带蒂岛状转位筋膜皮瓣治疗尿道外口及舟状窝狭窄的临床研究

Clinical study of transverse island fasciocutaneous fascia flap for treatment of meatus and navicular fossa stricture

目的探讨利用带蒂岛状转位筋膜皮瓣治疗尿道外口及舟状窝狭窄的临床效果。方法回顾性分析2014年10月至2018年12月我院行带蒂岛状转位筋膜皮瓣尿道重建的15例患者的临床资料。年龄28~73岁,平均54.4岁。发病原因:6例有尿道腔镜手术史,3例有阴茎头苔藓样变病史,3例有尿道扩张史,3例无明显诱因。15例术前均行逆行尿道造影及尿道超声检查,诊断为尿道外口至舟状窝段狭窄;行尿流率检查,最大尿流率3~4 ml/s,平均3.2 ml/s。手术取冠状沟下方横行切口,充分游离尿道后,于腹侧纵行剖开尿道。测量实际狭窄长度后,取切口处对应长度横行岛状带蒂筋膜皮瓣进行重建。术后1、3个月复查,记录有无狭窄复发或尿瘘等相关并发症。术后3个月行尿流率检查。结果本组15例手术均顺利完成。术中实际测量尿道狭窄长度0.5~4.0 cm,平均2.8 cm。术后3个月复查,尿流率13.5~23.7 ml/s,平均18.5 ml/s。14例手术成功,1例狭窄复发。术后3例出现尿瘘并发症:2例出现切口处针眼样尿瘘病灶,其中1例术后3个月自行愈合,另1例放弃进一步治疗;1例术后1个月出现尿道狭窄合并尿道皮肤瘘,再次予阴茎带蒂皮瓣尿道成形术成功修复。结论利用带蒂岛状转位筋膜皮瓣治疗尿道外口及舟状窝狭窄成功率高,并发症发生率低,短期内狭窄复发率较低,是一种安全、可行、有效的手术方式。

Objective To investigate the clinical effect of transverse island fasciocutaneous penile flap in the treatment of meatus and navicular fossa stricture.Methods Fifteen patients with urethral reconstruction with transverse island fasciocutaneous penile flap from October 2014 to December 2018 were enrolled.Six patients had a history of urethroscopic surgery,three had a history of lichensclerosus,three had a history of urethral dilation,and three had no obvious causes.All patients underwent transverse incision under the coronal sulcus,and after fully dissecting the urethra,the urethra was opened longitudinally ventrally.After measuring the actual length of stenosis,the irradiance fascia flap with the corresponding length of the incision was reconstructed.The patients were reviewed at 1 and 3 months after operation,and any complications such as recurrence or urinary fistula were recorded.The urine flow rate was tested 3 months after surgery.Results All 15 patients in this group underwent a successfully operation.The actual measurement of urethral stricture length was 0.5-4.0 cm during operation,with the average of 2.82 cm.Three months after the operation,the urine flow rate ranged from 13.5 ml/s to 23.7 ml/s,with an average of 18.5 ml/s.The overall successful rate was 93.3%(14/15).The rate of post-operative fistula was 20.0%(3/15).Two cases complained of needle-like fistula at the incision.One case healed after 3 months,and the other gave up further treatment.One patient developed urethral stricture and urethral skin spasm again 1 month later and was surgically repaired again.Conclusions The initial experience of pedicled island fascia flap for the treatment of urethral stenosis and scaphoid stenosis is safe,feasible and effective for the treatment of urethral stricture.