尿道下裂术后尿道狭窄在青春期后的处理经验(附71例报告)  

Experience for post-adolescent postoperative urethral stricture of hypospadias in a single center(a report of 71 cases)

作　　者：宋鲁杰[1] 王泽宇 张楷乐[1] 梁涛[1] 张炯[1] 金三宝[1] 徐月敏[1] 傅强[1] Song Lujie;Wang Zeyu;Zhang Kaile;Liang Tao;Zhang Jiong;Jin Sanbao;Xu Yuemin;Fu Qiang(Department of Urology,Shanghai Jiaotong University Affiliated Sixth People’s Hospital,Shanghai Eastern Institute of Urologic Reconstruction,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院泌尿外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》2021年第1期28-32,共5页Chinese Journal of Urology

摘　　要：目的探讨尿道下裂术后尿道狭窄在青春期后的处理经验。方法回顾性分析2015年1月至2019年12月上海交通大学附属第六人民医院收治的71例青春期后就诊的尿道下裂术后尿道狭窄患者的临床资料。年龄平均27.7(12~65)岁;病程平均33.4(1~240)个月。既往手术次数平均2.5(1~9)次;尿道异位开口32例,其中开口于阴茎体部22例,阴囊部8例,会阴部2例。尿道狭窄合并阴茎弯曲17例,尿道皮肤瘘11例,尿道憩室9例,尿道结石11例,尿道感染25例。已有膀胱造瘘10例;61例尚能自行排尿,但排尿困难,尿线变细;71例平均最大尿流率4.7(0~11.2)ml/s。33例行一期尿道重建手术,其中11例行阴茎或阴囊中隔皮瓣尿道成形术,2例行尿道憩室壁瓣尿道成形术,12例行口腔黏膜尿道成形术,8例行狭窄段尿道劈开成形术。33例行二期手术,一期行狭窄段劈开,阴茎背侧皮肤腹侧转移或口腔黏膜预置尿道板,对于其中16例阴茎下弯>30°的患者,同期行阴茎伸直;二期23例行埋藏皮条法(Denis Brown)尿道成形术,6例行尿道板纵切卷管法(Snodgrass法)尿道成形术,4例行尿道板镶嵌口腔黏膜(Snodgraft法)尿道成形术。5例二期预置口腔黏膜,三期行Denis Brown法尿道成形术。阴茎弯曲采用阴茎腹侧瘢痕切除松解,必要时结合阴茎背侧海绵体白膜折叠予以纠正。结果平均随访30.5(4~59)个月。术后61例排尿通畅,平均最大尿流率22.7(15.8~37.2)ml/s。10例出现狭窄复发(一期手术者6例,二期手术者4例),7例出现尿瘘(均为二期手术者)。狭窄复发患者中5例行狭窄尿道劈开术,4例行皮瓣扩大成形术,1例行口腔黏膜尿道成形术。术后尿瘘患者行瘘修补手术,5例行1次瘘修补术治愈,1例行2次瘘修补术治愈,1例尿瘘未做处理。术后2例仍有阴茎弯曲。结论尿道下裂术后尿道狭窄在青春期后处理较为困难,特别是对于残留阴茎下弯>30°,阴茎皮肤缺乏的患者,采用分期矫�Objective To explore management experience for post-adolescent postoperative urethral stricture of hypospadias in a single center.Methods The clinical data of 71 cases of postoperative urethral stricture of post-adolescent hypospadias from January 2015 to December 2019 were retrospectively analyzed.The average age was 27.7(12-65)years.The mean duration of urethral stricture was 33.4(1-240)months.The number of prior surgeries was 2.5(1-9).There were 32 cases of ectopic urethral orifice,including 22 on penile,8 on scrotum and 2 on perineum.There were 17 cases of urethral stricture with penile curvature,11 with urethra-cutaneous fistula,9 with urethral diverticulum,11 with urethral calculus and 25 with urethral infection.Ten patients kept suprapubic tubes;61 patients were able to urinate on their own,but suffered from dysuria and weak steam.The average maximum uroflow rate of 71 cases was 4.7(0-11.2)ml/s.The primary urethral reconstruction procedures were performed on 33 cases,included 11 penile or scrotal septum flap urethroplasty,2 urethral diverticulum wall flap urethroplasty,12 oral mucosal urethroplasty and 8 urethrotomy.Thirty-three cases underwent two-staged surgery.For patients with penile curvature greater than 30 degrees,the penis was straightened with a urethrotomy in first stage.Besides,the dorsal skin of penis or oral mucosal graft were transferred to the ventral side of the penis to the preset urethral plate.In second-stage,Denis Brown urethroplasty was performed on 23 patients,tubularized incised plate(Snodgrass)urethroplasty on 6,and oral mucosa inlay urethral plate(Snodgraft)urethroplasty on 4.In 5 cases,preplacing of oral mucosa was done in the second stage with a third-staged urethroplasty.Penile curvature was relieved by ventral scar resection with the folding the dorsal tunica albuginea of corpus cavernosum when necessary.Results The mean follow-up time was 30.5(4-59)months.Sixty-one patients got satisfying postoperative urination,with an average maximum uroflow rate of 22.7 ml/s(15.8-37.2 ml/s)

关 键 词：尿道下裂 青春期后 尿道狭窄 尿瘘 阴茎弯曲 

分 类 号：R699.6[医药卫生—泌尿科学]