包皮环形带蒂皮瓣在复杂性长段尿道狭窄中的应用  

Application of preputial circular pedicle flap in complex long segment urethral stricture

作　　者：段刘剑[1] 徐艳[1] 曹建伟 张林[1] 崔心刚 李超[1] Duan Liujian;Xu Yan;Cao Jianwei;Zhang Lin;Cui Xingang;Li Chao(Department of Urology,Xinhua Hospital Affiliated to Shanghai Jiaotong University,School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院泌尿外科,上海200092

出　　处：《中华泌尿外科杂志》2024年第11期848-851,共4页Chinese Journal of Urology

摘　　要：目的探讨包皮环形带蒂皮瓣治疗复杂性长段前尿道狭窄的疗效。方法回顾性分析2019年10月至2022年11月上海交通大学医学院附属新华医院采用包皮环形带蒂皮瓣治疗11例复杂性长段前尿道狭窄患者的临床资料。患者年龄40~66岁,平均46岁;尿道狭窄长度6~13 cm,平均7cm;术前最大尿流率3~7ml/s,平均5ml/s。11例既往有反复尿路感染病史及尿路结石腔内治疗手术史。11例均行包皮环形带蒂皮瓣重建尿道,其中1例患者为阴囊坏死性筋膜炎,阴囊段尿道完全毁损缺失,急性期给予膀胱造瘘,手术清创及创面负压封闭引流,6个月后行包皮环形带蒂皮瓣卷管尿道重建;余10例行包皮环形带蒂皮瓣Onlay尿道重建。分析患者最大尿流率变化,是否出现再狭窄、尿瘘、尿道憩室。结果11例手术均顺利完成。手术时间96~246min,平均121min;术中出血量10~200ml,平均46ml;住院时间6~13d,平均9d;留置导尿时间18~28d,平均20d。术后随访9~32个月,平均24个月。11例拔除导尿管后均排尿通畅,拔除导尿管后3个月最大尿流率16.1~24.2ml/s,平均17.6ml/s,较术前明显增加。2例术后4周排尿后出现尿道口滴尿,尿道造影检查显示重建段尿道憩室形成。结论包皮环形带蒂皮瓣尿道重建术是复杂性长段尿道狭窄可选择的治疗方式,手术效果确切,可根据患者自身条件及术者技术水平,进行合理选择。Objective To explore the application selection of preputial circular flap pedicle in the treatment of complex long segment urethral stricture.Methods The data of 11 patients who underwent surgical reconstruction of the urethra for complex long segment urethral stricture between October 2019 and November 2022 in Xinhua Hospital Affiliated to Shanghai Jiaotong University,School of Medicine were retrospectively analyzed.The patients'average age was 46(range 40-66)years old,with average urethral stricture length of 7(range 6-13)cm and average maximum preoperative urinary flow rate of 5(range 3-7)ml/s.They had a history of recurrent urinary tract infections and endoscopic treatment for urinary tract stones.Among the 1l cases,one patient had necrotizing fascitis of the scrotum with complete destruction and loss of the scrotal urethra.This patient received acute bladder diversion,surgical debridement,vacuum sealing drainage,and negative pressure suction during the acute phase.And six months later,a circular preputial pedicle flap was used to reconstruct a 12 cm urethral defect in the scrotal region.The remaining 10 patients underwent preputial circular flap pedicle onlay urethral reconstruction.The changes in the patients maximum urinary flow rate,and the signs of restenosis,urinary fistula,or urethral diverticulum were analyzed.Results All 1l patients who underwent preputial circular flap pedicle urethral reconstruction had unobstructed urination after surgery.Surgical time ranged from 96 to 246 min,with an average of 121 min.The intraoperative blood loss ranged from 10 to 200 ml,with an average of 46 ml.The hospital stay ranged from 6 to 13 d,with an average of 9 d.The indwelling catheterisation time ranged from 18 to 28 d,with an average of 20 d.The patients were followed-up for 9 to 32 months,with an average of 24 months.All 11 cases had smooth urinary flow after surgery,and the maximum urinary flow rate ranged from 16.1 to 24.2 ml/s,with an average of 17.6 ml/s,which was significantly higher than that before surger

关 键 词：尿道狭窄 坏死性筋膜炎 尿道毁损 尿道重建 

分 类 号：R699.8[医药卫生—泌尿科学]