减张双蒂皮瓣修补尿瘘的临床应用

Application of tension-reduced double-pedicles flap in the repair of urethrocutaneous fistula

目的 探讨尿瘘修复的一种新技术.方法 采用减张双蒂皮瓣法修复尿瘘患者24例,手术分两期于局部麻醉下进行：Ⅰ期行局部瘘口缝合,通过皮肤减张技术的原理于瘘口旁设计双蒂皮瓣,局部推进后无张力缝合瘘口处皮肤创缘,遗留减张创面;Ⅱ期手术于10 ～ 14 d待瘘口处切口愈合良好后进行,经皮下分离后减张创面直接拉拢缝合,术后10～14 d根据切口愈合情况拆除缝线.结果 24例患者术后皮瓣均Ⅰ期愈合,未出现感染及愈合不良,术后排尿及外形良好.随访6～24个月,均无尿道狭窄及尿瘘复发.结论 减张双蒂皮瓣法是治疗尿瘘的一种有效方法,其操作简单,效果可靠,对外形影响较小.

Objective To investigate a new technique for repairing urethrocutaneous fistula （UCF）.Methods Twenty-four patients with UCF underwent surgery with tension-reduced double-pedicle skin flap from October 2013 to July 2015.A two-stage operation was performed under local anesthesia.In the first stage,the urethral fistula was sutured directly and a double-pedicle advanced flap was raised to close the cutaneous fistula.As a result,a tension-reduced wound was left to provide no tension for the fistula incision.At postoperative 10 to14 days,the wound was closed directly through subcutaneous dissection in the second stage.The stitches were removed at 10 to 14 days depending on the healing status of the incision.Results All the flaps survived primarily without infection.All healed well.After 6 to 24 months,all patients were satisfied with good urination,shape of penis,no recurrence of UCF or urethral stricture.Conclusion Tension-reduced double pedicle skin flap is an effective technique for repairing UCF.It is easily performed with reliable results.