转移口腔粘膜治疗尿道下裂(附19例报告)

Oral Mucosa for Hypospadias Repair:A Report of 19 Cases

目的:探讨应用转移口腔粘膜治疗尿道下裂的适应证及手术疗效。方法:尿道下裂患者19例,其中,阴茎根型10例,阴囊型7例,会阴型2例。8例接受过1次尿道成形术,6例接受过两次尿道成形术,5例为第一次尿道手术,7例合并阴茎下弯。14例患者取下唇粘膜,5例取口腔颊粘膜。15例使用加盖口腔粘膜尿道成形,背侧皮肤浅筋膜瓣覆盖新尿道。4例使用口腔粘膜代替尿道板使阴茎伸直,半年后二期行尿道板卷管尿道成形。结果:19例手术患者中,15例加盖口腔粘膜法13例成功,二期尿道板卷管尿道成形4例均成功,手术成功率89.5%(17/19)。阴茎外观满意,尿道开口于阴茎头部前端,经随访3～18个月,无尿道狭窄、尿瘘等并发症。2例术后出现阴茎切口感染而出现尿瘘,半年后再次行补瘘手术后治愈。19例均无口腔创面的并发症。结论:转移口腔粘膜治疗多次手术失败、局部组织缺乏的尿道下裂是一种手术成功率较高的手术方式,值得推广应用。

Objective： To investigate the indications and clinical effect of using oral mucosa as the graft in hypospadias repair.Methods： We performed hypospadias repair using oral mucosa for 19 patients,10 with the urethral opening at the root of the penis,7 at the scrotum and 2 at the perineum.Of these patients,8 had received urethraplasty once,and 6 twice,unsuccessfully,and 7 of them were complicated by penile chordee.The lower lip mucosa was used as the graft for 14 cases,and the buccal mucosa for the other 5.Fifteen cases received autologous oral mucosa onlay for repair,with the new urethra covered by the dartos coat of the dorsal skin.For the other 4 cases,whose urethral plates had been damaged in the previous operations,oral mucosa strips were used to substitute the urethral plates to get the penis straightened,followed by urethroplasty 6 months later.Results： Of the 19 patients,17（89.5%） achieved satisfactory results,with a desirable shape of the penis and a vertical slit-like meatus at the tip of the glans.Chordee was corrected in all the patients.No urethral stricture was found during the 3-18 months follow-up.Urethral fistula occurred in 2 cases because of infection,but cured by surgical repair 6 months later.Conclusion： Using oral mucosa as the graft is an effective surgical option for hypospadias repair.