经阴茎头隧道带蒂阴茎皮瓣扩大尿道成形治疗阴茎头尿道狭窄的临床效果  

Clinical outcomes of augmentation urethroplasty using pedicled skin flap through glans tunnel in the treatment of glansurethral stricture

作　　者：姬福浩 王林 赵彤 刘毅东[1] 吕向国 Ji Fuhao;Wang Lin;Zhao Tong;Liu Yidong;Lv Xiangguo(Department of Urology,Renji Hospital,Shanghai JiaoTong University School of Medicine,Shanghai 200127,China;Department of Urology,Jiaozuo People's Hospital,Jiaozuo,Henan 454000,China)

机构地区：[1]上海交通大学医学院附属仁济医院泌尿外科,上海200127 [2]焦作市人民医院泌尿外科,河南焦作454000

出　　处：《泌尿外科杂志（电子版）》2024年第4期18-22,共5页Journal of Urology for Clinicians(Electronic Version)

摘　　要：目的探讨阴茎头隧道技术联合带蒂阴茎皮瓣扩大尿道成形术治疗阴茎头尿道狭窄的临床效果。方法回顾性分析2023年1月至2024年1月就诊于上海交通大学医学院附属仁济医院泌尿外科的21例阴茎头尿道狭窄患者的临床资料,21例患者均为医源性狭窄(包括前列腺增生手术、经尿道膀胱病损切除术、导尿)。其中,尿道口狭窄9例,舟状窝狭窄12例。术前患者中位狭窄长度为2.00(2.00,3.00)cm,手术前后常规评估最大尿流率(_(max)imum flow rate,Q_(max))、国际前列腺症状评分(International Prostate Symptom Score,IPSS)、国际勃起功能问卷评分(International Index of Erectile Function-5,IIEF-5)。结果术后平均随访时间(8.24±2.17)个月,术后Q_(max)、IPSS分别为为21.00(19.00,26.00)ml/s、(6.86±2.29)分,高于术前6.00(4.50,8.00)ml/s、(17.24±5.68)分,差异有统计学意义(P<0.01);术后IIEF-5为21.00(10.00,22.50)分,与术前21.00(9.00,22.50)分相比,差异无统计学意义(P>0.30)。术后21例患者均无狭窄复发,阴茎头裂开,尿瘘,伤口感染、缺血坏死。结论对于尿道口及舟状窝狭窄患者,保留阴茎头完整性的阴茎头隧道阴茎皮瓣扩大尿道成形术,可实现功能与美观的统一,是疗效相对确切的方法。Objective To evaluate the clinical outcomes of glans tunnel augmentation urethroplasty combined with pedicledsk in flap for the treatment of glans urethral stricture.Methods A retrospective analysis was conducted on 21 patients with glans urethral stricture treated at the Department of Urology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,from January 2023 to January2024.All cases were iatrogenic strictures,including those caused by prostate surgery,transurethral resection of bladder tumor,and catheterization.Among them,9 cases had meatal strictures,and 12 had navicular fossa strictures,with a stricture length of 2.00(2.00,3.00)cm.Maximum flow rate(Q_(max))International Prostate Symptom Score(IPSS),International Index of Erectile Function-5(IIEF-5)were assessed before and after surgeries.Results The average follow-up period was(8.24±2.17)months.Postoperative Q_(max)was 21.00(19.00,26.00)ml/s,IPSS was(6.86±2.29),and they were higher than 6.00(4.50,8.00)ml/s and(17.24±5.68)which before surgeries with significant differences(P<0.01).The postoperative IIEF-5 was 21.00(10.00,22.50),which was not significantly different from the preoperative 21.00(9.00,22.50)(P>0.30).There were no recurrences of stricture,glans dehiscence,fistula,or wound infection/ischemic necrosis among the 21 patients postoperatively.Conclusion For patients with meatal and navicular fossa strictures,glans tunnel urethroplasty with pedicled skin flap provides a reliable and aesthetically pleasing solution,effectively balancing functionality and appearance.

关 键 词：尿道口狭窄 尿道舟状窝 带蒂皮瓣 阴茎头 

分 类 号：R699.6[医药卫生—泌尿科学]