摘要目的 针对前尿道较长段狭窄,探讨采用自体口腔黏膜游离移植重建尿道的可行性.方法 2012年1月至2017年12月,中国医学科学院整形外科医院收治42例前尿道狭窄患者,均为男性,年龄9～59岁,平均27岁.采用分期手术的方法进行治疗,一期手术包括切除狭窄段尿道、应用片状或管状口腔黏膜再造缺损段尿道;二期行尿道吻接,阴囊中隔皮瓣或一侧阴囊皮瓣转移覆盖,膀胱穿刺尿流改道.结果 本组42例患者,术后网络与面访患者共38例,随访时间5～12个月,平均8个月,35例对手术效果满意;2例再次出现尿道狭窄,其中有1例狭窄位于阴茎体尿道吻接处,狭窄长度0.5 cm,行狭窄段尿道切除、尿道端端吻合术,1例狭窄位于尿道外口,行尿道外口扩大成形术,经合理治疗后该2例患者尿道狭窄症状均解除;1例患者对术后阴茎外观不满意.所有患者均无尿瘘发生,无阴茎下弯,排尿及排精通畅,尿道内有少许残余尿存留.结论 对于较长段前尿道狭窄,应用手术切除狭窄尿道、口腔黏膜移植分期再造缺损段尿道,带蒂阴囊皮瓣转移覆盖的方法进行修复,可取得良好效果.

abstractsObjective To evaluate the feasibility of buccal musoca grafting in the treatment of longer anterior urethral stricture.Methods From January 2012 to December 2017,42 cases of anterior urethral stricture were treated in staged procedure.Stage 1 included the excision of the narrow urethra and the reconstruction of the urethra by transplanting buccal mucosa sheet or tube.In Stage 2,patients underwent operation including urethra anastomosis and transfer the scrotal flap for coverage,and perform suprapubic puncture cystostomy at the same time.Results Thirty-eight of 42 cases were followed up for 5-12 months with an average of 8 months.In the followed-up 38 cases,35 of them obtained satisfactory result.Complications occurred in 2 patients,all of them suffered from urethra restricture.One patient's urethra stricture was located in the anastomosis,stricture length was 0.5 cm.This patient received excision of the narrow urethra and anastomosis.Stricture in another patient was located in the external urethral meatus,this patient received expansion of the external urethral meatus.With proper treatment,all of them were recovered.One patient was not satisfied with the appearence of penis postoperatively.Of all these patients,no urethral fistula or penile curvature was observed.Urination and ejaculation were normal.Conclusions A successful treatment of long anterior urethral stricture can be achieved with the excision of affected urethra,reconstruction of defect urethra with buccal mucosa flap in staged procedure,and covering the new urethra by transferring the scrotal flap.