舌黏膜尿道成形术治疗复杂性尿道下裂  

Urethral reconstruction using lingual mucosal graft for the treatment of complex hypospadias

作　　者：刘中华[1] 范志强[1] 皇甫雪军[1] 

机构地区：[1]河南省人民医院郑州大学人民医院泌尿外科,郑州450003

出　　处：《中华整形外科杂志》2012年第6期440-443,共4页Chinese Journal of Plastic Surgery

摘　　要：目的总结21例舌黏膜尿道成形术治疗复杂性尿道下裂的经验与体会。方法根据阴茎局部尿道皮肤和尿道缺损的程度，以及阴茎腹侧既往手术后瘢痕、阴茎皮肤张力情况，切取口腔舌黏膜游离皮瓣，宽1．5—2．0em、长2～9em，2010年11月至2011年10月临床应用21例，其中舌黏膜嵌入式即Dorsal inlay术式16例，舌黏膜管状法即Tube术式5例（其中Tube＋Duply术式2例），术后定期进行随访并进行尿流率检测观察排尿情况。结果术后随访3～12个月，21例患者的舌黏膜游离皮瓣均存活，术后排尿通畅、尿线粗、无尿瘘、外形良好及尿流率测定正常者13例，占61．9％（13／21）；并发症为尿瘘3例、尿道狭窄5例，占38．1％（8／21）。舌供皮区均一期愈合，且未出现出血、麻木、舌活动受限、发声异常及味觉改变等。结论舌黏膜尿道成形术是治疗复杂性尿道下裂较理想的术式，但Tube术式易发生尿道狭窄，应早期发现及定期尿道扩张；Dorsal inlay术式术后并发症发生率较低且效果良好，可优先考虑此术式。Objective To review and summarize the experience of urethral reconstruction using lingual mucosal graft for the treatment of complex hypospadias. Methods We evaluated the methods using lingual mucosal graft for the treatment of complex hypospadias. The dorsal inlay graft method and the tube graft method were used in our study. Results From Nov. 2010 to Oct. 2011,21 cases were treated. All the cases had at least one failed hypospadisa surgery before. The dorasl inlay grafting technique was used for 16 patients, the tube grafting technique was carried out in 5 patients（2 cases received Tube ＋ Duply method）. The follow-up period ranged from 3 months to 12 months（by average 6 months）. The success rate of the methods was 61.9% with complications in 8 cases. Urethral fistula developed in 3 patients and urethral stricture developed in 5 patients. All cases who suffered stricture received the tube grafting technique. The fistula and urethral stricture were occurred at the site of the urethral termonoterminal anostomosis. Urethral stricture is the most common complication after the tube graft method for the treatment of the complex hypospadias. Conclusions Harvesting the lingual mueosal graft is feasible and easy to perform. The complex hypospadias repair technique using lingual mueosal graft method provides good results. There fore it should be one of the preferred techniques for complex hypospadias repair. The dorsal inlay grafting technique has lower complication rate than the tube grafting technique. Early and regular urethral sounding should be carried out when patients received the tube graft method.

关 键 词：尿道下裂 舌黏膜 外科皮瓣 尿道成形术 

分 类 号：R699.6[医药卫生—泌尿科学]