环带状包皮皮瓣法尿道成形术治疗复杂性前尿道狭窄

Urethroplasty with circular fasciocutaneous flap in the treatment of complex anterior urethral strictures

目的总结15例带蒂环带状包皮皮瓣法尿道成形术治疗复杂性前尿道狭窄的经验。方法采用包皮环形带状裁取一周，切开后带蒂旋转至阴茎腹侧，长段前尿道狭窄处切开，行皮瓣尿道腹侧加盖的术式。术后定期随访及行尿流率、尿道造影检查，观察排尿情况。结果2006年11月至2012年10月，临床治疗15例，年龄20一76岁，平均45岁，其中尿道感染致狭窄4例，术后长期留置尿管致狭窄6例，经尿道灌注化疗药物致狭窄3例，尿道下裂术后尿道狭窄2例。狭窄段长度3．5～12．0cm，平均7．0cm，均采用包皮瓣尿道腹侧狭窄段切开加盖术式。术后随访3个月至3年，平均18个月。手术成功12例，出现尿道狭窄2例，成形尿道憩室样扩张1例。结论环形带状包皮皮瓣的裁取，可以获得足够的带蒂皮瓣来治疗复杂性前尿道狭窄。带蒂包皮瓣具有弹性好、无毛发、获取较易、循环好、组织成活率高等特点。腹侧加盖术式尿道成形创伤小，手术成功率高，外形美观，是治疗复杂性尿道狭窄的良好术式。

Objective To summarize the experience of urethral reconstruction using circular fasciocutaneous flap for the treatment of complex anterior urethral strictures. Method The circular faseiocutaneous flap was harvested from the distal penile shaft or foreskin. Then the circular configuration was converted into longitudinal strip of skin which was rotated to ventral side to repair the exposured urethral strictures using the ventral onlay method. The surveillance protocol after urethroplasty was urination observation, regularly uroflowmetry and urethrography examination. Results From Nov. 2006 to Oct. 2012, 15 cases were treated. The mean age was 45 years （20-76 years） and mean follow-up period was 18 months（3 months-3 years）. Stricture was caused by chronic urethritis in 4 cases, long-term urethral catheterization in 3 cases, transurethral perfusion chem other aphy in 3 cases, transurethral prostatectomy in 3 cases and hypospadias after surgery in 2 patients. The mean stricture length was 7.0 cm （3.5- 12.0 cm）. The overall success rate was 80. 0% （12/15）. Recurrence stenosis was noted in 2 cases and diverticulum formation in 1 case. Conclusions The penile circular fasciocutaneous flap can be used for anterior urethral stricture in nearly any length. The flap has the characteristics of hairless, adequate mobile and length, well-vascularized pedicle and easy to harvest. The onlay reconstruction provides excellent cosmetic results, less trauma, higher success rate. Therefore it should be one of the preferred techniques for complex anterior urethral stricture repair.