口腔黏膜尿道成形术治疗前尿道狭窄:单中心5年经验总结

Clinical study of oral mucosal graft urethroplasty for the treatment of anterior urethral stricture

目的探讨口腔黏膜尿道成形术治疗前尿道狭窄的有效性和安全性。方法 2011年6月至2016年6月利用口腔黏膜尿道成形术治疗105例前尿道狭窄,其中颊黏膜尿道成形25例、舌黏膜尿道成形80例。狭窄段长度为2.5~15cm,平均(7.31±3.42)cm。术前耻骨上膀胱造瘘85例;余20例术前最大尿流率2.2~10.2mL/s,平均(4.6±1.2)mL/s。结果术后随访6~59月,平均(38.6±10.4)月。术后患者排尿通畅98例(93.33%);尿动力学检查显示最大尿流率为16.2~37.4mL/s,平均(23.2±1.3)mL/s。7例(6.67%)出现尿道再狭窄,包含尿道外口狭窄2例、吻合口处状狭窄5例。尿道外口狭窄1例行尿道扩张后排尿通畅,1例行尿道外口成形。吻合口狭窄4例经历尿道扩张后排尿通畅,1例行颊黏膜尿道成形术后排尿通畅。所有患者均无感染,口腔黏膜移植物均存活,无尿道皮肤瘘发生。结论口腔黏膜可作为较理想的尿道替代物,适合多段或长段前尿道狭窄的修复治疗,颊黏膜和舌黏膜具有同等优势,而舌黏膜具有取材方便、材料充足等优点更适合于前尿道狭窄的治疗。

Objective To investigate the efficacy and safety of urethral reconstruction with oral mucosal graft for the treatment of anterior urethral stricture. Methods During June 2011 to June 2016, 105 patients with anterior urethral stricture were treated with oral mucosal graft urethroplasty. The reconstructed urethra ranged from 2.5 to 15 cm [mean （7.31±3.42） cm. Preoperatively, 85 cases had undergone suprapubic cystostomy and the remaining 20 cases had Qmax of 2.2-10.2 mL/s [mean （4.6±12.2）mL/s]. Follow-up included urethrography, urethrocystoscopy and uroflowmetry. Results During the follow-up of 6-59 months [mean （38.6±10.4）months], 98 patients （93.33%） voided well, and 7 cases had recurred urethral stricture （6.67%）. No case developed urethrocutaneous fistula. Conclusions Oral mucosal graft urethroplasty is a feasible procedure for the treatment of anterior urethral stricture.