舌黏膜在全程隧道法修复尿道下裂中的应用  

The application of lingual mucosa in repairing hypospadias with whole tunnel method

作　　者：王国录[1] 刘智明[1] 朱付勇 朱明挺[1] 易文发[1] 于湧[1] 

机构地区：[1]青海省人民医院泌尿外科,青海西宁810007

出　　处：《现代泌尿外科杂志》2018年第1期23-26,共4页Journal of Modern Urology

摘　　要：目的探讨以阴茎腹侧全程隧道法修复尿道下裂中应用舌黏膜成形尿道的临床效果。方法自2009年3月至2017年4月,我们在以膀胱黏膜成形尿道、全程隧道法二期修复尿道下裂手术基础上,采用舌黏膜代尿道、阴茎腹侧全程隧道法二期修复尿道下裂56例,并评价其临床效果。结果所有病例顺利完成手术,无尿道憩室发生。其中,3例术后发生尿瘘(5.4%),二次手术修补后痊愈;7例术后3~12d感觉舌有轻度疼痛或转动受限(12.5%),术后1月症状均消失;5例术后3~5月出现尿道外口狭窄(8.9%),1例行尿道逆行造影确认出现尿道吻合口狭窄(1.8%),均经丝状探条及尿道探条扩张尿道5~7次后,排尿通畅,尿线恢复正常,最大尿流率(Q_(max))4.5~7.6mL/s。其余病例排尿通畅,尿线较粗,术后随访8个月~2年10个月,尿道外口无赘生物形成,无尿瘘及尿道憩室等并发症发生,阴茎阴囊部小弧形切口瘢痕平整,最大尿流率(Q_(max))4.6~7.3mL/s,平均5.2mL/s。结论在阴茎腹侧全程隧道法修复尿道下裂手术中,以舌黏膜成形尿道,杜绝了既往切取膀胱黏膜术后发生切口感染、血尿、膀胱切口瘘以及下腹部遗留手术疤痕等一系列并发症,同时较好地解决了尿道下裂尿瘘的难题,是阴茎腹侧全程隧道法修复尿道下裂手术中较为良好的尿道替代物。ObjectiveTo explore the clinical efficacy of applying lingual mucosa grafts in hypospadias repair surgery by using ventral penile whole tunnel method.MethodsDuring Mar. 2009 and Apr. 2017,we conducted 56 cases of hypospadias repair surgery using lingual mucosa grafts with ventral penile whole tunnel method.The clinical efficacy was evaluated.ResultsAll operations were successfully completed with no occurrence of urinary fistula.Postoperative urinary fistula developed in 3 cases （5.4%）,which was repaired with a second stage surgery.Mild pain or limited rotation of the tongue occurred in 7 cases （12.5 %） 3-12 days after operation,which disappeared after one month.Urethral orifice stenosis occurred in 5 cases （89%） 3-5 months after operation.Urethral stricture occurred in 1 case （1.8%）,which was cured after 5-7 times of filiform and urethral bougie dilatation,and the maximum flow rate was 4.5-7.6 mL/s.During the followup of 8 to 34 months,no neoplasm was found in the external urethral orifice,the scars were smooth,and the maximum urinary flow rate was 4.6-7.3 mL/s （average 5.2 mL/s）.ConclusionLingual mucosa grafts applied in hypospadias repair with ventral penile whole tunnel method can avoid a series of complications,such as incision infection,hematuria,the bladderincision fistula,surgery scars,and urinary fistula.

关 键 词：舌黏膜 全程隧道法 尿道下裂 尿道成形 

分 类 号：R691[医药卫生—泌尿科学]