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。

The treatment of complex urethral stricture greater than 8 cm long

Objective To evaluate the selection of different procedures and the feasibility for the treatment of long segment urethral stricture.Methods Seventy-six patients with complex urethral stricture greater than 8 cm long underwent different procedures of urethroplasty.Of them various mucosa grafts urethral reconstruction were adopted in 42 cases (colonic mucosal graft,n26; buccal mucosal graft,n10; bladder mucosal graft,n6);One-stage pedicle flaps urethroplasty in 20; two-stage urethroplasty of Johanson procedure in 12; and penile urethra- prostatic urethra anastomosis, three-stage urethroplasty in 2.Results In early followed up (within 6 months postoperatively), 67 patients (88%) voided well and complications developed in 10. Among the 70 patients who lasted more than 1 year after operation , 51 cases were followed up. Forty-four patients voided well ,and complications developed in 8. Of the 8 cases urethral restructure developed in 2(18%) for pedicle flaps urethroplasty, 2 for colonic mucosal urethroplasty (9%),1 for buccal mucosal graft(1/7), 1 for bladder mucosal graft(1/3); penile chordee in 2(2/5),and one of them was accompanied by hair bearing neourethra for two-stage urethroplasty of Johanson procedure.Conclusions Colonic mucosal and buccal mucosal grafts urethroplasty are feasible procedures for the treatment of long segment urethral stricture, and Colonic mucosal graft urethroplasty may be considered when more conventional procedures fail or complicated urethral strictures greater than 10 cm long.