舌黏膜尿道成形治疗前尿道狭窄(附80例报告)

The Treatment of Anterior Urethral Strictures Using Lingual Mucosas Urethroplasty(Report of 80 Cases)

目的:研究舌黏膜尿道成形治疗尿道狭窄的有效性和安全性。方法:2006年8月～2008年12月采用舌黏膜尿道成形治疗80例前尿道狭窄,尿道狭窄段2.5～18 cm,其中30例为长段尿道狭窄(9～18 cm)采用双侧舌黏膜或舌黏膜与颊黏膜或与带蒂包皮拼接尿道成形治疗。尿道成形采用两种术式:保留原尿道板的扩大尿道腔37例;埋藏黏膜条43例。结果:术后随访4～30(平均1 6.8)个月,7例发生并发症,其中尿瘘4例,再次发生尿道狭窄3例,其余患者排尿通畅,最大尿流率从15.2～54.6(平均28.7)ml/s。结论:舌黏膜是一种修复前尿道狭窄较好的尿道替代物,双侧舌黏膜尿道成形能成功治疗长段、复杂性尿道狭窄。

Objective：To evaluate the efficacy and safety of using lingual mucosa grafts（LMG） for urethroplas ty in the treatment of urethral strictures. Methods： Between August 2006 and December 2008, 80 cases of anteridr urethral strictures （length ranging from 2.5 to 18 cm） were treated using LMGs. Of the 80 patients 30 cases with long segment urethral strictures （9 to J8 cm） underwent dual LMG or LMG combined with foreskin flap or buccal mucosal graft urethroplasty. Two techniques were used for urethral reconstruction, the first involves tubularized dorsal LMG augmentation of the urethral plate in 37 patients; the second technique was dorsal patch graft urethro- plasty for atretic strictures of the urethra or hypospadia repair failure in 43 cases. Results： Follow-up was obtained for 4-30 months （mean, 16.8 months） postoperatively. Complications occurred in 7 patients, including urinary fistulas in 4 patients, recurrent strictures developed in 3 patients. The remaining patients voided well postoperatively, with peak flows between 15.2 and 54.6 ml/s （mean, 28.7 ml/s ）. Conclusions：The tongue is an excellent source of graft material for the repair of anterior mucosal strictures. Dual LMG substitution urethroplasty can successfully treat longer, more complex urethral strictures.