游离黏膜组织重建尿道治疗复杂性尿道狭窄的临床研究

目的 探讨利用游离黏膜一期尿道成形治疗复杂性尿道狭窄或闭锁的疗效。方法 2000年8月至2004年7月采用2种游离黏膜一期尿道成形术治疗73例复杂性尿道狭窄。术前42例已行耻骨上膀胱造瘘，余31例最大尿流率1．2～6．5ml／s。用游离结肠黏膜(n=22)重建尿道长10～18cm，平均13cm；用口腔黏膜(n=51)重建尿道长3～11cm，平均5cm。术后随访分别行逆行尿道造影及尿流率，部分患者行尿道镜检查。结果随访2～48个月，平均19个月。术后排尿通畅67例(91．8％)。发生再次狭窄4例，其中结肠黏膜重建者1例，口腔黏膜重建者3例；排尿欠畅2例，定期行尿道扩张；尿道皮肤瘘2例；结肠腹壁瘘1例。1例结肠黏膜重建尿道者术后47个月移植物活检示结肠黏膜的组织形态学基本无变化。结论口腔与结肠黏膜均可作为较理想的尿道替代物，口腔黏膜较适合狭窄段不长的尿道修复，结肠黏膜较适合复杂性超长段尿道狭窄或缺损的治疗。

Clinical study of one-stage urethroplasty using free mucosa for the treatment of complex urethral stricture

Objective To investigate the effect of urethral reconstruction with free mucosa for the treatment of complex urethral stricture. Methods Between August 2000 and July 2004,73 patients with complex urethral stricture were treated with colonic mucosal and buccal mucosal graft urethroplasty.Preoperatively,42 cases had undergone suprapubic cystostomy and the remaining 31 cases had Qmax of 1.2-6.5 ml/s(mean,3.6 ml/s).Of the 73 cases,51 underwent buccal mucosal urethroplasty with a free graft of buccal mucosa as reconstructed urethra ranging from 3 to 11 cm (mean,5 cm);and 22 underwent colonic mucosal urethroplasty with a free graft of colonic mucosa as reconstructed urethra ranging from 10 to 18 cm (mean,13 cm).Follow-up included retrograde urethrography, urethroscopy, uroflowmetry. Results The patients were followed up for 2-48 months postoperatively (mean,19 months). Among the 73 patients,67( 91.8 %) voided well. Urethral stricture developed again in 4 cases (3 with buccal mucosal urethroplasty and 1 with colonic mucosal urethroplasty). Urethrocutaneous fistula occurred in 2 cases and colonioabdominal fistula in 1.Biopsy on reconstructed urethra with colonic mucosa showed no primary changes of morphological structure in 1 case with colonic mucosal urethroplasty 47 months after operation. Conclusions Buccal mucosal and colonic mucosal graft urethroplasty is a feasible procedure for the treatment of different types of complex urethral stricture.