舌黏膜尿道成形治疗男性生殖器苔藓样变性尿道狭窄的体会

The experience of lingual mucosal graft urethroplasty in the treatment of male genitalia lichen sclerosus urethral stricture

目的探讨利用舌黏膜移植尿道成形治疗男性生殖器苔藓样变性导致尿道狭窄的体会,提高手术成功率。方法回顾性分析我科自2016年10月至2017年6月收治的23例男性生殖器苔藓样变性行舌黏膜移植尿道成形术患者的临床资料,评估其术前狭窄长度、术式选择、术后最大尿流率、尿道镜检查结果、残余尿、并发症等指标。结果全部23例患者术后主观感受排尿困难明显改善,最大尿流率8.2~26.3mL/s,平均18.4mL/s,残余尿均在30mL以下。对于2例(8.7%)最大尿流率10mL/s以下的患者行尿道镜检查,见舌黏膜上皮化良好,未见明显狭窄。2例(8.7%)患者出现尿道外口挛缩。口腔并发症主要为局部麻木,轻微发音障碍,均在3个月内恢复。1例(4.3%)患者出现轻度阴茎下弯。结论舌黏膜移植尿道成形术对于治疗男性生殖器苔藓样变性导致的尿道狭窄是一种良好的手术方式,口腔并发症均可逐渐恢复。

Objective To summarize the surgical experience of lingual mucosal graft urethroplasty in the treatment of male genitalia lichen sclerosus urethral stricture.Methods The clinical data of 23 cases of genitalia lichen sclerosus urethral stricture treated with lingual mucosa graft urethroplasty during Oct.2016 and Jun.2017 were retrospectively analyzed.The preoperative length of stricture,choice of operative methods,postoperative maximum urinary flow rate（Qmax）,urinary tract examination results,residual urine volume,and complications were reviewed.Results Dysuria was greatly improved in all patients.The Qmax was 8.2-26.3（average 18.4）mL/s,and the average residual urine volume was≤30 mL/s.For 2 cases with Qmax≤10 mL/s,urethroscopy was performed,the lingual mucosa epithelized well,and no stenosis recurred.The complications included external urethral orifice in 2 cases,oral complications such as local numbness and mild sound barriers,which recovered in 3 months.Slight chordee of penis occurred in 1 case.Conclusions Lingual mucosal graft urethroplasty is effective in the treatment of male genitalia lichen sclerosus urethral stricture,and the oral complications can recover gradually.