尿道背侧颊黏膜镶嵌补片法治疗长段前尿道狭窄

目的 评价颊黏膜尿道背侧镶嵌技术尿道修复重建手术的有效性和安全性.方法 男性前尿道狭窄患者57例.平均年龄36(17～52)岁.尿道狭窄长度平均3.0(2.5～7.0)cm.颊黏膜取材长度平均4.0(3.5～8.0)cm,平均宽度2.3(I.8～2.5)am.57例均有经尿道内窥镜冷切电切手术史,其中1次手术史29例(51%),2次20例(35%),3次8例(14%),行耻骨上膀胱造瘘48例,9例采用尿道扩张维持.手术游离并旋转尿道,并于尿道背侧纵行切开,6-0可吸收线缝合颊黏膜与尿道切缘.保留尿管4周,拔管时行顺行尿道造影.患者排尿困难和尿线变细、尿道造影或尿道镜发现尿道管腔狭窄<16 F确定为尿道狭窄复发.结果 57例手术均成功,平均手术时间135(105150)min.平均随访11.2(1～23)个月.尿道通畅54例(95%),术后2～3个月复发3例(5%),狭窄部位均为远端的颊黏膜与尿道结合部,行尿道内窥镜冷刀切开,定期尿道扩张治疗.伤口感染3例,未发生尿瘘及尿道憩室.患者口腔疼痛持续2～5 d,平均2.3 d.术后无张VI困难、颊部麻木及腮腺导管梗阻等并发症发生,VI腔颊部均未见瘢痕形成.结论 VI腔颊黏膜尿道背侧镶嵌补片修复重建尿道,效果确切、并发症少、狭窄复发率低,是理想的长段前尿道狭窄的修复重建手段.

Dorsal onlay buccal mucosal graft urethroplasty for anterior urethral stricture

Objective To evaluate the efficacy and safety of dorsal onlay buccal mucosa urethro-plasty for the treatment of long anterior urethral stricture. Methods From October 2005 to SeDtem-ber 2007,57 patients(17-52 years old)underwent buccal mucosal dorsal onlay urethroplastv for the treatment of anterior urethral stricture.The mean urethral stricture length was 3.0cm(2.5-7.0 cm).Previously,29(51%)patients had experienced one direct vision internal urethrotomy(DVIU),20(35%)patients had accepted twice DVIU and 8(14%)patient had 3 times DVIU for the treatment of urethral stricture.All patients recurred urethral stricture after DVIU.The length of urethral stric-ture was measured by combined retrograde urethrography and voiding cystourethrography before ure-throplasty.All patients accepted urethroplasty at more than 6 months after last failed surgery.Buccal mucosa was harvested from right cheek.The urethra was exposed and dors'al side was rotated to out-side. A longitudinal incision was made on urethra. Buccal mucosal free grafts were sutured to the open edges of urethra with 6-0 absorbable suture. 1 8 F silicon fenestrated urethral catheter was Dlaced and kept for 4 weeks. Urethrography was used at 4 weeks and 3 months after the urethroplastv,and thenevery 6 months to evaluate the urethral recovery.Dysuria and urethral caliber less than 1 6 F which was confirmed by urethrography and urethroscopy were regarded as stricture recurrence. Resuits The mean fellow-up time were 11.2 months(1-23 months).Fifty-four(95%) patients remained stricture free.Three(5%)patients recurred at the 2 to 3 months after the operation and were treated with DVIU.Three patients had wound infection and recovered without other complication.There was no fistula,diverticulum in all patients.The pain of cheek lasted for 2 5 days(average 2.3 days).No case had hypoesthesia of cheek,obstruction of stenseffs duct or cheek scar.Conclusions Dorsal on-1ay buccal mucosal urethroplasty for long anterior urethral stricture provides stable results with few and acceptable complications.