带蒂阴囊纵隔皮瓣尿道成形术重建长段后尿道的临床疗效  

CLINICAL EFFECT OF PEDICLED SCROTAL SEPTAL FLAP URETHROPLASTY ON LONG-SEGMENT POSTERIOR URETHRAL STRICTURE

作　　者：魏强[1] 刘久敏[2] 

机构地区：[1]南方医科大学南方医院肾移植科,广州510515 [2]广东省人民医院泌尿外科

出　　处：《中国修复重建外科杂志》2009年第8期937-939,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结带蒂阴囊纵隔皮瓣尿道成形术在长段后尿道狭窄中的应用价值及疗效。方法2003年1月-2007年12月,收治24例年龄6～54岁的长段后尿道狭窄患者。病程1～5年。狭窄原因:外伤引起后尿道损伤或断裂22例,耻骨上经膀胱前列腺摘除术后1例,长期留置尿管反复尿道感染1例。尿道镜检或膀胱尿道造影均确诊为后尿道狭窄,狭窄长度2.0～5.5cm。其中11例合并尿道假道形成,6例伴尿瘘,2例伴肠瘘,6例合并勃起功能障碍。双侧上尿路排泄性造影检查结果均正常。术中切取大小为2.5cm×2.0cm～6.5cm×2.5cm带蒂阴囊纵隔皮瓣尿道成形术治疗。结果术中出血100～500mL,平均270mL。手术时间90～220min,平均135min。患者皮瓣均成活,切口均Ⅰ期愈合,术后均能正常排尿。24例均获随访,随访时间12～36个月,平均18.6个月。术后1例出现轻度尿失禁,2例尿道狭窄,1例尿道狭窄合并尿瘘,1例远端吻合口旁尿道憩室,均对症处理后能正常排尿。无尿道结石形成,无尿失禁发生,未新增勃起功能障碍患者。术后16个月最大尿流率为14～21mL/s,平均17.6mL/s;术后22个月排尿性造影检查示尿路通畅,未见狭窄及窦道形成。结论带蒂阴囊纵隔皮瓣尿道成形术操作简便,皮瓣易成活,是一种治疗长段后尿道狭窄的安全有效方法。Objective To investigate the therapeutic effect of pedicled scrotal septal flap urethroplasty on longsegment posterior urethral stricture and to assess its application value. Methods From January 2003 to December 2007, 24 patients （age range, 6-54 years old） with long-segment urethral stricture underwent pedicled scrotal septal flap urethroplasty. The duration of the disease was 1-5 years. The stricture was caused by traumatic urethral injury or disruption in 22 cases, postoperative complication of suprapubic transvesical prostatectomy in 1 case, and recurrent urethral infection due to long-term indwelling urinary catheter in 1 case. Urethroscopy or cystourethrography examination confirmed that all cases had urethral stricture 2.0-5.5 cm in length. Eleven cases were complicated with urethral false passage, 6 with urethral fistula, 2 with intestinal fistula, and 6 with erectile dysfunction. The result of excretion urography of bilateral upper urinary tracts was negative in all cases. Pedicled scrotal septal flap 2.5 cm ×2.0 cm-6.5 cm ×2.5 cm in size was harvested during operation, and urethroplasty was performed. Results Volume of blood loss during operation was 100-500 mL （average 270 mL）. The operative time was 90-220 minutes （average 135 minutes）. M1 flaps survived. All wounds healed by first intention. All patients had normal urination after operation. Over the follow-up period of 12-36 months （average 18.6 months）, 1 of the 24 patients suffered from urinary incontinence,. 2 from urethral stricture, 1 from urethral stricture and urethral fistula, and 1 from urethral diverticulum around the distal anastomosis. Those patients got normal urination after symptomatic treatment. No urethral stone, urinary incontinence, and new case of erectile dysfunction occurred. The maximum urinary flow rate 16 months after operation was 14-21 mL/s （average 17.6 mL/s）. Voiding cystourethrography 22 months after operation showed unblocked urinary tract and no formation of stricture and fistula. Conclusion Ped

关 键 词：带蒂阴囊纵隔皮瓣 长段后尿道狭窄 尿道成形术 尿道重建 

分 类 号：R699[医药卫生—泌尿科学]