颊黏膜片背侧镶嵌法尿道成形术在尿道下裂中的应用

Application of dorsal onlay buccal mucosal patch graft urethroplasty in hypospadias

目的评价采用背侧镶嵌法颊黏膜片移植加镍钛记忆合金尿道支架,对各型尿道下裂行尿道再造的效果。方法2004年10月至2006年6月对21例不同类型的尿道下裂,再造尿道内置入镍钛记忆合金尿道支架并经支架内插入6#静脉切开引流管达膀胱以引流尿液,将颊黏膜之黏膜面朝向支架移植缝合固定于阴茎海绵体腹侧(再造尿道背侧)行尿道再造。结果2例有早期伤口渗尿,14～20d自愈,余19例患者伤口均一期愈合。21例患者随访8～18月,2例发生尿瘘、2例发生吻合口狭窄。尿瘘及吻合口狭窄于术后3～5月成功修复,尿道口及龟头形态良好,阴茎无歪斜。拔除尿道支架后排尿均通畅、尿线粗、无尿瘘及尿道狭窄等并发症。供区愈合良好,无不良并发症。结论颊黏膜片背侧镶嵌法尿道成形术对治疗各型尿道下裂是简单、效果好而创伤小的方法,尤其适合再造尿道的局部组织不足的患者。

Objective To evaluate the effect of urethroplasty using dorsal onlay buccal mucosal patch graft （BMG） and niti-alloy urethral stent in hypospadias. Methods From October 2004 to June 2006, 21 patients with different types of hypospadias underwent urethroplasty and were inserted an niti-alloy urethral stent into the reconstructive urethra and a 6^# phlebotomizing duct into bladder through the urethral stent to drain urine. The buccal mucosal patch grafts were sutured and fixed on ventral surface of the corpus cavernosum penis through the mucosal face towards the urethral stent. Results In two paticnts with urinary leakage from their wounds, the wounds spontaneously healed 14-20 days postoperatively. All 21 patients were followed-up （range 8 to 18 months）, and 2 patients had fistulas and 2 had anastomotic stenosis. The fistulas and the anastomotic stenosis were successfully repaired at 3 to 5 months postoperatively. Apart from these complications, good cosmetic results, functional glans and meatus and vertical penis were achieved in all of the cases. After the removal of the stent, the urinary stream was unobstructed and no fistula or urethral stricture was observed. The donor sites healed well without any complication. Conclusions Dorsal onlay buccal mucosal patch graft urethroplasty is a selectable technique for all types of hypospadias because of its simplicity, good results and minimal injury, and it is especially suitable for patients with insufficient local tissues required for urethroplasty.