摘要
目的 探讨一期尿道成形治疗前后尿道同时狭窄的术式选择.方法 2008年1月至2014年12月收治27例男性前后尿道同时有狭窄或闭锁的患者,年龄13-83岁,平均38岁.病因为硬化性苔藓样变相关的尿道狭窄2例,医源性尿道狭窄3例,外伤性后尿道狭窄22例.尿道狭窄段长6-14cm,平均11 cm.手术方法：前尿道狭窄治疗采用2种术式：①阴茎带蒂皮瓣扩大尿道成形术20例;②舌黏膜扩大尿道成形术7例.后尿道狭窄采用3种术式修复：①不离断尿道海绵体的尿道端端吻合术3例;②尿道端端吻合术17例;③不同组织替代性尿道成形术,其中带蒂阴囊皮瓣尿道成形术2例,舌黏膜尿道成形术5例.结果 本组患者术后随访6个月到6年,平均2.6年.27例中24例（88.9％）术后排尿通畅,3例（11.1％）有并发症;其中17例行后尿道端端吻合术者中2例分别于术后4、6个月狭窄复发,再次采用阴囊皮瓣扩大后尿道后排尿通畅;另1例采用阴茎皮瓣扩大尿道术治疗前尿道狭窄的患者于术后9个月发生尿道假性憩室,经再次手术后排尿通畅;余患者逆行尿道造影示尿道管腔粗大;尿流率检查示最大尿流率14.2ml-37.9 ml/s,平均21.3 ml/s.结论 在前后尿道同时狭窄患者的治疗中,采用阴茎皮瓣或口腔黏膜的替代性尿道成形术是治疗前尿道狭窄较合适的方法,后尿道狭窄的治疗应根据狭窄段的长短和局部条件选择尿道端端吻合或其他组织替代性尿道成形术。
Objective To explore selection of the procedures in one stage urethroplasty for treatment of the coexistence of urethral strictures in anterior and posterior urethra.Methods Between January 2008 and December 2014, a total of 27 patients with coexist strictures simultaneously in anterior urethra and posterior urethra were treated in our hospital.The mean age was 38 years old （ranging 13-83 years old.Stricture etiology was secondary to lichen sclerosus in 2 patients, iatrogenic in 3 and posttraumatic in 22.The mean length of urethral stricture was 11cm （ranging 6-14cm）.Two procedures for treatment of anterior urethral stricture, including augmentation of urethroplasty using penile skin flap was performed in 20 patients and augmentation of urethroplasty using lingual mucosa in 7.Three procedures for treatment of posterior urethral stricture, including non-transecting spongiosum end to end anastomosis of the two urethral ends was performed in 3 patients, end to end anastomosis of the two urethral ends was performed in 17 and substitution urethroplasty using different tissues was performed in reminder 7 patients.Of them, pedicle scrotal skin urethroplasty was performed in 2 patients and lingual mucosal graft urethroplasty in 5 patients.Results The patients were mean followed up 2.6 years （ranging 0.545.0 years） with an overall success rate of 88.9% （24 of 27 cases）.Complications developed in 3 patients （11.1%）.Of the 17 patients with end to end anastomosis, urethral stricture developed respectively 4 and 6 months in 2 patients and voiding well after pedicle scrotal skin urethroplasty.Urethral pseudodiverticulum developed 9 months after pedicle penile flap urethroplasty in another patient and voiding well after urethroplasty.Urethrography showed patent urethra with adequate lumen in the remaining patients and mean urinary peak flows was 21.3 ml/s （ranging 14.2-37.9 ml/s）.Conclusions Substitution urethroplasty using penile skin or oral mucosa was more good procedure for anterior urethral stricture during the treatment of the coexistence of urethral stricture in the anterior and posterior urethra.The treatment of posterior urethral stricture was based on the length of the stricture, local condition to make a choice between anastomotic urethral reconstruction and substitution urethroplasty using other tissue.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2016年第1期43-47,共5页
Chinese Journal of Urology
关键词
尿道狭窄
尿道重建
皮瓣
舌黏膜
Urethral stricture
Urethral reconstruction
Skin flap
Lingual mucosa
