游离舌黏膜在儿童再次尿道下裂成形术中的应用

Application of urethroplasty with free lingual mucosal graft for hypospadias repair failure in children

目的探讨采用游离舌黏膜再次修复儿童先天性尿道下裂的疗效。方法既往经手术治疗次数均为3次的10例尿道下裂儿童,其阴茎腹侧均有瘢痕,下曲矫正不全,局部尿道缺损修复材料缺乏。矫正下曲后,10例儿童分别接受游离舌黏膜卷管一期尿道下裂成形术或游离舌黏膜镶嵌补片尿道成形术,术后观察疗效。结果 10例中5例接受游离舌黏膜卷管一期尿道下裂成形术,5例接受游离舌黏膜镶嵌补片尿道成形术。10例患儿手术过程均顺利。所有游离舌黏膜片均成活,裁取游离舌黏膜长度4.15 cm（4.0~4.5 cm）,手术时间180 min（150~230 min）。术后所有患儿舌运动灵活,言语清晰。术后随访3.5年（3个月~5.5年）,出现尿道狭窄3例,2例经尿道扩张术治愈,另1例经尿道狭窄补片扩大术治愈;尿瘘1例,经尿瘘修补术治愈。所有患儿阴茎外观恢复良好。结论游离舌黏膜可安全、有效地应用于既往多次尿道下裂成形术失败患儿的再次尿道成形术,但仍存在一定的术后并发症。

Objective To evaluate the clinical efficacy of urethroplasty with lingual mucosal grafts for hypospadias repair failure in children. Methods Ten children with hypospadias who had undergone surgery for three times were recruited in this clinical trial. These children had residual scars in the ventral side of penis,undercorrection of congenital chordee and deficiency of donor sources for urethral defect repair. After surgical correction of chordee,children underwent one-stage urethroplasty using free lingual mucosal graft tube or receiving stricture urethroplasty using ventral onlay lingual mucosal grafting technique. Results Five children underwent one-stage urethroplasty using free lingual mucosal graft tube and 5 receiving stricture urethroplasty using ventral onlay lingual mucosal grafting technique. Operation success rate was 100%. All free lingual mucosal grafts survived. The average length of lingual mucosal graft was 4. 15 cm（ range： 4. 0-4. 5 cm）. The mean operation time was 180 min（ range： 150-230 min）. Postoperatively,all patients could speak normally and clearly without limit of tongue movement. The mean follow-up time was 3. 5 years（ range： 3 months-5. 5 years）.Three cases had urethral stricture after surgery,two was healed by urethral dilation and the other one underwent patch enlargement. One child suffered from urethral fistula and recovered after repairing surgery. All children presented with normal penile morphology. Conclusions Urethroplasty with lingual mucosa graft is a safe and efficacious surgical procedure for hypospadias repair failure in children,yet postoperative complications will probably occur.