皮瓣卷管预构尿道在阴茎再造术二期尿道再造与修复中的应用

Application of tubed pedicled flap for prefabricating urethra in second stage of phalloplasty and revision urethroplasty

目的探索带蒂皮瓣卷管预构尿道在阴茎再造术中的应用效果。方法回顾性分析2009年12月31日至2020年11月30日中国医学科学院整形外科医院采用皮瓣卷管预构尿道进行尿道再造与修复的阴茎发育不良或阴茎缺损的患者资料。术中以旋髂浅动脉穿支皮瓣或阴部外动脉穿支皮瓣进行卷管预构尿道。术后随访观察皮瓣成活情况、尿瘘和尿道狭窄发生情况,以及患者排尿情况。结果共纳入30例患者,均为男性,年龄22~36岁,平均28岁。其中17例为阴茎再造术二期尿道再造的患者;13例患者因阴茎再造术后尿道狭窄或坏死,进行尿道修复成形术。17例应用旋髂浅动脉穿支皮瓣卷管预构尿道,13例应用阴部外动脉穿支皮瓣卷管预构尿道。皮瓣面积约(10.0~13.0)cm×(3.5~4.0)cm。术后2例出现皮瓣坏死;5例出现尿瘘,其中3例为术后早期尿瘘,3周后自愈,2例患者行尿瘘修补术;4例患者出现尿道狭窄。其余患者均为一期愈合。26例患者通过电话或微信方式获得随访,随访时间13~108个月,平均35个月。随访结果显示,完成尿道吻接后,26例患者均可站立排尿,治疗效果满意。结论卷管预构法尿道再造手术步骤简单、方便可行,是阴茎再造术后尿道修复及二期前尿道成形的良好选择。

Objective To investigate the clinical effect of the tubed pedicled flap for prefabricating urethra in phalloplasty.Methods From 31 December 2009 to 30 November 2020,we retrospectively analyzed the data of patients with penile dysplasia or penile defect,who underwent urethral reconstruction and revision with the tubed pedicled flap for prefabricating urethra in the Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College.The urethra was prefabricated with the superficial iliac circumflex artery perforator flap or the external pudendal artery perforator flap.The survival of the flap,the complications such as fistula and stricture,and the micturition were observed.Results A total of 30 males were enrolled.The ages ranged from 22 to 36 years,with an average of 28 years.Among them,17 cases had undergone penile reconstruction and needed the second stage urethral reconstruction,and another 13 underwent revision urethroplasty because of urethral necrosis and stricture.The size of the flap was about(10.0-13.0)cm×(3.5-4.0)cm.Two patients suffered urethral necrosis.Urinary fistula occurred in 5 patients,among which 3 patients were early stage fistula and healed spontaneously after three weeks,and 2 patients underwent fistula revision.Four patients suffered urethral stricture.All the other patients healed primarily.26 patients were followed up with phone or WeChat.The follow-up ranged from 13 to 108 months,with an average of 35 months.The follow-up results showed that after completion of urethral anastomosis,all 26 patients could urinate while standing up.The outcome is satisfactory.Conclusions The application of tubed pedicled flap for prefabricating urethra is a convenient and feasible transfer method.It is a good choice for urethral repair and the second stage anterior urethroplasty after penile reconstruction.