阴茎皮瓣尿道成形术治疗前尿道狭窄的长期疗效

Long-term efficacy of penile skin flaps for reconstruction of anterior urethral stricture

目的 评估阴茎皮瓣尿道成形术治疗前尿道狭窄的长期疗效. 方法 2006年1月至2012年12月采用阴茎皮瓣尿道成形术治疗前尿道狭窄患者138例,年龄7～82岁,平均38岁.尿道狭窄病因：外伤性78例,医源性41例,感染性17例,原因不明2例.尿道狭窄部位：尿道悬垂部110例,球部28例.尿道狭窄段长3～ 14 cm,平均6.5 cm,其中≥10 cm者48例.根据尿道狭窄段的长度、部位和阴茎皮肤的条件选择不同类型的皮瓣：①带蒂纵形皮瓣;②带蒂环形皮瓣;③倒L形带蒂皮瓣;④Q形阴茎皮瓣,采用3种尿道成形方法：①侧面补片尿道成形（1组）80例;②背腹侧联合镶嵌成形（2组）42例;③管状重建尿道（3组）16例. 结果 本组138例中4例失访,余134例随访8～ 84个月,平均39个月.29例出现并发症：尿道再狭窄17例,其中1组12例,2组2例,3组3例;尿道皮肤瘘7例,1组5例,2组和3组各1例;尿道憩室5例,1组4例,3组1例.105例排尿通畅,最大尿流率13 ～49 ml/s,平均25 mL/s,总成功率78.4％（105/134）. 结论 阴茎皮肤薄、血运丰富、取材操作简单,是重建尿道较理想的材料之一;L形或Q形阴茎皮瓣重建尿道是治疗超长段（≥10 cm）前尿道狭窄的有效方法.

Objective To evaluate the long-term efficacy of using penile skin flaps for urethroplasty in the treatment of anterior urethral strictures.Methods Between Jan 2006 and Dec 2012,138 patients with anterior urethral stricture were treated by using penile skin flaps for urethroplasty.The mean age was 38 years （range,7-82 year）.The etiology of stricture included trauma in 78 cases,iatrogenicity in 41 cases,infection in 17 cases,unknown reason in 2 cases.The penile urethral stricture was found in 110 cases and the bulbourethral stricture was found in 28 cases.The mean length of anterior urethral stricture was 6.5 cm （range 3-14 cm）.Among them,the length of urethral stricture was more than 10 cm in 48 patients.Basing on location,length of stricture and condition of penile skin,different penile skin flaps were chosen,including vertical pedicle skin flap,pedicle circular flap,L-flap,Q-flap.Three different techniques were used for urethroplasty,such as lateral patch flap urethroplasty （group1,n=80）,dorsal and ventral inlaid flap urethroplasty （group 2,n =42） and tubularized flap urethroplasty （group 3,n =16）.Results 4 patients were lost during follow-up.The mean duration of follow-up in the remaining 134 patients was 39 months （range,8-84 months）.Complications developed in 29 of 134 patients （21.6%）,including strictures recurrence in 17 （group 1,n =12,group 2,n=2 and group 3,n =3）,urethrocutaneous fistulas in 7 （group 1,n =5,group 2,n=1 and group 3,n =1） and urethral diverticulum in 5 （group1,n =4,and group 3,n =1）.105 cases voided well and the urinary peak flows ranged from 13-49 ml/s （mean 25 ml/s）,The overall success rate was 78.4% （105/134）.Conclusions Penile skin is thinner,rich in blood supply and easy to be manipulated,which is one of the excellent materials for the urethral reconstruction.Q-flap or L-flap urethroplasty is an effective technique for the treatment of long-segment urethral strictrues （≥ 10 cm）.