尿道憩室壁用于尿道成形术后狭窄段尿道重建的临床研究
Urothroplasty by using the mucosa of diverticulum secondary to recurrence of urethral stricture
目的 探讨采用带蒂憩室壁修复重建尿道成形术后狭窄段尿道的疗效.方法 2007年1月至2012年10月收治6例尿道成形术后患儿,年龄12~45个月,平均(28±16)个月.其中尿道下裂术后5例,尿道上裂术后1例.6例术后均出现尿道狭窄导致尿道憩室形成,尿道憩室持续时间平均6个月.自然尿流率3.1~7.3 ml/s,平均(5.1 ±1.4) ml/s.均经尿道膀胱镜及排尿性膀胱尿路造影检查明确憩室远端尿道狭窄,狭窄段位于冠状沟5例,阴茎头1例.狭窄段尿道长度8.8~20.5 mm,平均(13.3±4.2)mm.憩室段尿道长度21.8~55.2 mm,平均(37.5 ±15.3) mm.6例均采用将狭窄近端憩室壁带蒂转移至狭窄段尿道的方法进行修复.术中完整切除憩室远端狭窄段尿道,游离并显露尿道憩室,从侧面打开憩室,保留憩室1/2的黏膜原位自卷成管形成尿道,游离并翻转剩余1/2憩室壁至憩室尿道远端,与狭窄段尿道板缝合重建尿道.结果 本组6例手术均顺利完成,手术时间84 ~ 192 min,平均(133 ±48) min.术后2周拔除尿管,拔管后均能自行排尿,自然尿流率6.3 ~ 15.9 ml/s,平均(10.9±3.3) ml/s.术后随访1~4年,平均2.2年.2例出现冠状沟尿瘘,行尿瘘修补术后治愈,余4例无并发症发生.结论 采用憩室壁重建修复狭窄段尿道充分利用了原有组织,解决了重建材料缺乏的问题,可以一次性完成重建手术.此方法对于术者转移皮瓣的技术要求较高,术后仍可能发生尿道成形术后的并发症.
更多Objective To assess the efficacy of urethroplasty by using the mucosa of diverticulum as the distal urethral for the recurrence of urethral stricture.Methods We reviewed our experience about 6 cases from Jan.2007 to Oct.2012,including 5 hypospadias and 1 epispadias.The mean age of the patients was 28 ± 16 (12-45)month,range 12 to 45 months.The patients presenting urethral diverticulum should last for 6 months after urethroplasty,which should last for 6 months.The preoperative mean urinary flow rate was 5.1 ± 1.4 (range 3.1 to 7.3) ml/s.All the patients took the retrograde urethrography and cystoscopy to confirm the position and length of urethrostenosis.The positions of urethrostenosis were at the penis coronary in 5 cases and glans penis in 1 case.The mean length of stricture was 13.3 ±4.2(range 8.8 to 20.5) mm.The mean length of diverticulum was 37.5 ± 15.3 (range 21.8 to 55.2) mm.All patients received the urethral reconstruction by using the pedicel diverticulum mucosa.After resecting the stenosis urethra and exposed the whole diverticulum,we opened the diverticulum laterally and halved it.One was used for tabularized urethroplasty in situ,the other was flipped to the distal urethral as pedicel flap to remedy the defect of the urethral.Results Totally 6 cases received the procedure.The mean operating time was 133 ± 48 (range 84 to 192) min.Postoperatively,urethral catheter was remained 2 weeks.All the patients can urinate smoothly after removing the catheter.The postoperative mean urinary flow rate was 10o 9 ± 3.3 (range 6.3 to 15.9) ml/s.The mean follow-up time was 2.2 yrs(range 1 to 4 years).At the end point of follow-up,all patients had not experienced a recurrent diverticulum or stricture at the anastomotic site.Urethrocutaneous fistula in the coronary glan was reported in 2 patients,which were finally cured after 2nd repair.No complication was found in other 4 patients.Conclusions Urethroplasty by flipping the mucosa of diverticulum takes full advantage of urinary mucosa that already existing,which can be very useful in those patients who are lack of foreskin.This approach can also reduce the patient's pain by completing the urethroplasty in situ and avoiding staging operation.But up till now,it can only be applied to the urethral diverticulum secondary to urethrostenosis.It also demands flip flap skilled.And the long-term effects and complications still remain to be seen.
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