分期颊黏膜及阴囊皮瓣重建功能性尿道的临床意义

Clinical significance of reconstruction of functional urethra with staged buccal mucosa and scrotal skin flaps

目的探讨采用口腔颊黏膜及阴囊皮瓣再造功能性尿道的可能性及临床意义。方法一期应用口腔黏膜卷管成形尿道内壁,二期行尿道吻接后,应用阴囊平滑肌肉膜组织瓣覆盖再造尿道,形成复合组织尿道。术后6个月,利用逆行性注水超声检查及核磁共振检测患者再造尿道内残余尿、残余精液量;利用肌电图检测排尿过程中复合组织尿道的收缩性及顺应性。结果本组共163例患者,2例术后1周内出现尿瘘,保持局部清洁,1个月内自行愈合;4例住院期间并发感染,术后给予抗生素治疗。其余患者均无尿道狭窄及尿瘘形成,尿道内无明显残余尿及残余精液,尿线及排尿射程良好。结论应用口腔黏膜卷管和阴囊肉膜平滑肌组织瓣再造的复合组织尿道具有一定的功能性,能有效降低尿道下裂并发症的发生率,值得推广应用。

Objective To explore the possibility and clinical significance of functional urethra reconstruction with staged buccal mucosa and scrotal skin flaps. Methods In the first stage, the urethral wall was reconstructed by buccal mucosa tube grafts. In the second stage, the reconstructed urethra was covered with scrotal skin flap to form a compound tissue urethra after anastomosis of urethra. Six months after operation, residual urine and semen in the reconstructed urethra was detected by ultrasound and MRI;contractility and compliance of reconstructed urethra in the process of urination were detected by electromyogram(EMG). Results In 163 patients, urinary fistula occurred in 2 patients within 1 week after operation and spontaneously healed within 1 month after keeping local cleaning. Four patients were complicated with infection during hospitalization and antibiotics were given for treatment after operation. No urethral stricture or urinary fistula formed in residual patients, and no residual urine or semen in the urethra. The urinary stream and urination range was good.Conclusion Reconstruction of compound tissue urethra by buccal mucosa and scrotal skin flaps has certain function. This method can effectively reduce the incidence of complications such as hypospadias.