| 摘要: |
| 目的 探讨利用口腔黏膜（下唇黏膜、舌黏膜）、带蒂阴茎皮瓣修复复杂前尿道狭窄的疗效及经验。方法 回顾性分析2012年8月至2018年5月我科收治的因各种原因引起的复杂性男性前尿道狭窄行口腔黏膜移植物或带蒂阴茎皮瓣修复治疗的33例患者资料。对于阴茎包皮组织预估不足、多段尿道狭窄或有尿道手术史的患者采用口腔黏膜移植物尿道成形术，对于阴茎包皮组织预估足够且无尿道手术史者采用带蒂阴茎皮瓣尿道成形术。收集患者术前基本信息及术后随访资料，对比分析术前、术后患者最大自由尿流率及国际勃起功能指数问卷表5（ⅡEF-5）评分的差异。结果 33例患者年龄为12～80岁，平均年龄为（43.5±19.3）岁。行口腔黏膜移植物尿道成形术的患者23例，尿道狭窄段长度为5.0（3.0～12.0）cm。行带蒂阴茎皮瓣尿道形术者10例，尿道狭窄段长度为4.0（3.0～7.0）cm。术后随访时间为20（12～36）个月。术后随访期内口腔黏膜移植物尿道成形术组有2例患者出现尿道狭窄复发，带蒂阴茎皮瓣尿道成形术组1例患者出现尿瘘。口腔黏膜移植物尿道成形术组21例术后排尿通畅患者术前与术后1年最大自由尿流率分别为5.0（0.0～8.2）mL/s和19.6（12.2～21.7）mL/s，差异有统计学意义（P<0.01）；术前与术后1年ⅡEF-5评分分别为14.0（5.0～18.0）分和16.0（4.0～21.0）分，差异无统计学意义（P>0.05）。带蒂阴茎皮瓣尿道成形术组9例术后排尿通畅患者术前与术后1年最大自由尿流率分别为6.1（0.0～12.0）mL/s和20.4（13.6～23.6）mL/s，差异有统计学意义（P<0.01）；术前与术后1年ⅡEF-5评分分别为15.0（7.0～19.0）分和17.5（3.0～23.0）分，差异无统计学意义（P>0.05）。结论 口腔黏膜和带蒂阴茎皮瓣均是良好的尿道替代修复材料，可根据患者病情及身体条件灵活选用这2种自体移植物行前尿道修复手术。 |
| 关键词: 前尿道狭窄 尿道成形术 口腔黏膜 带蒂阴茎皮瓣 |
| DOI：10.16781/j.0258-879x.2021.05.0490 |
| 投稿时间：2020-07-13修订日期：2020-11-24 |
| 基金项目:国家自然科学基金青年科学基金（30500503）. |
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| Oral mucosa graft urethroplasty and penile skin flap urethroplasty for anterior urethral stricture: an analysis of efficacy |
| XU Cheng,SONG Qi-xiang,PIAO Shu-guang,CHENG Xin,WANG Lei*,LIU Zhi-yong* |
(Department of Urology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding authors) |
| Abstract: |
| Objective To investigate the efficacy and experience of oral mucosa (lower lip mucosa and tongue mucosa) and penile skin flap in repairing complex anterior urethral stricture. Methods The data of 33 patients with complex anterior urethral stricture caused by various reasons undergoing oral mucosa graft urethroplasty or penile skin flap urethroplasty in our hospital from Aug. 2012 to May 2018 were retrospectively analyzed. Oral mucosa graft urethroplasty was suitable to patients with insufficient prepuce, multiple urethral stricture, or a history of urethral surgery. Penile skin flap urethroplasty was suitable to patients with sufficient prepuce and without a history of urethral surgery. The preoperative information and postoperative follow-up data were collected, and the differences of maximum urinary flow rate and international index of erectile function 5 (ⅡEF-5) were compared and analyzed before and after operation. Results The 33 patients were 12-80 years old, with an average of (43.5±19.3) years old. Twenty-three patients underwent oral mucosa graft urethroplasty, and the length of the urethral stricture was 5.0 (3.0-12.0) cm. Ten patients underwent penile skin flap urethroplasty, and the length of the urethral stricture was 4.0 (3.0-7.0) cm. The postoperative follow-up period was 20 (12-36) months. Two patients in the oral mucosa graft urethroplasty group developed urethral stricture recurrence and 1 patient in the penile skin flap urethroplasty group developed urinary fistula during the follow-up. In the oral mucosa graft urethroplasty group, 21 patients voided well, and the maximum urinary flow rates were 5.0 (0.0-8.2) mL/s and 19.6 (12.2-21.7) mL/s before and 1 year after operation, respectively, showing significant difference (P<0.01); the ⅡEF-5 scores were 14.0 (5.0-18.0) and 16.0 (4.0-21.0) before and 1 year after operation, respectively, showing no significant difference (P>0.05). In the penile skin flap urethroplasty group, 9 patients voided well, and the maximum urinary flow rates were 6.1 (0.0-12.0) mL/s and 20.4 (13.6-23.6) mL/s before and 1 year after operation, respectively, showing significant difference (P<0.01); the ⅡEF-5 scores were 15.0 (7.0-19.0) and 17.5 (3.0-23.0) before and 1 year after the operation, respectively, showing no significant difference (P>0.05). Conclusion Oral mucosa and penile skin flap are promising substitutes for urethroplasty, and they can be selected for urethroplasty according to patient's physical condition. |
| Key words: anterior urethral stricture urethroplasty mouth mucosa penile skin flap |
