舌黏膜背侧替代一期尿道成形术治疗修复失败的尿道下裂患者的疗效  

Efficacy of one-stage dorsal lingual mucosal graft urethroplasty for the treatment of failed hypospadias repair

作　　者：徐月敏[1] 撒应龙[1] 傅强[1] 张炯[1] 谢弘[1] 冯超[1] 宋鲁杰[1] 郭辉[1] 

机构地区：[1]上海交通大学附属第六人民医院泌尿科上海东方泌尿修复重建研究所,200233

出　　处：《中华泌尿外科杂志》2015年第3期217-220,共4页Chinese Journal of Urology

摘　　要：目的 探讨采用舌黏膜尿道背侧替代一期尿道成形术治疗男性尿道下裂修复失败后皮源少患者的效果. 方法 回顾性分析2008年1月至2013年12月收治的68例男性尿道下裂修复失败患者的临床资料.年龄4- 45岁,平均22岁.尿道下裂手术修复失败次数1-6次,平均1.9次.纳入标准：有尿道下裂手术修复失败史,阴茎皮肤不足以用于尿道重建,必须采用其他组织来替代尿道;排除标准：有尿道下裂手术修复失败史,但仍可采用阴茎皮肤重建尿道或采用分期尿道成形者.根据阴茎勃起时是否弯曲采用两种术式：舌黏膜尿道背侧完全替代一期尿道成形术52例,舌黏膜尿道背侧嵌入式替代（改良Snodgrass技术）一期尿道成形术16例.舌黏膜替代长度4-13 cm,平均5.6 cm. 结果 术后随访5-70个月,平均39个月.54例排尿通畅,最大尿流率14.0 -46.0 ml/s,平均24.5 ml/s.术后14例出现并发症,包括尿道皮肤瘘8例,新尿道狭窄6例（3例吻合口狭窄,3例尿道外口狭窄）.8例尿道皮肤瘘患者中4例经再次修补后治愈,余4例尚未治疗.3例尿道外口狭窄患者行狭窄外口再次整形后排尿通畅;3例吻合口狭窄患者采用尿道扩张6-12个月后恢复正常排尿. 结论 采用舌黏膜尿道背侧替代一期尿道成形术治疗修复手术失败后皮源少的男性尿道下裂患者可行、有效.Objective To evaluate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using lingual mucosal grafts （LMG） to treat male patients with less available skin after a failed attempt at hypospadias repair.Methods We retrospective analyze the clinical material of 68 patients with failed hypospadias repairs were treated in our hospital between Jan.2008 and Dec.2013,The median age was 22 （4-45） years.The median prior unsuccessful repairs was 1.9 （1-6） times.Inclusion criteria were a history of failed hypospadias repair,insufficiency of the local skin that made a reoperation with skin flaps difficult,and necessity of another graft urethroplasty.Patients were excluded if they had undergone a failed hypospadias repair with a reoperative urethroplasty using the foreskin or a multistage repair urethroplasty.Two techniques of urethroplasty were performed according to the patients with or not penile curvature during the erection.One-stage onlay LMG urethroplasty was performed in 52 patients and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 16.The median LMG urethroplasty length was 5.6 （4-13） cm.Results The median follow-up was 39 （5-70） mon,54 patients voided well with urinary peak flow rates were median 24.5 （14.0 to 46.0） mL/s and complications developed in 14 patients （21.6%）,including urethrocutaneous fistulas in 8 patients and neourethral strictures in 6 patients （meatal stenosis in 3 cases,proximal anastomotic site stricture in 3 cases）.8 patients with urethrocutaneous fistulas were repaired with salvage procedure,succeed in 4 and another 4 patients await further reoperation.Three patients with meatal stenosis were corrected by meatoplasty and 3 patients with proximal anastomotic site stenosis were only treated by dilatation for 4 and 6 months respectively,after that the patients voided well.Conclusions One stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available sk

关 键 词：尿道下裂 失败 尿道成形 舌黏膜 

分 类 号：R699.6[医药卫生—泌尿科学]