尿道背侧颊黏膜镶嵌补片法治疗长段前尿道狭窄

Dorsal onlay buccal mucosal graft urethroplasty for anterior urethral stricture

目的评价颊黏膜尿道背侧镶嵌技术尿道修复重建手术的有效性和安全性。方法男性前尿道狭窄患者57例。平均年龄36（17～52）岁。尿道狭窄长度平均3．0（2．5～7．0）cm。颊黏膜取材长度平均4．0（3．5～8．0）cm，平均宽度2．3（1．8～2．5）cm。57例均有经尿道内窥镜冷切电切手术史，其中1次手术史29例（51％），2次20例（35％），3次8例（14％），行耻骨上膀胱造瘘48例，9例采用尿道扩张维持。手术游离并旋转尿道，并于尿道背侧纵行切开，6-0可吸收线缝合颊黏膜与尿道切缘。保留尿管4周，拔管时行顺行尿道造影。患者排尿困难和尿线变细、尿道造影或尿道镜发现尿道管腔狭窄〈16F确定为尿道狭窄复发。结果57例手术均成功，平均手术时间135（105～150）min。平均随访11．2（1～23）个月。尿道通畅54例（95％），术后2～3个月复发3例（5％），狭窄部位均为远端的颊黏膜与尿道结合部，行尿道内窥镜冷刀切开，定期尿道扩张治疗。伤口感染3例，未发生尿瘘及尿道憩室。患者口腔疼痛持续2～5d，平均2．3d。术后无张口困难、颊部麻木及腮腺导管梗阻等并发症发生，口腔颊部均未见瘢痕形成。结论口腔颊黏膜尿道背侧镶嵌补片修复重建尿道，效果确切、并发症少、狭窄复发率低，是理想的长段前尿道狭窄的修复重建手段。

Objective To evaluate the efficacy and safety of dorsal onlay buccal mucosa urethroplasty for the treatment of long anterior urethral stricture. Methods From October 2005 to September 2007, 57 patients （17-52 years old） underwent buccal mucosal dorsal onlay urethroplasty for the treatment of anterior urethral stricture. The mean urethral stricture length was 3. 0cm （2. 5- 7. 0 cm）. Previously, 29（51%） patients had experienced one direct vision internal urethrotomy（DVIU）, 20（35%） patients had accepted twice DVIU and 8（14%） patient had 3 times DVIU for the treatment of urethral stricture. All patients recurred urethral stricture after DVIU. The length of urethral stric ture was measured by combined retrograde urethrography and voiding cystourethrography before urethroplasty. All patients accepted urethroplasty at more than 6 months after last failed surgery. Buccal mucosa was harvested from right cheek. The urethra was exposed and dorsal side was rotated to out side. A longitudinal incision was made on urethra. Buccal mucosal free grafts were sutured to the open edges of urethra with 6-0 absorbable suture. 18 F silicon fenestrated urethral catheter was placed and kept for 4 weeks. Urethrography was used at 4 weeks and 3 months after the urethroplasty, and then every 6 months to evaluate the urethral recovery. Dysuria and urethral caliber less than 16 F which was confirmed by urethrography and urethroscopy were regarded as stricture recurrence. Results The mean fellow-up time were 11. 2 months （1- 23 months）. Fifty-four（95%） patients remained stricture free. Three（5%） patients recurred at the 2 to 3 months after the operation and were treated with DVIU. Three patients had wound infection and recovered without other complication. There was no fistula, diverticulum in all patients. The pain of cheek lasted for 2 5 days （average 2.3 days）. No ease had hypoesthesia of cheek, obstruction of stensen＇s duct or cheek scar. Conclusions Dorsal onlay bueeal mueosal urethroplasty for long anterior urethral stricture provides stable results with few and acceptable complications.