非离断尿道海绵体结合舌黏膜扩大管腔在男性球部尿道狭窄修复中的疗效观察

目的观察非离断尿道海绵体技术结合舌黏膜扩大管腔在男性球部尿道狭窄修复重建中的疗效及并发症。 方法男性球部尿道狭窄患者21例，分离出球部狭窄段尿道后，不离断尿道海绵体，纵向剖开尿道管腔，其中尿道狭窄长度在2 cm以内12例，直接行勺状尿道端端吻合。其中尿道狭窄段长度超过2 cm 9例，考虑直接尿道吻合张力大，应用舌黏膜作为修复材料，行尿道加盖扩大尿道管腔，观察所有病例疗效及尿道瘘、尿道狭窄和勃起功能障碍等相关并发症的发生率。所有患者术前经RigiScan检测夜间阴茎勃起硬度和膨胀度，术后1个月再次通过NPTR证实患者是否存在正常勃起。 结果所有患者均手术顺利，其中一次手术成功18例（85.71%），无任何并发症发生，舌黏膜尿道成形术后出现严重感染1例，经抗炎、换药、冲洗愈合后出现尿道瘘，6个月后行尿道瘘修补术，愈合良好，排尿通畅。出现阴囊局部血肿1例，经清创，加压包扎以及换药等处理，最终恢复良好。出现会阴部切口裂开1例，经换药、抗炎及红外治疗等处理，最终切口恢复良好，拔除尿管后出现尿道狭窄，经尿道扩张后，可通畅排尿。21例患者无1例术后勃起功能障碍发生。对所有患者进行随访，要求患者能够通畅排尿，并且尿道扩张能够坚持3个月以上。 结论非离断尿道海绵体技术结合舌黏膜扩大管腔在球部尿道狭窄修复重建中的临床应用效果肯定，不会增加术后勃起功能障碍的发生率，有临床推广价值。

Observation of curative effect of non-dissected cavernous body of urethra combined with widening of urethral lumen with lingua lmucosa in repairing bulbar urethral stricture in males

ObjectiveTo observe the effect and complications of non-dissected cavernous body of urethra combined with widening of urethral lumen with lingual mucosa in the repair and reconstruction of bulbar urethral stricturein males.MethodsA total of 21 male patients with bulbar urethral stricture were enrolled in this study. After the urethra of the bulbar stenosis was isolated, the corpus cavernosum was not cut off and the urethral lumen was opened longitudinally. Among them, 12 cases of urethral stricture were less than 2 cm in length, and a spoon-shaped urethral anastomosis was performed directly. Nine cases of urethral stricture were more than 2 cm in length. Considering the tension of direct urethral anastomosis, lingual mucosa served as a repair material, and the urethra was capped to widen the urethral lumen. The curative effect of all cases and the incidence of related complications such as urinary fistula, urethral stricture and erectile dysfunction were observed.ResultsAll patients underwent surgery successfully. Of them, 18 cases(85.71%) were successful in one operation without any complications. One case had severe infection after lingual mucosa urethroplasty, which resulted in urethral fistula after anti-inflammatory treatment, multiple dressing changes and rinses. Six months later, the urethral fistula was repaired, the healing was good and he urinated smoothly. One case developed a local hematoma of the scrotum. After debridement, compression bandaging and dressing change, he recovered well. One case had a dehiscence of the perineal incision. After dressing changes, anti-inflammatory and infrared treatments, the incision healed well. After the catheter was removed, the urethra became narrow. After the urethra was dilated, urination could be unblocked. No erectile dysfunction occurred in 21 patients. All patients were followed up, and the patients should be able to urinate smoothly, and the urethra dilatation could persist for more than 3 months.ConclusionThe clinical application of non-dissected cavernous body of urethra combined with widening of urethral lumen with lingual mucosa in the repair and reconstruction of bulbar urethral stricture has a positive effect and will not increase the incidence of postoperative erectile dysfunction. Therefore, it is worthy of clinical promotion.