舌黏膜耦合阴茎皮瓣一期修复残废型尿道下裂的疗效分析

Clinical analysis of single stage lingual mucosa graft coupled penile flap urethroplasty of crippled hypospadias

目的探讨舌黏膜耦合阴茎皮瓣一期修复残废型尿道下裂的临床疗效。方法回顾性分析上海市第六人民医院2016年1月至2019年8月收治的16例残废型尿道下裂患者的临床资料。年龄25〜44岁,平均35.2岁。16例均有不同程度的排尿困难,最大尿流率(Qmax)3.8〜9.6 ml/s,平均6.7 m l/s。16例人院前有2〜7次尿道修复手术史,平均4.6次;6例伴阴茎下弯,2例伴尿道憩室,2例伴尿道皮肤瘘。16例均接受舌黏膜耦合阴茎皮瓣一期尿道修复手术,通过去除缺血、纤维化的尿道,采用舌黏膜铺板重建尿道板,阴茎皮瓣翻转覆盖于重建的尿道板形成新的尿道管腔,一期重建缺损的尿道。术后3周拔除导尿管,拔管后1个月行尿流率、尿道造影和膀胱镜检查等。结果16例手术均顺利完成,手术时间105〜150 m in,平均128.4 min。16例术后随访3〜30个月,平均18.6个月。14例手术修复成功,术后7周尿流率检查Qmax为15.6〜29.8 ml/s,平均22.4 m l/s。2例出现尿道皮肤瘘,经瘘修补术后正常排尿。2例仍有一定程度的阴茎下弯,患者自我感觉满意,未进一步处理。结论舌黏膜耦合阴茎皮瓣替代一期尿道成形术治疗有多次手术史的残废型尿道下裂患者手术周期短,成功率较高,术后并发症较少,短期内尿道狭窄的复发率低,是•种可行、有效的治疗方法。

Objective To investigate the clinical efficacy of lingual mucosa graft coupled penis flap urethroplasty for crippled hypospadias.Methods Between January 2016 and August 2019,16 patients with crippled hypospadias in Shanghai Sixth Peoples Hospital were included in this study.Their mean age was 35.2 years(range from 25 to 44 years).All patients presented voiding difficulty and failed after 2 or more times of urethroplasty.Their mean times was 4.6(range from 2 to 7 tim es).Uroflowmetry examination showed their mean Qnlaxwas 6.7 ml/s(range from 3.8 to 9.6 ml/s).Chordee was found in six patients.Urethrocele was found in 2 patients.Urethrocutaneous fistula was found in 2 patients.All patients received lingual mucosa graft coupled penis flap urethroplasty.By removing the ischemic and fibrotic urethra,urethral plate was reconstructed with lingual mucosa graft and the penis flap was transplanted to cover the reconstructed urethra plate to form a new urethral lum en,which was used to repair the defective urethra.The catheters were removed three weeks after the surgery.Uroflowmetry examination,cystourethrography and cystoscope were performed after the catheters out.Results All patients underwent smooth surgery with an average duration of 128.4 minutes(range from 105 to 150 minutes).After mean follow-up of 18.6 months(range from 3 to 30 months),successful outcome was achieved in 14 patients and uroflowmetry examination at the seventh week after surgery showed their mean Qmaxwas 22.4 ml/s(range from 15.6 to 29.8 ml/s).2 cases had urethrocutaneous fistula which were cured after repair of penile urethral fistula.2 patients still had a certain level of chordee while they were satisfied with the appearance of their penis,so there was no further treatment.Conclusions Single stage lingual mucosa graft coupled penis flap urethroplasty has short operation period,relatively high success rate and relatively few complications.Single stage lingual mucosa graft coupled penile flap urethroplasty is an available option for crippled hypospadias with several times of failed urethroplasty.