口腔黏膜管及阴囊皮瓣分期修复成年人严重型尿道下裂

目的 总结口腔黏膜卷管游离移植及阴囊皮瓣修复成年人严重型尿道下裂的疗效.方法 应用口腔黏膜卷管游离移植预制远段尿道,二期进行吻接,同时应用以阴囊动脉为蒂的阴囊中隔皮瓣或阴囊筋膜皮瓣修复创面,皮瓣最宽3 cm,最长6.5 cm.结果 2002年1月至2007年12月,治疗成年人严重型尿道下裂患者76例,除4例并发感染、2例出现阴囊皮瓣远端血运障碍而形成尿漏,术后2～4周内自行愈合外,其余患者均一期愈合.结论 应用口腔黏膜卷管游离移植预制远段尿道,二期尿道吻接、应用阴囊皮瓣修复阴茎创面,是治疗成年人严重型尿道下裂的较好方法.     

游离口腔黏膜代尿道治疗尿道下裂及前尿道狭窄50例

目的 探讨口腔黏膜游离移植,治疗严重尿道下裂和长段前尿道狭窄的手术适应证及疗效.方法 2006年5月至2010年4月期间我科共进行口腔黏膜游离代尿道治疗严重尿道下裂及长段前尿道狭窄50例,年龄5-48岁.其中尿道下裂28例,有过一次手术史15例,多次手术史10例.前尿道狭窄22例,狭窄段4～7cm长.结果 28例尿道下裂患者,26例成功;22例尿道狭窄患者,20例成功,手术成功率92.00%(46/50),尿道下裂患者术后阴茎外观满意,尿道开口于阴茎前端,排尿通畅.尿道狭窄患者术后1个月最大尿流率为14～40ml/s,平均29ml/s.所有手术成功患者术后随访1～10个月无尿道狭窄,无尿瘘.尿道下裂和尿道狭窄患者中各有2例失败,术后出现阴茎皮肤切口感染发生尿瘘,6个月行补瘘手术治愈.结论 对于多次手术,局部组织缺乏的尿道下裂及长段前尿道狭窄,应用口腔黏膜游离移植修复尿道,手术疗效好,值得推广.     

应用口腔黏膜炎卷管游离移植修复尿道下裂的围手术期护理

目的:探讨应用口腔黏膜炎卷管游离移植修复尿道下裂的围手术期护理经验。方法:2007年1月～2012年1月应用口腔黏膜炎卷管游离移植修复尿道下裂患者68例患者。年龄5～27岁,平均年龄12岁。表现为不同类型的尿道下裂畸形,均采用矫直阴茎后,应用口腔黏膜炎卷管游离移植预制缺损段尿道,二期进行吻接,同时应用以阴囊动脉为蒂的阴囊筋膜皮瓣覆盖创面进行修复,围手术期给予心理方面和口腔、会阴手术区的对症护理。结果:术后68例均愈合良好,术后并发尿瘘4例,黏膜炎成活66例(97%)。结论:应用口腔黏膜炎卷管游离移植分期修复尿道下裂成功率较高,并发症少,术后阴茎外观好,术后严密观察的护理措施是保障手术成功的重要因素。     

口腔黏膜预植尿道板分期治疗残废型尿道下裂

目的探讨应用口腔黏膜预植尿道板分期治疗残废型尿道下裂的效果。方法回顾性分析2019年3月至2023年3月遵义市第一人民医院小儿外科收治的残废型尿道下裂患儿的临床资料。手术方式均采用口腔黏膜预植尿道板分期治疗, 即一期手术行阴茎伸直、口腔黏膜预植尿道板, 二期手术行尿道成形。术后随访观察尿道板存活、尿瘘、尿道裂开、尿道憩室、尿道狭窄、阴茎下弯复发、阴茎外观及排尿情况。结果纳入12例男性患儿, 年龄5岁1个月至14岁, 中位年龄8岁2个月。12例患儿入院前有2～4次尿道下裂手术史, 平均3.2次, 所有病例均伴有中、重度阴茎下弯和包皮缺乏, 其中尿道裂开5例, 多处尿瘘3例, 尿道狭窄4例。所有患儿术后随访6～36个月, 平均25个月。一期术后发生预植尿道板部分感染、失活1例, 经高压氧治疗及局部换药后愈合;二期术后发生尿瘘2例, 经再次尿瘘修补术后治愈;其他患儿无尿道裂开、尿道憩室、尿道狭窄、阴茎下弯复发, 阴茎外观无臃肿, 尿道开口位于阴茎头正位, 呈纵向裂隙状, 排尿通畅、尿线连续。结论口腔黏膜预植尿道板分期治疗残废型尿道下裂效果满意, 是一种安全、可行的有效方法。     

尿道缩短型尿道下裂修复的临床观察

目的 介绍尿道缩短型尿道下裂的治疗方法及经验.方法 回顾性分析自1995年1月至2018年12月,中国医学科学院整形外科医院整形二科收治的23例尿道缩短型尿道下裂患者的临床资料,一期采用口腔黏膜片或卷管游离移植尿道成形,二期采用阴囊平滑肌肉膜组织瓣修复创面.结果 术后所有患者均排尿顺畅,尿线及射程良好,阴茎勃起时腹侧弯...     

后型尿道下裂二期膀胱黏膜半管状重建尿道术的临床研究

目的探讨采用二期膀胱黏膜半管状重建尿道术治疗后型尿道下裂的临床研究。方法81例后型尿道下裂病例采用二期手术：一期手术将阴茎海绵体完全伸直,阴茎包皮内板和背侧皮肤预置于阴茎腹侧;二期手术采用半管状阴茎阴囊皮肤＋半管状膀胱黏膜成形尿道术。结果81例后型尿道下裂患者矫形后形态几乎接近正常。手术成功率为86．4％（70／81）,尿瘘发生率为13．6％（11／81）,8例（9．9％,8／81）发生尿道狭窄,经尿道扩张治疗后痊愈。结论二期膀胱黏膜半管状重建尿道术治疗后型尿道下裂的手术成功率较高,值得临床推荐。     

微粒黏膜复合明胶海绵移植耦合局部皮瓣再造尿道

目的 探讨明胶海绵复合微粒包皮内板黏膜或尿道板黏膜游离移植,并耦合局部皮瓣治疗阴囊型及阴茎阴囊型尿道下裂的手术方法及疗效.方法 2006年4月-2007年12月,收治8例重度尿道下裂患儿,年龄8个月～3岁.阴囊型尿道下裂3例,余均为阴茎阴囊型尿道下裂.阴茎牵拉长度为2.5～4.5 cm.应用明胶海绵复合微粒包皮内板黏膜或尿道板黏膜游离移植,并与大小为2.5 cm×1.0 cm～4.5 cm×1.2 cm的局部皮瓣耦合再造尿道.其中一期修复7例,二期修复1例.结果 患儿手术时间为(150×35)min,术中测量修复尿道缺失长度为(3.38×0.79)cm.皮瓣均顺利成活.8例均获随访,随访时间2～24个月.无尿瘘和尿道狭窄并发症发生.患儿阴茎下弯彻底矫正,再造尿道口位于阴茎头部,能正常勃起和站立排尿,尿道顺应性良好.1例术后12个月出现轻度阴茎下弯,未行治疗.结论 明胶海绵复合微粒包皮内板黏膜或尿道板黏膜游离移植耦合局部皮瓣修复阴囊型及阴茎阴囊型尿道下裂,具有减少局部皮肤应用、改善成形龟头外观、减少尿道并发症的优点,近期疗效较好.     

尿道口蒂皮瓣与口腔黏膜联合一期修复尿道下裂

目的探讨尿道口蒂皮瓣与口腔黏膜对合重建尿道的方法.方法 2002年3月～2004年5月,采用尿道口蒂皮瓣与口腔黏膜联合重建尿道21例,年龄14个月～8岁.切断挛缩尿道板,彻底矫直阴茎后,将口腔黏膜移植于阴茎腹侧白膜,尿道口蒂皮瓣翻转后与口腔黏膜对合,形成管状尿道.结果术后所有患儿均获3～18个月随访,平均7个月.阴茎弯曲完全矫正,尿道外口位于阴茎头前端,阴茎外形良好,排尿通畅.2例发生尿瘘,其中1例自愈,1例术后6个月再修补成功.结论尿道口蒂皮瓣与口腔黏膜联合重建尿道能彻底矫正阴茎弯曲,提高手术成功率和改善术后阴茎外形.     

应用口腔黏膜再造尿道远期观察研究

目的观察口腔黏膜再造尿道的远期外观与结构变化,以及与正常尿道黏膜的差异.明确口腔黏膜用作再造尿道材料的优缺点,以及与尿道下裂术后并发症是否有相关性.探讨用口腔黏膜作再造尿道材料的可行性.方法随访应用口腔黏膜再造尿道患者的远期形态与功能.应用尿道镜观察应用口腔黏膜再造尿道的远期外观.应用光学显微镜观察取自口腔黏膜再造尿道内壁的标本,同时对比观察正常口腔黏膜和尿道黏膜标本.结果应用口腔黏膜再造尿道,远期外形良好,排尿功能正常.再造尿道壁大体外观接近正常,但组织结构仍为典型口腔黏膜.结论应用口腔黏膜再造尿道,远期形态、功能均接近正常尿道,但组织结构没有改变.口腔黏膜是良好的再造尿道组织材料.     

联合口腔黏膜与阴囊皮瓣重建尿道一期修复尿道下裂

目的 总结联含口腔黏膜和阴囊皮瓣重建尿道一期修复尿道下裂的手术方法及临床效果.方法 2002年3月-2007年12月,联合口腔黏膜和阴囊皮瓣重建尿道一期修复尿道下裂42例.年龄1岁6个月～18岁.阴茎阴囊型21例,阴囊型12例,会阴型9例.34例为既往尿道下裂修复手术失败,初次于术至该次手术时间为6～19个月,平均10个月:8例为初次手术.术中阴茎矫直后尿道缺损3～7 cm,平均4.2 cm.将人小为3.0 cm×1.2 cm～7.0 cm×1.5 cm的口腔黏膜移植于阴茎腹侧白膜,与大小为3.0 cm×1.5 cm～7.0 cm×1.5 cm的阴囊皮瓣对合形成完整尿道.结果 38例术后切口期愈合,无并发症发生.4例术后7 d分别于冠状沟及吻合口端出现尿瘘,其中1例尿瘘于术后2个月自行封闭,3例于术后6个月行尿瘘修补术后愈合.42例均获随访,随访时间3～48个月,平均18个月.术后排尿通畅,重建尿道口均位于阴茎头远端,无回缩,外形接近正常尿道外口形态.阴茎阴囊彤态较满意,阴茎完全矫直.口腔形态、功能无异常.结论 联合口腔黏膜和阴囊皮瓣重建尿道组织量充裕,形成尿道狭窄率低,是一期修复尿道下裂的有效方法之一.     

口腔粘膜游离移植再造尿道

目的：探讨采用口腔粘膜游离移植，对局部缺乏组织的尿道下裂行尿道再造的方法。方法：1998－2001年对25例患者应用口腔粘膜游离移植再造阴茎段尿道，半年后吻合瘘口。结果：1例一期术后并发感染，愈后无尿道狭窄，所有病例二期吻合瘘口后，再造尿道通畅。结论：口腔粘膜丰富的网状毛细血管网、韧厚的上皮层和相对较薄的皮下板层结构是移植成功的关键。以口腔粘膜游离移植行尿道再造是一种可行的方法。     

Buccal mucosal graft in reconstructive urology: Uses beyond urethral stricture

The use of buccal mucosal grafts for the reconstruction of urethral strictures is an established procedure. Because of its robustness, the buccal mucosal graft could also potentially provide an alternative for other indications in reconstructive urology. We report here six consecutive patients who received a buccal mucosal graft for ureteral strictures, glans reconstruction and stoma stenosis. The follow up for all patients ranged from 26 to 50 months. The buccal mucosal graft showed excellent functional results for the ureteral strictures and stenosis from ureterocutaneostomy. For glans reconstructions, the buccal mucosal grafts delivered excellent cosmetic and functional results without causing meatal stenosis. We conclude the buccal mucosal graft can be used in reconstructive surgery beyond the reconstruction of urethral strictures.     

Substitution urethroplasty of complex and long-segment urethral strictures: a rationale for procedure selection

OBJECTIVES: We evaluated the applications and outcomes of substitution urethroplasty, using a variety of techniques, in 65 patients with complex, long-segment urethral strictures. METHODS: From January 1995 to December 2005, 65 patients with complex urethral strictures >8cm in length underwent substitution urethroplasty. Of the 65 patients, 43 underwent one-stage urethral reconstruction using mucosal grafts (28 colonic mucosal graft, 12 buccal mucosal graft, and 3 bladder mucosal graft), 17 patients underwent one-stage urethroplasty using pedicle flaps, and 5 patients underwent staged Johanson's urethroplasty. RESULTS: The mean follow-up time was 4.8 yr (range; 0.8-10 yr), with an overall success rate of 76.92% (50 of 65 cases). Complications developed in 15 patients (23.08%) and included recurrent stricture in 7 (10.77%), urethrocutaneous fistula in 3 (4.62%), coloabdominal fistula in 1 (1.54%), penile chordee in 2 (3.08%), and urethral pseudodiverticulum in 2 (3.08%). Recurrent strictures and urethral pseudodiverticulum were treated successfully with a subsequent procedure, including repeat urethroplasty in six cases and urethrotomy or dilation in three. Coloabdominal fistula was corrected only by dressing change; five patients await further reconstruction. CONCLUSIONS: Penile skin, colonic mucosal, and buccal mucosal grafts are excellent materials for substitution urethroplasty. Colonic mucosal graft urethroplasty is a feasible procedure for complicated urethral strictures involving the entire or multiple portions of the urethra and the technique may also be considered for urethral reconstruction in patients in whom other conventional procedures failed.     

8 cm以上复杂性尿道狭窄的外科治疗

目的探讨长段尿道狭窄手术方法的选择与疗效。方法对76例尿道狭窄8cm以上的患者采用不同尿道成形术式治疗,其中不同黏膜重建尿道42例（结肠黏膜26例,膀胱黏膜6例,口腔黏膜10例）;带蒂皮瓣一期尿道成形20例;尿道狭窄段切开、二期尿道成形（Johanson术）12例;阴茎段尿道与前列腺部尿道吻合、三期尿道成形术2例。结果术后初期（6个月内）排尿通畅67例（88％）,有并发症者10例。术后1年以上70例,其中获得随访51例,排尿通畅44例,有并发症者8例,其中采用带蒂皮瓣者发生尿道狭窄2例（18％,2／11）;Johanson术者发生阴茎弯曲2例（2／5）,其中1例成形段尿道内毛发生成和结石形成;采用口腔黏膜者发生尿道狭窄1例（1／7）,膀胱黏膜者发生尿道狭窄1例（1／3）,结肠黏膜者发生后尿道狭窄2例（9％,2／23）。结论口腔与结肠黏膜尿道成形对长段尿道狭窄是较理想的术式;结肠黏膜较适合在常规手术治疗失败后或复杂性尿道狭窄10cm以上的治疗。     

One-stage circumferential buccal mucosa graft urethroplasty for bulbous stricture repair

A one-stage onlay urethroplasty, using a buccal mucosa graft, is presented for patients with bulbous strictures in whom the urethral mucosa is seriously involved in the disease. Of 40 patients who underwent a dorsal buccal mucosa graft urethroplasty for bulbous urethral strictures, 5 required complete removal of the urethral mucosa and its replacement by a buccal mucosa graft. All these patients had undergone previous urethrotomy with a false passage inside the bulbous urethra and had a suprapubic tube in place. The goal of removal and replacement of the urethral mucosa in each case was to create a new, wide urethral mucosal bed to promote successful one-stage reconstruction. All patients voided spontaneously without problems after removal of the catheter. After 4 months, the mean peak flow was 21 mL/s. After 6 months, urethroscopy did not show any stricture recurrence. None of the patients required instrumentation or dilation. In patients with bulbous urethral strictures and false passage into the mucosa and spongiosum tissues, the complete removal and replacement of the urethral mucosa using a circumferential buccal mucosa graft promotes successful one-stage urethral reconstruction.     

A Buccal Mucosal Harvesting Technique for Urethral Reconstruction

Purpose

A step-by-step harvesting technique for buccal mucosa is described that maximizes graft yield while minimizing potential donor site morbidity in urethral reconstruction.

Materials and Methods

A specialized oral retractor was used to expose and retract the buccal mucosal lining of the oral cavity for graft harvesting in 12 patients.

Results

Adequate buccal mucosal graft size was obtained for each reconstruction. There were no oral donor site or urethral recipient site complications.

Conclusions

This harvesting technique offers a simple and effective method for optimizing buccal mucosal graft harvests.     

颊黏膜尿道成形术治疗前尿道狭窄的临床分析

目的 探讨利用游离口腔颊黏膜尿道成形术治疗前尿道狭窄的疗效.方法 2011年6月至2012年12月采用颊黏膜腹侧扩大替代尿道成形术治疗25例前尿道狭窄,狭窄段长度为3.5～10 cm,平均5.74 cm.术前耻骨上膀胱造瘘16例,余9例术前最大尿流率2.4～7.6 mL/s,平均4.3 mL/s.结果 术后随访3～18个月,平均6.5个月.术后患者排尿通畅22例(88％),尿动力学检查显示最大尿流率为14～28mL/s,平均19.4 mL/s.3例(12％)吻合口处狭窄,经历尿道扩张后,排尿通畅.所有患者均无感染及尿道皮肤瘘发生,口腔颊黏膜移植物均成活.结论 口腔颊黏膜可作为较理想的尿道替代物,适合长段或多段狭窄的尿道修复.     

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。     

The multistage use of buccal mucosa grafts for complex hypospadias: histological changes

PURPOSE: We report our experience using buccal mucosa in the multistage repair of complex hypospadias, and the observed histological changes. MATERIALS AND METHODS: We evaluated 31 patients (14 adults and 17 children). A total of 19 patients presented after failed hypospadias repair with deficient ventral skin, 5 presented with scrotal hypospadias and 7 presented with perineal hypospadias. Patients who had previously undergone hypospadias repair had 3 to 7 failed trials. Two stage buccal mucosa graft was performed using the Bracka technique. In the first stage residual fibrosis was released, the glans was split and the buccal mucosa graft was sutured to the ventral surface of the penis to form a future urethral plate. Second stage reconstruction was performed after 6 months with interposed scrotal dartos tissue. Buccal mucosa was histologically studied before grafting, and at 6 months after graft uptake and exposure to the air. RESULTS: Buccal mucosa free graft showed excellent uptake within 5 days in all cases. At 6 months the buccal mucosa was well vascularized and pliable. Minute fistulas occurred in 3 cases (9.7%), which were closed at a later stage. Histological analysis of buccal mucosa tissues before and after graft and prolonged exposure to the air (more than 6 months) was conducted. The buccal mucosa displayed epithelial hyperplasia with mild and focal keratinization. The lamina propria was slightly edematous and minimally infiltrated by mononuclear inflammatory cells. The lamina propria papillae were elongated, extending to 75% of the mucosal thickness compared to the normal buccal mucosa. The buccal mucosal graft displayed good vascularization, similar to that of the normal mucosa. CONCLUSIONS: Multistage repair using buccal mucosa is an excellent option for urethral reconstruction. It guarantees excellent graft uptake and good vasculature, which improves success. It also provides supple tissue for glanular and urethral reconstruction in cases of severe complex hypospadias.     

口腔内黏膜尿道成形治疗前尿道狭窄10年经验总结

目的 探讨口腔内黏膜尿道成形治疗尿道狭窄的长期效果. 方法 2001年1月至2010年12月,应用口腔内黏膜(颊黏膜和舌黏膜)尿道成形治疗前尿道狭窄255例.尿道狭窄段长度3 ～18 cm,平均6 cm.尿道成形采用保留原尿道板的扩大尿道成形术或埋藏黏膜条背侧替代尿道成形术.对49例尿道狭窄段≥8 cm者采取双侧颊黏膜拼接、颊粘膜与舌黏膜拼接或双侧连续长条舌黏膜尿道成形. 结果 术后随访8 ～120个月,平均37个月.230例患者排尿通畅,尿线粗,最大尿流率为16～51 ml/s,平均26 ml/s.尿道造影显示重建段尿道管腔通畅.总成功率90.2％.25例患者于术后1年内发生并发症,其中尿道再次狭窄17例,尿道皮肤瘘8例.17例尿道再狭窄患者中15例再次行口腔内黏膜尿道成形,2例吻合口狭窄行尿道内切开,术后排尿通畅;8例尿道皮肤瘘均接受尿瘘修补术后治愈. 结论 口腔颊黏膜和舌黏膜均是良好的尿道替代物,舌黏膜取材较颊黏膜更为便利;口腔内多种黏膜的组合移植重建尿道是治疗长段前尿道狭窄( ≥8 cm)的有效方法.