倒L形阴茎带蒂皮瓣治疗复杂性长段前尿道狭窄的临床研究  

Clinical research with inverted L-shaped penis pedicle flap treatment of complicated long segment anterior urethral stricture

作　　者：徐庆康[1] 段跃[1] 于田强[1] 洪翔[1] 孙先军[1] 杨益[1] 陈峰[1] 于永涛[1] 徐哲丰[1] 

机构地区：[1]武警浙江省总队医院泌尿外科,嘉兴314000

出　　处：《中华泌尿外科杂志》2013年第11期851-854,共4页Chinese Journal of Urology

摘　　要：目的 探讨倒L形阴茎带蒂皮瓣修复复杂性长段前尿道狭窄的疗效. 方法 2008年6月至2011年11月收治男性前尿道超长段狭窄患者12例.年龄28～72岁,平均56岁.狭窄段长度8～ 14 cm,平均10 cm.病因为外伤所致3例,慢性炎症所致7例,前列腺电切术后2例.患者排尿困难病史1～9年,平均2.5年,均有尿道扩张病史,7例曾行尿道内切开手术.术中将尿道狭窄段切开至正常尿道黏膜1 cm处,取阴茎腹侧纵行并向冠状沟处横行延伸的倒L形皮瓣,5-0可吸收线将皮瓣两侧与剪开的狭窄段尿道做连续缝合,两端分别与尿道断端做间断吻合. 结果 术后随访6～38个月,平均21个月.10例患者排尿通畅,最大尿流率17.0～24.5 ml/s,平均19.8 ml/s.尿道造影显示重建段尿道管腔通畅.1例出现漏尿,6个月后再次手术修补治愈；另1例术后6个月出现舟状窝处尿道狭窄,行冷刀内切开治愈. 结论 倒L形阴茎带蒂皮瓣取材方便,手术操作简便,是治疗超长段尿道狭窄的较好材料.Objective To explore the therapeutic effect of using inverted L-shaped penis pedicle flap to treat complicated long segment anterior urethral stricture. Methods From June 2008 to November 2011, 12 male patients with long segment anterior urethral stricture were treated in our hospital. The length of urethral stricture was from 8 cm to 14 cm （mean 10 cm）. The age was from 28 to 72 years （mean 56 years）. In our operation, we cut through the urethral stricture segment to the point that was 1 cm to the normal urethral mucosa. We gained the L-shaped flap from penile ventral that was longitudinal and was trans- verse extension to the Coronal Sulcus. Two apices of the L-shaped flap were sutured to the proximal and distal apices of the urethrotomy with 5-0 polyglactin interrupted stitches. The margins of the opened urethra were sutured to the L-shaped flap with 5-0 polyglactin running sutures. Results The patients were followed up for 6-38 months postoperatively （mean 21 months）. Of the 12 cases, 10 cases voided well and the urinary peak flows ranged from 17.0 to 24.5 ml/s （mean 19.8 ml/s）. Urinary fistula occurred in 1 case, and the pa- tient was cured after the second repair operation 6 months later. Only 1 case had urethral stricture in navicu- lar fossa 6 months after the operation and was cured by cold knife incision treatment. Conclusions Invert- ed L-shaped penis flap is easy to get and the operation is not complicated. So inverted L-shaped penis flap is a good material in the treatment of complicated long segment anterior urethral stricture.

关 键 词：尿道狭窄 外科皮瓣 包皮 外科手术 

分 类 号：R699[医药卫生—泌尿科学]