结肠粘膜重建尿道治疗复杂性尿道狭窄的探讨

Urethral reconstruction with colonic mucosa in treatment of complex urethral stricture

目的 探讨结肠粘膜替代尿道治疗复杂性较长段尿道狭窄或闭锁的可能性。 方法采用结肠粘膜重建尿道一期尿道成形术治疗 6例复杂性较长段尿道狭窄 ,患者术前有平均 3次不成功的尿道修复史 ,用结肠粘膜重建的尿道长 10～ 15cm ,平均 12 7cm。术后随访时分别行逆行尿道造影 ,尿道镜和尿流率检查。 结果 术后随访 3～ 14个月 ,平均 7 8个月。 1例在术后 3个月并发尿道外口狭窄性 ,经手术矫正后排尿通畅 ,术后 1年随访时最大尿流率 2 8 7ml/s。余 5例术后排尿通畅 ,最大尿流率大于 15ml/s。术后 6个月 4例经尿道镜检查 ,肉眼较难将尿道的结肠粘膜与正常的尿道粘膜相区别。 结论 结肠粘膜重建尿道治疗较长段尿道狭窄或闭锁是一种可行而有效的方法 ,适合阴茎皮肤或膀胱粘膜利用有困难时的尿道重建。

Objective To investigate the possibility of urethral reconstruction with colonic mucosa for the treatment of complex longer urethral stricture(≥10 cm). Methods From October 2000 to September 2001, 6 patients with complex longer urethral stricture were treated with colonic mucosal graft urethroplasty. They had under gone 3 previous unsuccessful urethral repairs on average. Urethral reconstruction with a free graft of colonic mucosa ranged from 10 to 15 cm (mean 12 17 cm). Follow up included retrograde urethrography, urethroscopy, and uroflowmetry. Results The patients were followed up 3 14 months postoperatively (mean 7 8 months). Meatal stenosis developed in one patient 3 months after operation needed reoperation. The patient voided very well with urinary peak flow 28 7 ml per second duing follow up for 12 months postoperatively. The other patients voided well with urinary peak flow greater than 15 ml per second. At urethroscopy, colonic mucosa was macroscopically difficult to distinguish from normal original urethral mucosa in 4 patients over 6 months after the operation. Conclusions Colonic mucosa graft urethroplasty is feasible for the treatment of complex longer anterior urethral stricture. The technique is useful for urethral reconstruction when penial skin and bladder mucosa are not available.