口腔黏膜预构尿道在成人复杂型尿道下裂修复中的应用

Oral mucosa prefabricated urethra in the treatment of complicated hypospadias in adult patients

目的探讨口腔黏膜预构尿道修复成人复杂型尿道下裂的临床效果。方法选择2011年1月至2020年12月于中国医学科学院整形外科医院整形二科就诊的复杂型尿道下裂成年患者,均进行二期手术修复。一期口腔黏膜预构尿道,采取口腔黏膜长5.0~6.0 cm,宽1.0~1.2 cm;二期行尿道吻接,并应用阴囊皮瓣覆盖创面。通过门诊、电话及微信随访患者术后阴茎外观及排尿情况。结果共纳入114例患者,年龄18~63岁,平均28岁;既往曾行修复手术1次者22例,2次者69例,3次者23例;距前次手术时间6~60个月,平均25个月;其中36例伴有尿瘘,52例伴有尿道外口狭窄,58例伴有阴茎瘢痕。46例阴茎创面应用阴囊中隔皮瓣修复,68例应用阴囊筋膜皮瓣修复,皮瓣大小1.2 cm×3.0 cm~3.0 cm×5.5 cm。术后6例并发尿外渗,经换药、理疗及局部清洁,2~4周自行愈合;2例出现阴囊皮瓣远端血运障碍,形成尿瘘,半年后再次手术修复;其余患者均一期愈合。94例患者获得6~84个月随访,平均37个月,所有患者阴茎无弯曲,排尿通畅,无尿道狭窄及尿瘘,阴茎外形良好。18例患者来院复诊,行尿道超声及磁共振水成像检查,显示再造尿道光滑,移植黏膜伸展性良好,尿道内无残余尿液。结论采用口腔黏膜预构尿道,二期修复成人复杂型尿道下裂,可获得较好的临床效果。

Objective To review the clinical effect of oral mucosa prefabricated urethra in the treatment of complicated hypospadias in adult patients.Methods A retrospective analysis was performed on adult patients with complicated hypospadias who underwent two-stage surgical repair in the Second Department of Plastic Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences from January 2011 to December 2020.In the first stage,the urethra was prefabricated with oral mucosa,which was 5.0-6.0 cm in length and 1.0-1.2 cm in width.The second stage was urethral anastomosis,in which scrotal flap was applied to cover the wound.Postoperative follow-up was conducted by telephone or WeChat,including penile appearance and the situation of urination.Results A total of 114 patients were enrolled,age raging from 18 to 63 years old,with an average age of 28 years.There were 22 cases who had underwent one previous repair operation,69 cases had two repair operations,and 23 cases had three repair operations.The time from the last operation was 6 months to 60 months,with an average of 25 months.Postoperative complications included urinary fistula in 36 cases,urethral orifice stenosis in 52 cases and penile scar in 58 cases.The scrotal septal skin flap was used in 46 cases and scrotal fascia flap was used in 68 cases.The flaps size ranged from 1.2 cm×3.0 cm to 3.0 cm×5.5 cm.Among the 114 patients,6 patients were complicated with urinary extravasation,which healed spontaneously in 2-4 weeks;2 patients developed urinary fistula due to blood supply disorder at the distal end of the scrotal flap,which was repaired half a year later.Other patients healed well.94 patients were followed up for 6-84 months,with an average of 37 months.All patients had no chordee,smooth urination,no urethral stricture and fistula.All patients were satisfied with the appearance of the penis.Urethral ultrasound and magnetic resonance hydrography were performed in 18 patients.The results showed that the reconstructed urethra was smooth,the mucosa graft had good extension,and there was no residual urine in the urethra.Conclusions Oral mucosa prefabricated urethra could be used for repair hypospadias in adult patients who failed in repair surgeries,and could obtain good clinical effect.