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-  2017 

尿生殖窦成形技术在性发育异常中的应用

DOI: doi:10.7507/1002-1892.201705004

Keywords: 尿生殖窦成形, 性发育异常, 外阴修复, 阴道成形

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Abstract:

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

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