸形[J];現(xiàn)代婦產(chǎn)科進展;2002年05期

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本文編號：1733812