兒科學(xué)學(xué)習(xí)資料：尿道下裂理論課教案

PAGEPAGE２０課程名稱小兒外科教研室小兒外科教研室授課題目尿道下裂學(xué)時數(shù)1教師姓名劉豐職稱副主任醫(yī)師授課日期2015.9.25授課年級2011授課專業(yè)兒科方向?qū)W生人數(shù)教材及參考書（含教材名稱、版次、主編、出版社）：《小兒外科學(xué)》蔡威、孫寧、魏光輝主編.第5版《PediatricUrology》RealL.第一版?！秾嵱眯好谀蛲饪茖W(xué)》黃澄如主編.第2版?！禤ediatricSurgery》ArnordG.第7版。教學(xué)目的及要求(掌握、熟悉、了解的具體內(nèi)容等)：ClinicalmanifestationDifferentialDiagnosis教學(xué)重點：ClinicalmanifestationDifferentialDiagnosis教學(xué)難點：ClinicalmanifestationDifferentialDiagnosis教學(xué)手段（含特殊教具與器材）：PPT課堂講授外語要求（根據(jù)專本七年制不同層次每個病種提出5-10個中英文關(guān)鍵詞）Hypospadias；Meatalabnomalities；Chordee；SkinAbnomalitiesEnlargedverumontanumandutricles；meatalandurethralstenosis,fistula,diverticulum學(xué)習(xí)指導(dǎo)（含思考題和課外閱讀建議）備注（1.關(guān)于相同內(nèi)容重復(fù)教學(xué)的修改情況等。2.執(zhí)行教案后的自我分析與評價）重慶醫(yī)科大學(xué)兒科學(xué)院理論課教案（續(xù)頁）主要教學(xué)內(nèi)容及時間分配教學(xué)方法（含互動設(shè)計）備注Introduction2minAetiology5minClinicalpresentation10minDiagnosisandAntidiastole10minTreatment10min總結(jié)復(fù)習(xí)3min講稿內(nèi)容（題目）（內(nèi)容：定義、病因、病理、臨床表現(xiàn)、診斷、鑒別診斷、治療等）HypospadiasPurposeClinicalmanifestationDifferentialDiagnosisIntroductionHypospadiascanbedefinedasanarrestinnormaldevelopmentoftheurethra,foreskin,andventralaspectofthepenis.oneofthemostcommoncongenitalanomalies.occurringin3per1000livebirths.AetiologyFormationoftheexternalmalegenitaliaisacomplexdevelopmentalprocessinvolvinggeneticprogramming,celldifferentiation,hormonalsignaling,enzymeactivity,andtissueremodeling.Theabnormaldevelopmentofexternalmalegenitalia.AetiologyEmbryology.（胚胎學(xué)）Geneticfactors.（基因遺傳因素）unclear.multiple-factorinheritance.20-25%.10fold.8%,14%Hormonefactors.（內(nèi)分泌因素）ManyinvestigatorshavealsoattemptedtolinkabnormalitiesinandrogenmetabolismortheARtohypospadias.ClinicalmanifestationMeatalabnomalities(尿道開口異位）ClassificationVentralcurvatureofthepenis（陰莖下彎）Deficientprepuceventrally（包皮分布異常）.Asaresultofthedisturbanceintheformationoftheurethra.Thereisoftendeficientofventralskin.Thefrenulum(系帶）isalwaysabsentinhypospadias.AssociatedAnomaliesUndescendedtestes.Anomalies

ofprocessus

vaginalis.9%ofpatientsUsuallyinposteriorforms.Enlargedverumontanumandutricles（前列腺囊）OtherUrologicalMalformations.penoscrotaltransposition（陰莖陰囊轉(zhuǎn)位）OtherUrologicalMalformations.duplicationofurethra（重復(fù)尿道）OtherUrologicalMalformations.vesicouretericreflux（膀胱輸尿管返流）DiagnosisEasy.Itisusuallydiagnosedbythedoctoruponaclinicalexam.Diagnosedearlyinlifebecauseofthepeculiarappearanceofthehoodedprepuce.DifferentialDiagnosisPosteriorHypospadiasassociatedwithanundescendedtestisshoulddomoreexaminationtoexcludedisordersofsexdifferentiation（性別畸形）.PhysicalexaminationChromosomalHormonalanalysisGonadalbiopsy（性腺活檢）Adrenogenitalsyndrome.（腎上腺性征異常）Truehermaphroditism.（真兩性畸形）TreatmentSurgery:goldstandard.Theobjectoftherapyistoreconstructastraightpeniswithameatusascloseaspossibletothenormalsite.Anoptimalwindowforsurgeryisat3-18mounthsofage.Methods：morethan300.1or2stage.Thisisbecauseofthewidespectrumofhypospadiaspresentationsandpartlybecausenosinglemethodproduces100%satisfactoryresults.Thesurgeonshouldusethetechniquethatissuitableforthepatientandwithwhichheismostconversant.OnlayMathieuDuckettSnodgrass/Tip2stageurethroplastyTreatmentCriterionofcure：haveagoodfunctioningpenis.ChordeecorrectedCompletely.Urethralmeatusinnormalposition.Theappearanceofthepenisissatisfactory.StandingurinationandNormalsexuallife.ComplicationsTheincidenced