口腔黏膜移植物尿道成形术治疗硬化性苔藓样变致长段前尿道狭窄的临床分析

Clinical study of oral mucosal graft urethroplasty for the treatment of lichen sclerosus-related long segment anterior urethral stricture

目的探讨口腔黏膜移植物尿道成形术治疗硬化性苔藓样变致长段前尿道狭窄的临床疗效。方法采用截石位尿道背侧2点~3点纵行切开狭窄段尿道,行尿道扩大成形术。选取34例2014年1月至2018年11月应用口腔黏膜尿道成形术治疗硬化性苔藓样变致长段前尿道狭窄的患者,狭窄段长度为8.0~17.0 cm,平均(11.7±2.6)cm。入院时10例患者最大尿流率为2.0~7.0 mL/s,平均为(4.4±1.7)mL/s,已行膀胱造瘘24例。结果术后随访10~67个月,平均(34.4±18.1)个月。术后1个月进行评估,患者排尿通畅31例(91.2%),最大尿流率为12.0~30.5 mL/s,平均(19.7±5.3)mL/s。尿道狭窄再发者3例(8.8%),1例尿道外口狭窄再次行尿道外口成形术;2例吻合口狭窄,行尿道扩张1例,再次行颊黏膜替代1例。所有移植黏膜均存活,尿道造影可见成形尿道宽阔,无尿道皮肤瘘及感染并发症。结论口腔黏膜移植物尿道成形术适用于阴茎硬化性苔藓样变致长段前尿道狭窄的治疗,口腔黏膜可作为较理想的尿道替代物,具有较高的成功率。

Objective To evaluate the clinical effects of oral mucosal graft urethroplasty for the treatment of lichen sclerosus(LS)-related long segment anterior urethral stricture.Methods The clinical data of 34 LS patients treated between January 2014 and November 2018 at the First Affiliated Hospital of Xi’an Jiaotong University were retrospectively analyzed.Oral mucosal graft urethroplasty was performed on all patients.The length of urethral stricture ranged from 8.0-17.0 cm(mean:11.7±2.6 cm).The preoperative maximum flow rate was 2.0-7.0 mL/s(mean:4.4±1.7 mL/s).There were twenty-four patients with suprapubic catheterization before hospitalization.We used an improved method for bladder lithotomy position 2-3 point dorsal urethrotomy.Results The follow-up time was 10-67 months(mean:34.4±18.1 months)and evaluation was performed one month after surgery,31(92.2%)patients voided with a good stream after surgery,the maximum flow rate was 12.0-30.5 mL/s(mean:19.7±5.3 mL/s).Urethral stricture recurred in three cases(8.8%),which includes one case with external urethral orifice stricture treated with external urethral orifice urethroplasty.Of the two cases of anatomic structure,one case was treated with urethral dilatation and the other with buccal mucosal graft urethroplasty.All oral mucosal grafts survived well.Urethrography revealed a wide urethra with no urethrocutaneous fistula and infection.Conclusion An oral mucosal graft is suitable for the treatment of LS-related long segment anterior urethral stricture,which is an ideal urethral replacement with a high success rate.