舌黏膜耦合颊黏膜与舌黏膜耦合ADM治疗尿道下裂修复失败患者的对比研究  

The comparative study of lingual mucosal graft combined with buccal mucosal graft and ADM urethroplasty for failed hypospadias repair

作　　者：李承勇[1] 郝川[1] 郭强[1] 撒应龙[2] 金重睿[2] 孙科[3] 曹伟[4] Li Chengyong;Hao Chuan;Guo Qiang;Sa Yinglong;Jin Chongrui;Sun Ke;Cao Wei(Department of Urology,The Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Urology,Shanghai Jiaotong University Affiliated Sixth People’s Hospital,Shanghai 200233,China;Department of Urology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Urology,The Second Affiliated Hospital of Harbin Medical Univercity,Harbin 150081,China)

机构地区：[1]山西医科大学第二医院泌尿外科,太原030001 [2]上海交通大学附属第六人民医院泌尿外科,上海200233 [3]郑州大学第一附属医院泌尿外科,郑州450052 [4]哈尔滨医科大学附属第二医院泌尿外科,哈尔滨150081

出　　处：《中华泌尿外科杂志》2021年第8期615-619,共5页Chinese Journal of Urology

摘　　要：目的:探讨舌黏膜耦合颊黏膜与舌黏膜耦合异种脱细胞基质生物膜(ADM)一期尿道成形术治疗男性尿道下裂多次修复失败患者的临床疗效。方法:回顾性分析2017年2月至2019年2月收治的26例成年男性尿道下裂修复失败患者的病例资料,其中上海交通大学附属第六人民医院18例,山西医科大学第二医院3例,郑州大学第一附属医院3例,哈尔滨医科大学附属第二医院2例。根据尿道替代材料不同将患者分为两组,A组为舌黏膜耦合颊黏膜组(14例),平均年龄(29.5±1.2)(18~41)岁;既往手术次数平均(3.6±0.7)(2~5)次;既往取口腔黏膜次数平均(1.0±0.5)(0~2)次;尿道缺损长度(6.4±0.6)cm。B组为舌黏膜耦合ADM组(12例),平均年龄(26.5±0.8)(20~38)岁;既往手术次数平均(4.6±0.8)(3~5)次;既往取口腔黏膜次数平均(1.0±0.5)(0~2)次;尿道缺损长度(6.7±0.4)cm。两组上述指标比较差异均无统计学意义(P>0.05)。手术方式:将阴茎伸直,切除纤维组织或瘢痕,测量尿道缺损长度。A组采用舌黏膜铺尿道板,加盖颊黏膜;B组采用舌黏膜铺尿道板,加盖ADM[异种(牛)脱细胞基质敷料,规格5 cm×5 cm]。A组取舌黏膜的长度平均(5.0±0.2)(4.0~6.0)cm,宽度平均(1.2±0.2)(1.0~1.5)cm;取颊黏膜的长度平均(4.1±0.2)(3.5~5.5)cm,宽度平均(1.2±0.2)(1.0~1.5)cm。B组取舌黏膜的长度平均(5.0±0.2)(5.0~6.0)cm,宽度平均(1.2±0.2)(1.0~1.5)cm。两组术中取口腔黏膜长度差异有统计学意义(P<0.05)。尿道下裂修复成功标准:①阴茎外观接近正常;②矫正阴茎下曲;③尿道正位开口;④尿流尿线正常,排尿通畅,成人最大尿流率>15 ml/s。比较两组的疗效和并发症发生率。结果:术后平均随访(16.3±1.6)(8~24)个月。A、B组口腔区域并发症发生比例分别为:口腔供区疼痛7/14例和1/12例,张口紧绷感8/14例和1/12例,口腔供区麻木感8/14例和1/12例,差异有统计学意义(P<0.05)。A、B组尿道并发症发生比例分别为:尿�Objective To compare the outcomes of combined lingual mucosal graft with buccal mucosal graft urethroplasty and combined lingual mucosal graft with ADM(acellular dermal matrix)urethroplasty for the treatment of repair failed hypospadias.Methods From February 2017 to February 2019,26 patients with failed hypospadias repairs were treated with combined lingual mucosal graft with buccal mucosal graft urethroplasty(14 cases in Group A),and combined lingual mucosal graft with ADM urethroplasty(12 cases in Group B).The mean age of Group A was(29.5±1.2)years(range 18.0-41.0 years),and(26.5±0.8)years(range 20.0-38.0 years)in Group B.The previous operation times was mean(3.6±0.7)(range 2-5 times)and(4.6±0.8)(range 3-5 times)in Group A and Group B respectively.Operation method:All patients were nasally intubated,the remaining curvature was corrected,the fibrous tissue or scar was removed,and the defected urethra was measured.In Group A,the lingual mucosa was spread and fixed to the corpora cavernosa over the midline as the urethral plate,the buccal mucosa was covered the lingual mucosa as ventral urethra,both the mucosa lateral edges was sutured.In Group B,the lingual mucosa was harvested and fixed to the corpora cavernosa the same as in Group A,the ADM was made appropriate length and width,covered and sutured with the lingual mucosa.The lingual mucosa was harvested mean(5.0±0.2)cm(range 4-6cm)long,mean(1.2±0.2)cm(range 1.0-1.5cm)wide and mean(5.0±0.2)cm(range 5-6cm)long,mean(1.2±0.2)cm(range 1.0-1.5cm)wide in Group A and Group B respectively(P<0.05).In Group A,the buccal mucosa was harvested mean(4.1±0.2)cm(range 3.5-5.5cm)long,mean(1.2±0.2)cm wide.Criteria for successful repair of hypospadias were set as:①The appearance of the penis is nearly normal;②The penis curvature was corrected;③Urethra orifice in normal position;④Urine flow line is normal.The outcomes of the two groups were analyzed and compared,statistical analysis was done using SPSS 18.0 software.Results The mean follow-up time was(16.3±1.6)(8

关 键 词：尿道下裂 尿道狭窄 口腔黏膜 脱细胞真皮基质 手术 

分 类 号：R699.6[医药卫生—泌尿科学]