唇黏膜耦合包皮岛状瓣治疗尿道下裂术后再发阴茎下弯的疗效分析  

Clinical analysis of labial mucosa graft coupled preputial island flap urethroplasty for recurrent penile curvature after hypospadias repair

作　　者：曹华林 姜心诚 叶惟靖[3] 王媛媛 郑立传 汪浩 Cao Hualin;Jiang Xincheng;Ye Wejing;Wang Yuanyuan;Zheng Lizhuan;Wang Hao(Department of Urology,Nanxishan Hospital of Guangxi Zhuang Autonomous Region,Guilin 541002,China;Department of Urology,Punan Hospital of Renji Hospital Affiliated of Medical School of Shanghai Jiaotong University,Shanghai 200120,China;Department of Urology,Renji Hospital Affiliated of Medical School of Shanghai Jiaotong University,Shanghai 200120,China;Department of Urology,Ningbo Hospital of Renji Hospital Affiliated of Medical School of Shanghai Jiaotong University,Ningbo 315336,China)

机构地区：[1]广西壮族自治区南溪山医院泌尿外科,桂林5541002 [2]上海交通大学医学院附属仁济医院浦南分院泌尿科,上海200120 [3]上海交通大学医学院附属仁济医院泌尿科,上海200120 [4]上海交通大学医学院附属仁济医院宁波医院泌尿科,宁波315336

出　　处：《中华泌尿外科杂志》2024年第1期44-48,共5页Chinese Journal of Urology

基　　金：广西壮族自治区卫生健康委员会自筹课题(Z20211603)。

摘　　要：目的探讨唇黏膜耦合包皮岛状瓣治疗尿道下裂术后再发阴茎下弯的临床效果。方法回顾性分析4个医疗中心2021年1月至2023年3月采用唇黏膜耦合包皮岛状瓣治疗35例尿道下裂术后再发阴茎下弯患者的临床资料。中位年龄15(13,18)岁,5例伴阴茎头裂开,4例伴尿道皮肤瘘。所有患者均采用唇黏膜耦合包皮岛状瓣行尿道成形术,人工勃起试验证实存在阴茎下弯,在阴茎干弯曲最明显处斜形离断尿道,去除阴茎腹侧的纤维化瘢痕组织,测量尿道缺损长度,取相应长度唇黏膜铺板重建尿道板,相邻包皮岛状瓣翻转覆盖于重建的尿道板形成新的尿道管腔。术后3d拔除尿道内支架管,术后3周拔除尿道外支架管,术后5周行诊断性尿道探查,术后7周行尿流率检查,分析患者围手术期及术后随访资料。结果35例手术均顺利完成,手术时间(114.7±20.1)min,术后随访(15.5±5.9)个月,无阴茎下弯发生。32例患者修复成功,其中21例术后7周复查尿流率,最大尿流率为(18.4±3.7)ml/s;3例(8.6%,3/35)出现尿道皮肤瘘,术后6个月予尿瘘修补后正常排尿。结论唇黏膜耦合包皮岛状瓣治疗尿道下裂术后再发阴茎下弯患者手术成功率高,术后并发症少,是一种安全、可行的治疗方法。Objective To investigate the clinical efficacy of labial mucosa graft coupled preputial island flap urethroplasty for recurrent penile curvature after hypospadias repair.Methods The data of 35 patients with recurrent penile curvature after hypospadias repair who underwent labial mucosa graft coupled preputial island flap urethroplasty in four hospitals from January 2021 to March 2023 were retrospectively reviewed.The median age of the patients was 15(13,18)years old,five of them had penile dehiscence,and four had urethrocutaneous fistula.All patients received labial mucosa graft coupled preputial island flap urethroplasty,the penile flexion was confirmed by artificial erection test,and the urethra is obliquely cut at the most obvious curvature of the penis.By removing the ventral fibrotic scar tissue,the length of the urethral defect was measured.The urethral plate was reconstructed with the same length of labial mucosa graft and an adjacent preputial island flap was transplanted to cover the reconstructed urethra plate to form a new urethral lumen.The inner urethral stent tube was extracted three days after the operation,and the outer urethral stent tube was removed three weeks after the surgery.Diagnostic urethral exploration was performed 5 weeks post-operation,uroflowmetry examination was performed seven weeks after the procedure,and the perioperative and postoperative follow-up data were analyzed.Results All patients underwent a successful surgery,with the average duration of the procedure being(114.7+20.1)minutes.After mean follow-up of(15.5±5.9)months,no penile curvature occurred,and 32 patients were successfully repaired.Uroflowmetry examination was achieved in 21 patients at the seventh week after surgery showed their mean maximum flow rate was(18.4±3.7)ml/s.Three cases(8.6%,3/35)developed urethrocutaneous fistula,who were repaired successfully 6 months after surgery.Conclusions Utilizing the combination of labial mucosa grafts and preputial island flaps for urethroplasty has been proven to be a reliab

关 键 词：尿道下裂 房尿道成形 唇黏膜 阴茎下弯 疗效 

分 类 号：R699.6[医药卫生—泌尿科学]