阴囊血管的显微解剖及临床应用
摘要
目的：
观察阴囊动脉走行规律、分布及各阴囊动脉的血管外径,为涉及到男性会阴区的临床显微外科手术提供解剖学依据。
方法：
随机选取5例成年男性标本,经股动脉行乳胶灌注,制作成显微解剖标本。解剖阴囊后动脉、阴囊前动脉和阴囊外侧动脉的起源、走行、分支、分支之间的吻合并测量其外径。血管外径用精度0.02mm的游标卡尺测量。统计学分析采用SPSS 13.0软件进行,结果用最大值、最小值及中位数值表示。
结果：
1.阴囊血液由阴囊后动脉、阴囊前动脉和阴囊外侧动脉供应。阴囊后动脉起源于阴部内动脉,为阴部内动脉的终末支之一；阴囊前动脉起源于阴部外动脉,为阴部外动脉终末支之一；阴囊外侧动脉来自闭孔动脉前皮支,为闭孔动脉终末支之一。
2.会阴动脉为阴部内动脉的分支,其主干在球海绵体肌和坐骨海绵体肌之间的沟内走行,会阴动脉越过会阴浅横肌后穿出内收肌点即为阴囊后动脉起始处,此后斜向腹侧走行,阴囊后动脉主干位于会阴浅横肌穿出点至阴囊后缘之间,阴囊后动脉起始处外径最大值为1.76mm,最小值为1.60mm,中位数值为1.70mm。其主干在阴囊后缘2cm范围内,分为2-3支,为阴囊后动脉内侧支(中隔支)和外侧支。内侧支供应中隔部下部皮肤,外侧支分出后向腹外侧走行,分为3-4支,分布于阴囊后1／3处皮肤和少部分的阴囊中隔处皮肤。阴囊后动脉内侧支外径最大值为0.76mm,最小值为0.62mm,中位数值为0.72mm；外侧支外径最大值为1.22mm,最小值为1.10mm,中位数值为1.16mm。
3.阴部外动脉分为阴部外浅动脉和阴部外深动脉,阴部外浅动脉分为阴囊前动脉和阴部外动脉阴茎支。阴部外浅动脉于阴茎根部恒定的发出阴囊前动脉,血管外径最大值为0.72mm,最小值为0.60mm,中位数值为0.66mm。
4.阴囊前动脉分为内侧支和外侧支,外侧支相对较细小,于阴茎根部外上方自阴部外浅动脉发出,分布于阴囊外上方；内侧支于阴茎根部外侧发出,血管外径最大值为0.62mm,最小值为0.48mm,中位数值为0.54mm。阴囊前动脉内侧支在阴囊肉膜层内走行,分布于阴囊前内侧皮肤,有同名静脉与之伴行。
5.阴囊外侧动脉来自闭孔动脉前皮支。闭孔动脉前皮支自耻骨下支外侧缘或穿经其外侧骨质浅出,分为内侧支和外侧支。外侧支分布于阴股沟区中部；内侧支即阴囊外侧动脉,分布于阴囊外侧中1／3区皮肤,血管外径最大值为0.70mm,最小值为0.56mm,中位数值为0.62mm,有同名静脉与之伴行。
6.阴囊后动脉内侧支在阴囊内上方和内下方分别与阴囊前动脉内侧支、阴囊后动脉外侧支之间有血管吻合；阴囊外侧动脉与阴囊后动脉外侧支和阴囊前动脉外侧支在阴囊外下、外上部也存在终末支血管吻合。
结论：
1.阴囊部血供来源于阴囊前动脉、阴囊后动脉和阴囊外侧动脉。阴囊前动脉起源于阴部外浅动脉,起始处血管外径最大值为0.72mm,最小值为0.60mm,中位数值为0.66mm；阴囊后动脉起源于阴部内动脉,起始处外径最大值为1.76mm,最小值为1.60mm,中位数值为1.70mm；阴囊外侧动脉起源于闭孔动脉,起始处血管外径最大值为0.70mm,最小值为0.56mm,中位数值为0.62mm。以上几条动脉管径已经达到临床皮瓣切取对管径的要求。
2.阴囊处血液供应丰富,不仅有三条主要动脉,而且部分分支：阴囊后动脉内侧支外径最大值为0.76mm,最小值为0.62mm,中位数值为0.72mm；阴囊后动脉外侧支外径最大值为1.22mm,最小值为1.10mm,中位数值为1.16mm；阴囊前动脉内侧支血管外径最大值为0.62mm,最小值为0.48mm,中位数值为0.54mm。这几条分支管径也能够达到临床皮瓣切取对管径的要求。
3.阴囊外侧后1／3主要由阴囊后动脉外侧支供应血液；阴囊外侧中间1／3由阴囊外侧动脉供应；阴囊外侧前1／3主要由阴囊前动脉外侧支供应；阴囊中隔处主要阴囊后动脉内侧支、阴囊前动脉内侧支供应。
4.阴囊前动脉与阴囊后动脉,阴囊外侧动脉与阴囊前、后动脉存在终末支吻合。
5.进行阴囊部血管的显微解剖研究,能够了解认识到阴囊区显微手术的解剖基础,从而能够对会阴部缺损修复、阴茎再造、阴囊部皮瓣及其其他阴囊部的手术认识更加深刻。
Objective
To study the course, distribution and anastomosis of scrotal arteries, measure the maximal diameters at different planes, and provide anatomical guides for clinical treatments involving the arteries around this area.
Methods
5 specimens were selected randomly and perfused with red latex to observe the arterial distribution and diameters of posterior scrotal artery, anterior scrotal artery and lateral scrotal artery. All the diameters were measured by vernier caliper, the reading error is 0.02mm. Data was handled by spss 13.0 analysis system.
Results
1. The main arterial blood supply to the scrotal region came from posterior scrotal artery, anterior scrotal artery and lateral scrotal artery. Anterior scrotal perineal artery originate from external pudendal arteries, it's the terminal branches of external pudendal artery; Posterior scrotal perineal artery is originated from internal pudendal arteries, it's the terminal branches of internal pudendal artery; Lateral scrotal perineal artery is originated from obturator artery, it's the terminal branches of obturator artery. Posterior scrotal artery, of which the max diameter is 1.76mm, is originated from the beginning of the pudendal artery. The max diameter of anterior scrotal artery from the beginning is 0.72mm. The max diameter of lateral scrotal artery is 0.70mm.
2. Posterior scrotal artery from the internal pudendal artery, the perineal artery across the superficial transverse perineal muscle adductor after the piercing point shall scrotal artery starting point, then take the form of the ventral oblique, trunk muscles and ischium in the sponge ball sponge walk between the trench-shaped muscle at the superficial transverse perineal muscle in to the posterior margin of scrotum.
3. Trunk of posterior scrotal artery in the posterior border of 2cm within the scrotum, divided into 2-3 pieces for the scrotal artery internal (septal branch) and the lateral branch. Internal septal branch under the Ministry of Supply Department of the skin. After separation of lateral support to the ventrolateral walk, divided into 3-4 branches located in the scrotum after the 1/3 across the skin and the skin in the scrotum. The max diameter of internal branch of posterior scrotal artery is 0.76mm, The max diameter of lateral branch is 1.22mm.
4. External pudendal artery is divided into the superficial external pudendal artery and the deep external pudendal artery, superficial external pudendal artery is divided into anterior scrotal artery and penile artery branch. On the base of the penis anterior scrotal artery whose max diameter is 0.72mm, comes from external pudendal artery.
5. Anterior scrotal scrotal artery can be divided into internal and lateral branches, lateral branches is relatively thinner, locates at outside of the superioral scrotum; internal branches whose max diameter is 0.62mm, locates at superioral part of scrotal septum.
6. Lateral scrotal artery comes from the anterior cutaneous branches of obturator artery. The latter is divided into internal and lateral branch. Internal branch is also called lateral scrotal artery, which locates at the outside of the middle 1/3 area of scrotal skin, it's max diameter is 0.70mm, with the vein accompanies.
7. There are existences of vascular anastomosis between posterior scrotal artery internal branch and posterior scrotal artery lateral branch outside the top of Scrotal septum; There are existences of vascular anastomosis between posterior scrotal artery internal branch and anterior scrotal artery internal branch outside the bottom of Scrotal septum.There are existences of vascular anastomosis between lateral scrotal artery and posterior scrotal artery lateral branch outside the top of Scrotum;There are existences of vascular anastomosis between lateral scrotal artery and anterior scrotal artery lateral branch outside the bottom of Scrotum.
Conclusion:
1. Blood of the scrotum are mainly supplied by the anterior scrotal arteries, lateral scrotal arteries and posterior scrotal arteries. Anterior scrotal perineal artery originate from external pudendal arteries, Posterior scrotal perineal artery originate from internal pudendal arteries, Lateral scrotal perineal artery originate from obturator artery.
2. The main artery of scrotum after lateral 1/3 are from the lateral scrotal branch supplying blood; scrotum outside the middle 1/3 by the scrotum lateral artery; scrotum outside of the top 1/3 by the scrotum before the main supply artery lateral branches; scrotum the main point scrotal septal artery internal branch, internal branch of anterior scrotal supply.
3. There are existences of vascular anastomosis between posterior scrotal artery and anterior scrotal artery. There are existences of vascular anastomosis between lateral scrotal artery and anterior、posterior scrotal artery.
4. Rich blood supply to scrotum, posterior scrotal arteries lateral branches, anterior scrotal arteries lateral provides a good vascular basis for cutting away flaps in clinic.
5. Understanding vascular anatomy of scrotum, would provide anatomical basis for the perineal defect, penis reconstruction, scrotal flap and the other genital surgery.
观察阴囊动脉走行规律、分布及各阴囊动脉的血管外径,为涉及到男性会阴区的临床显微外科手术提供解剖学依据。
方法：
随机选取5例成年男性标本,经股动脉行乳胶灌注,制作成显微解剖标本。解剖阴囊后动脉、阴囊前动脉和阴囊外侧动脉的起源、走行、分支、分支之间的吻合并测量其外径。血管外径用精度0.02mm的游标卡尺测量。统计学分析采用SPSS 13.0软件进行,结果用最大值、最小值及中位数值表示。
结果：
1.阴囊血液由阴囊后动脉、阴囊前动脉和阴囊外侧动脉供应。阴囊后动脉起源于阴部内动脉,为阴部内动脉的终末支之一；阴囊前动脉起源于阴部外动脉,为阴部外动脉终末支之一；阴囊外侧动脉来自闭孔动脉前皮支,为闭孔动脉终末支之一。
2.会阴动脉为阴部内动脉的分支,其主干在球海绵体肌和坐骨海绵体肌之间的沟内走行,会阴动脉越过会阴浅横肌后穿出内收肌点即为阴囊后动脉起始处,此后斜向腹侧走行,阴囊后动脉主干位于会阴浅横肌穿出点至阴囊后缘之间,阴囊后动脉起始处外径最大值为1.76mm,最小值为1.60mm,中位数值为1.70mm。其主干在阴囊后缘2cm范围内,分为2-3支,为阴囊后动脉内侧支(中隔支)和外侧支。内侧支供应中隔部下部皮肤,外侧支分出后向腹外侧走行,分为3-4支,分布于阴囊后1／3处皮肤和少部分的阴囊中隔处皮肤。阴囊后动脉内侧支外径最大值为0.76mm,最小值为0.62mm,中位数值为0.72mm；外侧支外径最大值为1.22mm,最小值为1.10mm,中位数值为1.16mm。
3.阴部外动脉分为阴部外浅动脉和阴部外深动脉,阴部外浅动脉分为阴囊前动脉和阴部外动脉阴茎支。阴部外浅动脉于阴茎根部恒定的发出阴囊前动脉,血管外径最大值为0.72mm,最小值为0.60mm,中位数值为0.66mm。
4.阴囊前动脉分为内侧支和外侧支,外侧支相对较细小,于阴茎根部外上方自阴部外浅动脉发出,分布于阴囊外上方；内侧支于阴茎根部外侧发出,血管外径最大值为0.62mm,最小值为0.48mm,中位数值为0.54mm。阴囊前动脉内侧支在阴囊肉膜层内走行,分布于阴囊前内侧皮肤,有同名静脉与之伴行。
5.阴囊外侧动脉来自闭孔动脉前皮支。闭孔动脉前皮支自耻骨下支外侧缘或穿经其外侧骨质浅出,分为内侧支和外侧支。外侧支分布于阴股沟区中部；内侧支即阴囊外侧动脉,分布于阴囊外侧中1／3区皮肤,血管外径最大值为0.70mm,最小值为0.56mm,中位数值为0.62mm,有同名静脉与之伴行。
6.阴囊后动脉内侧支在阴囊内上方和内下方分别与阴囊前动脉内侧支、阴囊后动脉外侧支之间有血管吻合；阴囊外侧动脉与阴囊后动脉外侧支和阴囊前动脉外侧支在阴囊外下、外上部也存在终末支血管吻合。
结论：
1.阴囊部血供来源于阴囊前动脉、阴囊后动脉和阴囊外侧动脉。阴囊前动脉起源于阴部外浅动脉,起始处血管外径最大值为0.72mm,最小值为0.60mm,中位数值为0.66mm；阴囊后动脉起源于阴部内动脉,起始处外径最大值为1.76mm,最小值为1.60mm,中位数值为1.70mm；阴囊外侧动脉起源于闭孔动脉,起始处血管外径最大值为0.70mm,最小值为0.56mm,中位数值为0.62mm。以上几条动脉管径已经达到临床皮瓣切取对管径的要求。
2.阴囊处血液供应丰富,不仅有三条主要动脉,而且部分分支：阴囊后动脉内侧支外径最大值为0.76mm,最小值为0.62mm,中位数值为0.72mm；阴囊后动脉外侧支外径最大值为1.22mm,最小值为1.10mm,中位数值为1.16mm；阴囊前动脉内侧支血管外径最大值为0.62mm,最小值为0.48mm,中位数值为0.54mm。这几条分支管径也能够达到临床皮瓣切取对管径的要求。
3.阴囊外侧后1／3主要由阴囊后动脉外侧支供应血液；阴囊外侧中间1／3由阴囊外侧动脉供应；阴囊外侧前1／3主要由阴囊前动脉外侧支供应；阴囊中隔处主要阴囊后动脉内侧支、阴囊前动脉内侧支供应。
4.阴囊前动脉与阴囊后动脉,阴囊外侧动脉与阴囊前、后动脉存在终末支吻合。
5.进行阴囊部血管的显微解剖研究,能够了解认识到阴囊区显微手术的解剖基础,从而能够对会阴部缺损修复、阴茎再造、阴囊部皮瓣及其其他阴囊部的手术认识更加深刻。
Objective
To study the course, distribution and anastomosis of scrotal arteries, measure the maximal diameters at different planes, and provide anatomical guides for clinical treatments involving the arteries around this area.
Methods
5 specimens were selected randomly and perfused with red latex to observe the arterial distribution and diameters of posterior scrotal artery, anterior scrotal artery and lateral scrotal artery. All the diameters were measured by vernier caliper, the reading error is 0.02mm. Data was handled by spss 13.0 analysis system.
Results
1. The main arterial blood supply to the scrotal region came from posterior scrotal artery, anterior scrotal artery and lateral scrotal artery. Anterior scrotal perineal artery originate from external pudendal arteries, it's the terminal branches of external pudendal artery; Posterior scrotal perineal artery is originated from internal pudendal arteries, it's the terminal branches of internal pudendal artery; Lateral scrotal perineal artery is originated from obturator artery, it's the terminal branches of obturator artery. Posterior scrotal artery, of which the max diameter is 1.76mm, is originated from the beginning of the pudendal artery. The max diameter of anterior scrotal artery from the beginning is 0.72mm. The max diameter of lateral scrotal artery is 0.70mm.
2. Posterior scrotal artery from the internal pudendal artery, the perineal artery across the superficial transverse perineal muscle adductor after the piercing point shall scrotal artery starting point, then take the form of the ventral oblique, trunk muscles and ischium in the sponge ball sponge walk between the trench-shaped muscle at the superficial transverse perineal muscle in to the posterior margin of scrotum.
3. Trunk of posterior scrotal artery in the posterior border of 2cm within the scrotum, divided into 2-3 pieces for the scrotal artery internal (septal branch) and the lateral branch. Internal septal branch under the Ministry of Supply Department of the skin. After separation of lateral support to the ventrolateral walk, divided into 3-4 branches located in the scrotum after the 1/3 across the skin and the skin in the scrotum. The max diameter of internal branch of posterior scrotal artery is 0.76mm, The max diameter of lateral branch is 1.22mm.
4. External pudendal artery is divided into the superficial external pudendal artery and the deep external pudendal artery, superficial external pudendal artery is divided into anterior scrotal artery and penile artery branch. On the base of the penis anterior scrotal artery whose max diameter is 0.72mm, comes from external pudendal artery.
5. Anterior scrotal scrotal artery can be divided into internal and lateral branches, lateral branches is relatively thinner, locates at outside of the superioral scrotum; internal branches whose max diameter is 0.62mm, locates at superioral part of scrotal septum.
6. Lateral scrotal artery comes from the anterior cutaneous branches of obturator artery. The latter is divided into internal and lateral branch. Internal branch is also called lateral scrotal artery, which locates at the outside of the middle 1/3 area of scrotal skin, it's max diameter is 0.70mm, with the vein accompanies.
7. There are existences of vascular anastomosis between posterior scrotal artery internal branch and posterior scrotal artery lateral branch outside the top of Scrotal septum; There are existences of vascular anastomosis between posterior scrotal artery internal branch and anterior scrotal artery internal branch outside the bottom of Scrotal septum.There are existences of vascular anastomosis between lateral scrotal artery and posterior scrotal artery lateral branch outside the top of Scrotum;There are existences of vascular anastomosis between lateral scrotal artery and anterior scrotal artery lateral branch outside the bottom of Scrotum.
Conclusion:
1. Blood of the scrotum are mainly supplied by the anterior scrotal arteries, lateral scrotal arteries and posterior scrotal arteries. Anterior scrotal perineal artery originate from external pudendal arteries, Posterior scrotal perineal artery originate from internal pudendal arteries, Lateral scrotal perineal artery originate from obturator artery.
2. The main artery of scrotum after lateral 1/3 are from the lateral scrotal branch supplying blood; scrotum outside the middle 1/3 by the scrotum lateral artery; scrotum outside of the top 1/3 by the scrotum before the main supply artery lateral branches; scrotum the main point scrotal septal artery internal branch, internal branch of anterior scrotal supply.
3. There are existences of vascular anastomosis between posterior scrotal artery and anterior scrotal artery. There are existences of vascular anastomosis between lateral scrotal artery and anterior、posterior scrotal artery.
4. Rich blood supply to scrotum, posterior scrotal arteries lateral branches, anterior scrotal arteries lateral provides a good vascular basis for cutting away flaps in clinic.
5. Understanding vascular anatomy of scrotum, would provide anatomical basis for the perineal defect, penis reconstruction, scrotal flap and the other genital surgery.
引文
1.杨志明,王乃佐,干季华,王发斌等.修复重建外科学[M].北京：人民卫生出版社,2001,1002-1003.
2.赵振民,翟洪峰,穆兰花,等.阴囊前动、静脉血管蒂阴囊岛状皮瓣修复尿道下裂[J].中华整形外科杂志,2000,16(5)：277-280.
3.龙道畴,吴小蔚,余墨声,罗定安,王松山,朱辉.阴囊皮瓣修复阴茎缺损的临床应用[J].中国美容整形外科杂志,2007,18(2)：96-97.
4. Woods J E,After G,Mcland B,et al,Experience with vaginal recondtruction utilizing the modified Singaporeflap[J]. Plast Reconatr Surg,1992,20(2):70-274.
5. Wee JT, Joseph V T. A new technique of vaginal reconstruction using neurovascular pudendal thigh flap:a preliminary report [J]. P last Reconst Surg,1989,83 (4):701-709.
6.郭恩覃,季正伦,张明利,等.会阴轴性皮瓣再造阴道[J].中华外科杂志,1990,28(9)：552.
7. Chen Z, Chen C, Chen M. et al. Vaginal reconstruction using Perineal-thigh flaps with subcutaneous pedicle [J]. Chin med Sci J, 1991,6(1):14.
8.何清濂,章惠兰,陈敏亮,等.阴股沟皮瓣一期器官(阴道、阴茎)再造[J].第二军医大学学报,1990,11(1)：94.
9. Canatra M A, Ansari N U. Pudendal thigh flap for con-genital absence of vagina [J]. J Pak Med Assoc,2005,55(4):143-145.
10.Copcu E, Odabasi A R, Sivrioglu N, et al. Protection of vaginal depth by laparoscopy in vaginal reconst ruction with Pudendal thigh flaps [J]. Plast Reconst r Surg,2005,115 (2):663-664.
11.白晋,宋建星,杨超,乌兰哈斯,刘冰,楼晓丽,阴股沟皮瓣的显微解剖研究[J].中国修复重建外科杂志,2007,21(4)：326-328.
12.刘元波,李森恺,李养群,杨明勇等,阴囊皮肤多源性血供系统应用解剖学研究[J].中华整形外科杂志,2001,17(1)：51-53.
13.Kuo YR, Jeng SF, Kuo MH, et al. Free anterior lateral thigh flap for
extremity reconstruction:clinical experience and functional assessment of donor site[J]. P last Reconstr Surg,2001,107 (7): 1766-1771.
14.Gray H. Gray's anatomy of human body,29th ed[M]. Philadelphia: Lea and Febiger,1978,870-872.
15.赵天兰,程新德,于光生,李光早,徐静,张莉,阴股沟皮瓣的解剖学研究与临床应用[J].1999,24,4：225-227.
16.Gallentine ML, Morey AF, Thompson IM Jr. Hypospadias:a contemporary epidemiologic assessment [J].Urology,2001, 57:788-790.
17.Ang IH, Kim HS, Shin JH, et al. Comparison of anti-androgenic activity of flutamide, vinclozolin, procymidone, linuron, and p, p'-DDE in rodent 10-day Hershberger assay [J]. Toxicology,2004, 1999(2-3):145-159.
18.Shirota M, Mukai M, Sakurada Y, et al. Effects of vertically transferred 3,3',4,4',5-pentachlorobiphenyl (PCB-126) on the reproductive development of female rats [J]. J Reprod Dev,2006, 52(6):751-761.
19.Bowman CJ, Barlow NJ, Turner KJ, et al. Effects of in utero exposureto finasteride on androgen-dependent reproductive development in the male rat [J]. Toxicol Sci,2003,74(2):393-406.
20.Agras K, Willingham E, Liu B, et al. Ontogeny of androgen receptor and disruption of its mRNA expression by exogenous estrogens during morphogenesis of the genital tubercle [J]. J-Urol,2006, 176(4 Pt 2):1883-1888.
21.Radpour R, Rezaee M, Tavasoly A, et al. Association of long polyglycine tracts (GGN repeats) in exon 1 of the androgen receptor gene with cryptorchidism and penile hypospadias in Iranian patients [J]. J Androl,2007,28(1):164-169.
22.Wogelius P, Horvath-Puho E, Pedersen L, et al. Maternal use of oral contraceptives and risk of hypospadias-a population-based case-control study [J]. Eur J Epidemiol,2006,21(10):777-781.
23.Brouwers MM, Feitz WF, Roelofs LA, et al. Hypospadias:a transgenerational effect of diethylstilbestrol [J]. Hum Reprod,2006, 21 (3):666-669.
24.Wang Z, Liu BC, Lin GT, et al. Up-regulation of estrogen responsive genes in hypospadias:microarray analysis [J]. J Urol.2007,177(5):1939-1946.
25.Li,-J;Willingham,-E; Baskin,-L-S, et al. Gene expression profiles in mouse urethral development [J]. BJU-Int.2006,98 (4):880-885.
26.Liu, B; Wang, Z; Lin, G, et al. Activating transcription factor is up-regulated in patients with hypospadias [J]. Pediatr-Res.2005, 58(6):1280-1283.
27.Willingham, E; Baskin, LS. Candidate genes and their response to environmental agents in the etiology of hypospadias [J].Nat-Clin-Pract-Urol,2007,4(5):270-279.
28.lexander K. C. Leung. William L. Hypospadias:an update [J]. Asian J Androl,2007,1:16-22.
29.Barcat J. Current concepts of treatment [M]. Boston:Little Brown, 1973:196.
30.张源峰等,尿道下裂外科治疗常用术式的现状和进展[J].中国男科学杂志,2009,23(10)：63-64.
31.黄澄如.中华小儿外科杂志.1997；18(1)：1-2.
32.Bellman AB, Cass EJ.J Urol 1982; 128(6):1273-1274.
33.American Academy of Pediatrics. Pediatrics 1996;97(4):590-594.
34.袁启龙,曾晓勇,叶章群.中国男科学杂志2008；22(5)：64-69.
35.冯旭生,周菊玲,梅骅,等.尿道下裂手术15年回顾(附322例报告)[J].中华泌尿外科杂志,2000；21(8)：494-496.
36.段晨旺,黄循镭,陈斌,李强,陈文,李森恺.应用阴囊中隔飞鸟状皮瓣修复尿道下裂[J]中国修复重建外科杂志,2009,23,(3)：316-317.
37.王彬,梁成均,阴囊纵隔皮瓣一期修复尿道下裂18例报告[J].华北煤炭医学院学报,2009,11,(6)：840-841.
38.陈敏,鲁功成,张齐钧,等.尿道下裂15年诊治经验总结[J].临床泌尿外科杂志,2002；17(8)：409.
39.梅骅,陈凌武,高新.泌尿外科手术学[M].3版.北京：人民卫生出版社，2008：457-458.
40.党向阳,刘成倍,王文敏,等.皮管一期正位尿道成形术治疗先天性尿道下裂250例[J].微创医学,2008,3(1)：51-52.
41.刘萃龙,郭建军,李晓武,改良阴囊皮瓣折叠尿道成形术修复尿道下裂临床观察[J].山东医药,2009,49(10)：75-76.
42.侯金华,黄峻松,顾恒,阴囊侧方皮瓣修复阴囊及会阴型尿道下裂8例[J].淮海医药,2004,20(2)：122-123.
43.B. Churchill, J. Van Savage, A. Khoury, G. McLorie. The Dartos Flap as an Adjunct in Preventing Urethrocutaneous Fistulas inRepeat Hypospadias Surgery [J]. TheJournal of Urology,156(6):2047-2049.
44.J.Chuang, C.Shieh. Two-layer versus one-layer closure in transverse island flap repair of posterior hypospadias [J]. Journal of Pediatric Surgery,30,5:739-742.
45.刘元波,李森恺,李养群,杨明勇,赵振民,霍然,阴囊后动脉外侧支血管蒂阴囊皮瓣的临床应用[J].中华整形外科杂志,2002,18,(6)：367-368.
2.赵振民,翟洪峰,穆兰花,等.阴囊前动、静脉血管蒂阴囊岛状皮瓣修复尿道下裂[J].中华整形外科杂志,2000,16(5)：277-280.
3.龙道畴,吴小蔚,余墨声,罗定安,王松山,朱辉.阴囊皮瓣修复阴茎缺损的临床应用[J].中国美容整形外科杂志,2007,18(2)：96-97.
4. Woods J E,After G,Mcland B,et al,Experience with vaginal recondtruction utilizing the modified Singaporeflap[J]. Plast Reconatr Surg,1992,20(2):70-274.
5. Wee JT, Joseph V T. A new technique of vaginal reconstruction using neurovascular pudendal thigh flap:a preliminary report [J]. P last Reconst Surg,1989,83 (4):701-709.
6.郭恩覃,季正伦,张明利,等.会阴轴性皮瓣再造阴道[J].中华外科杂志,1990,28(9)：552.
7. Chen Z, Chen C, Chen M. et al. Vaginal reconstruction using Perineal-thigh flaps with subcutaneous pedicle [J]. Chin med Sci J, 1991,6(1):14.
8.何清濂,章惠兰,陈敏亮,等.阴股沟皮瓣一期器官(阴道、阴茎)再造[J].第二军医大学学报,1990,11(1)：94.
9. Canatra M A, Ansari N U. Pudendal thigh flap for con-genital absence of vagina [J]. J Pak Med Assoc,2005,55(4):143-145.
10.Copcu E, Odabasi A R, Sivrioglu N, et al. Protection of vaginal depth by laparoscopy in vaginal reconst ruction with Pudendal thigh flaps [J]. Plast Reconst r Surg,2005,115 (2):663-664.
11.白晋,宋建星,杨超,乌兰哈斯,刘冰,楼晓丽,阴股沟皮瓣的显微解剖研究[J].中国修复重建外科杂志,2007,21(4)：326-328.
12.刘元波,李森恺,李养群,杨明勇等,阴囊皮肤多源性血供系统应用解剖学研究[J].中华整形外科杂志,2001,17(1)：51-53.
13.Kuo YR, Jeng SF, Kuo MH, et al. Free anterior lateral thigh flap for
extremity reconstruction:clinical experience and functional assessment of donor site[J]. P last Reconstr Surg,2001,107 (7): 1766-1771.
14.Gray H. Gray's anatomy of human body,29th ed[M]. Philadelphia: Lea and Febiger,1978,870-872.
15.赵天兰,程新德,于光生,李光早,徐静,张莉,阴股沟皮瓣的解剖学研究与临床应用[J].1999,24,4：225-227.
16.Gallentine ML, Morey AF, Thompson IM Jr. Hypospadias:a contemporary epidemiologic assessment [J].Urology,2001, 57:788-790.
17.Ang IH, Kim HS, Shin JH, et al. Comparison of anti-androgenic activity of flutamide, vinclozolin, procymidone, linuron, and p, p'-DDE in rodent 10-day Hershberger assay [J]. Toxicology,2004, 1999(2-3):145-159.
18.Shirota M, Mukai M, Sakurada Y, et al. Effects of vertically transferred 3,3',4,4',5-pentachlorobiphenyl (PCB-126) on the reproductive development of female rats [J]. J Reprod Dev,2006, 52(6):751-761.
19.Bowman CJ, Barlow NJ, Turner KJ, et al. Effects of in utero exposureto finasteride on androgen-dependent reproductive development in the male rat [J]. Toxicol Sci,2003,74(2):393-406.
20.Agras K, Willingham E, Liu B, et al. Ontogeny of androgen receptor and disruption of its mRNA expression by exogenous estrogens during morphogenesis of the genital tubercle [J]. J-Urol,2006, 176(4 Pt 2):1883-1888.
21.Radpour R, Rezaee M, Tavasoly A, et al. Association of long polyglycine tracts (GGN repeats) in exon 1 of the androgen receptor gene with cryptorchidism and penile hypospadias in Iranian patients [J]. J Androl,2007,28(1):164-169.
22.Wogelius P, Horvath-Puho E, Pedersen L, et al. Maternal use of oral contraceptives and risk of hypospadias-a population-based case-control study [J]. Eur J Epidemiol,2006,21(10):777-781.
23.Brouwers MM, Feitz WF, Roelofs LA, et al. Hypospadias:a transgenerational effect of diethylstilbestrol [J]. Hum Reprod,2006, 21 (3):666-669.
24.Wang Z, Liu BC, Lin GT, et al. Up-regulation of estrogen responsive genes in hypospadias:microarray analysis [J]. J Urol.2007,177(5):1939-1946.
25.Li,-J;Willingham,-E; Baskin,-L-S, et al. Gene expression profiles in mouse urethral development [J]. BJU-Int.2006,98 (4):880-885.
26.Liu, B; Wang, Z; Lin, G, et al. Activating transcription factor is up-regulated in patients with hypospadias [J]. Pediatr-Res.2005, 58(6):1280-1283.
27.Willingham, E; Baskin, LS. Candidate genes and their response to environmental agents in the etiology of hypospadias [J].Nat-Clin-Pract-Urol,2007,4(5):270-279.
28.lexander K. C. Leung. William L. Hypospadias:an update [J]. Asian J Androl,2007,1:16-22.
29.Barcat J. Current concepts of treatment [M]. Boston:Little Brown, 1973:196.
30.张源峰等,尿道下裂外科治疗常用术式的现状和进展[J].中国男科学杂志,2009,23(10)：63-64.
31.黄澄如.中华小儿外科杂志.1997；18(1)：1-2.
32.Bellman AB, Cass EJ.J Urol 1982; 128(6):1273-1274.
33.American Academy of Pediatrics. Pediatrics 1996;97(4):590-594.
34.袁启龙,曾晓勇,叶章群.中国男科学杂志2008；22(5)：64-69.
35.冯旭生,周菊玲,梅骅,等.尿道下裂手术15年回顾(附322例报告)[J].中华泌尿外科杂志,2000；21(8)：494-496.
36.段晨旺,黄循镭,陈斌,李强,陈文,李森恺.应用阴囊中隔飞鸟状皮瓣修复尿道下裂[J]中国修复重建外科杂志,2009,23,(3)：316-317.
37.王彬,梁成均,阴囊纵隔皮瓣一期修复尿道下裂18例报告[J].华北煤炭医学院学报,2009,11,(6)：840-841.
38.陈敏,鲁功成,张齐钧,等.尿道下裂15年诊治经验总结[J].临床泌尿外科杂志,2002；17(8)：409.
39.梅骅,陈凌武,高新.泌尿外科手术学[M].3版.北京：人民卫生出版社，2008：457-458.
40.党向阳,刘成倍,王文敏,等.皮管一期正位尿道成形术治疗先天性尿道下裂250例[J].微创医学,2008,3(1)：51-52.
41.刘萃龙,郭建军,李晓武,改良阴囊皮瓣折叠尿道成形术修复尿道下裂临床观察[J].山东医药,2009,49(10)：75-76.
42.侯金华,黄峻松,顾恒,阴囊侧方皮瓣修复阴囊及会阴型尿道下裂8例[J].淮海医药,2004,20(2)：122-123.
43.B. Churchill, J. Van Savage, A. Khoury, G. McLorie. The Dartos Flap as an Adjunct in Preventing Urethrocutaneous Fistulas inRepeat Hypospadias Surgery [J]. TheJournal of Urology,156(6):2047-2049.
44.J.Chuang, C.Shieh. Two-layer versus one-layer closure in transverse island flap repair of posterior hypospadias [J]. Journal of Pediatric Surgery,30,5:739-742.
45.刘元波,李森恺,李养群,杨明勇,赵振民,霍然,阴囊后动脉外侧支血管蒂阴囊皮瓣的临床应用[J].中华整形外科杂志,2002,18,(6)：367-368.