基于复杂性前尿道狭窄游离舌黏膜改良尿道重建的临床观察  

Modified urethral reconstruction with lingual mucosa for complicated anterior urethral stricture

作　　者：周正兴 陈红兵 许国胜 刘伟[1] 梁朝朝[2] 撒应龙[3] ZHOU Zheng-xing;CHEN Hong-bing;XU Guo-sheng;LIU Wei;LIANG Chao-zhao;SA Ying-long(Department of Urology,The Third Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230061,China;Department of Urology,The First Affiliated Hospital of Anhui Medical University,Hefei y Anhui 230022,China;Department of Urology,Shanghai Sixth Peoples Hospital,Shanghai 200233,China)

机构地区：[1]安徽医科大学第三附属医院泌尿外科,安徽合肥230061 [2]安徽医科大学第一附属医院泌尿外科,安徽合肥230022 [3]上海市第六人民医院泌尿外科,上海200233

出　　处：《中华男科学杂志》2021年第7期621-625,共5页National Journal of Andrology

摘　　要：目的:探讨舌黏膜在复杂性前尿道狭窄中尿道重建的疗效及其并发症。方法:回顾性分析安徽医科大学第三附属医院泌尿外科2017年12月至2019年6月间收治的10例复杂性前尿道狭窄采用舌黏膜尿道重建术的患者,收集患者的年龄、尿道狭窄的病因、尿道狭窄的长度临床资料。统计分析患者术前术后最大尿流率(Qmax)、心理状态评分(MSSNS)、生活质量指数(QOL),观察术后味觉异常、舌头麻木、尿道感染、切口愈合、尿道憩室和尿道狭窄等并发症发生情况。结果:舌黏膜尿道重建患者术后3、6、12个月以上的Qmax均较术前明显提高,MSSNS、QOL均较术前明显降低(P<0.001)。术后尿道旁感染1例,经换药后痊愈,尿道外口膜状狭窄1例,经定期尿道外口扩张后好转,2例术后1个月舌头轻度麻木,后逐渐好转,无味觉异常,所有患者拔管前尿道造影均无尿道憩室,未见其他异常并发症。结论:舌黏膜是理想的复杂性前尿道狭窄尿道重建替代材料,侧缘舌黏膜容易获取,舌黏膜尿道背侧基底部嵌入重建复杂前尿道狭窄,临床效果确切,术后尿道及口腔并发症少,值得临床推广应用。Objective: To investigate the efficiency and complications of modified urethral reconstruction with lingual mucosa in the treatment of complicated anterior urethral stricture(CAUS). Methods: We retrospectively studied the clinical data on 10 cases of CAUS treated by modified urethral reconstruction with lingual mucosa from December 2017 to June 2019 concerning the age of the patients and the causes, location and length of urethral stricture. We statistically analyzed the pre-and post-operative maximum urine flow rate(Qmax), scores on Mental Status Scale in Non-psychiatric Settings(MSSNS) and quality of life(QOL) scores and observed post-operative complications such as abnormal taste, tongue numbness, urinary tract infection, urethral diverticulum, and urethral stricture. Results: Compared with the baseline, Qmax was significantly improved and the MSSNS and QOL scores dramatically decreased at 3, 6 and 12 months after surgery(P < 0.01). Paraurethral infection developed in 1 case postoperatively, which was cured after dressing change, external urethral orifice stenosis occurred in another, which was improved after regular urethral orifice expansion, and mild tongue numbness was found in 2 cases at 1 month but gradually restored to abnormal. Urethrography showed no urethral diverticulum before catheter removal. Conclusion: Lingual mucosa is an ideal alternative material for urethral reconstruction in the treatment of CAUS, and lateral lingual mucosa can be easily obtained. Modified urethral reconstruction by embedding lingual mucosa in the dorsal base of the urethra, with the advantages of definite effectiveness and few postoperative complications, is worthy of clinical application.

关 键 词：复杂性前尿道狭窄 舌黏膜 尿道重建术 临床观察 

分 类 号：R699.6[医药卫生—泌尿科学]