复杂性前尿道狭窄的治疗(附78例报告)

The treatment of complex anterior urethral stricture (report of 78 cases)

目的 探讨复杂性前尿道狭窄手术方法的选择及成功的关键。 方法 对 78例复杂性前尿道狭窄患者采用不同手术方法的尿道成形术 ,其中不同黏膜重建尿道 4 0例 ,带蒂皮瓣一期尿道成形 2 6例 ,狭窄段尿道劈开、二期尿道成形 (Johanson术 ) 12例。 结果 术后随访 6～ 36个月 ,平均 16 .5个月。 6 7例排尿通畅 ,11例效果欠佳。其中黏膜重建尿道组发生尿道皮肤瘘 1例 ,尿道外口狭窄 2例 ,阴茎弯曲 1例 ;带蒂皮瓣尿道成形组发生尿道狭窄 3例 ,尿道皮肤瘘 1例 ,尿道皮肤瘘合并成形段尿道内毛发生成和结石形成 1例 ;Johanson术组发生阴茎弯曲 2例 ,其中 1例合并成形段尿道内毛发生成。 结论 复杂性前尿道狭窄手术方法的选择应根据尿道狭窄段长短、位置和严重程度。尿道狭窄段 <8～ 10cm者宜选用阴茎皮肤 (包括包皮 )带蒂皮瓣 ,阴茎皮肤取材有困难时可选用膀胱或口腔黏膜 ;尿道狭窄段 >10cm者可选用结肠黏膜 ,尤其在膀胱黏膜取材有困难时。

Objective To evaluate the selection of different procedures for the treatment of complex anterior urethral stricture and the key to successful operation. Methods 78 patients with complex anterior urethral strictures underwent different procedures of urethroplasty.Of them various mucosa urethral reconstruction were adopted in 40 cases,one-stage pedicle flaps urethroplasty in 26 and two-stage urethroplasty of Johanson procedure in 12. Results The patients were followed up for 6 to 36 months (mean 16.5 months).67 patients voided well and complications developed in 11. Of the 11 cases urethrocutaneous fistula occurred in 1,meatal stenosis in 2 and penile chordee in 1 for mucosal urethroplasty;urethrocutaneous fistula occurred in 2 and 1 of them was accompanied by hair bearing neourethra,urethral re-stricture in 3 for pedicle flaps urethroplasty;penile chordee developed in 2 and 1 of them was accompanied by hair bearing neourethra for two-stage urethroplasty of Johanson procedure. Conclusions Selection of different procedures for treatment of complex anterior urethral strictures depends on stricture length,location and severity.Penile pedicle flap urethroplasty is an effective method for those with urethral stricture <8～10 cm.Buccal or bladder mucosa can be used when penile pedicle flap is not available.Colic mucosa graft urethroplasty can be used for the treatment of complex anterior urethral stricture >10 cm,especially in those whose bladder mucosa is not available.