尿道成形术治疗男性尿道狭窄的技术变迁  

Urethroplasty technological changes for the treatment of male urethral stricture

作　　者：修贤杰 宋鲁杰[1] Xiu Xianjie;Song Lujie(Department of Urology,Shanghai Jiao Tong 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,上海200233

出　　处：《中华外科杂志》2022年第11期981-986,共6页Chinese Journal of Surgery

摘　　要：尿道成形术是治疗男性尿道狭窄的重要手段。目前尿道成形术主要分为吻合成形术和替代成形术两大类,其中吻合成形术主要包括端端吻合和非离断吻合,替代成形术主要包括带蒂皮瓣成形术和游离黏膜成形术。吻合成形术在短段球部尿道狭窄与骨盆骨折后尿道狭窄中显示出良好效果,其中非离断吻合成为医源性、单发、短段、非闭锁性狭窄的新术式。在移植物尿道成形术方面,目前一期手术使用最为广泛,但仍有许多复杂尿道狭窄病例必须通过分期手术解决。在替代材料的选择上,阴茎皮瓣与口腔黏膜目前应用较为广泛。如何个性化选择最优的术式和替代材料将是未来值得关注的问题。积累更多的长期随访资料,有助于客观比较各种术式和移植物的治疗效果。Urethroplasty is an important method to treat male urethral stricture.Nowadays,urethroplasty mainly includes two types:anastomotic urethroplasty and substitution urethroplasty.Anastomotic urethroplasty mainly includes primary anastomosis urethroplasty and non-transecting anastomotic urethroplasty.Substitution of urethroplasty mainly includes staged urethroplasty and one-stage urethroplasty.Substitution materials always are chosen by pedicle skin flap and free mucosal graft.Anastomosis urethroplasty has shown good results in short bulbar urethral stricture and posterior urethral stricture after pelvic fracture.Among them,non-transecting anastomosis urethroplasty has become a new surgical method for iatrogenic,single,short or non-occluded stenosis.At present,the one-stage substitution urethroplasty is the most widely used.However,there are still many complicated cases that must be solved by staged urethroplasty.Pedicle skin flap and oral mucosa are widely used as substitutes at present.How to select the best surgical procedure and substitute materials individually would be the problem worthy of attention in the future.Accumulating more long-term follow-up data is helpful for objective comparison of various surgical procedures and grafts.

关 键 词：尿道狭窄 泌尿外科手术 尿道吻合成形术 尿道替代成形术 前尿道狭窄 后尿道狭窄 

分 类 号：R726.9[医药卫生—儿科]