下唇黏膜代尿道在尿道下裂治疗中的应用

目的 分析评估下唇黏膜代尿道在复杂性尿道下裂手术中的应用价值.方法 2006年3月至2009年10月共对24例复杂性尿道下裂患儿施行了下唇黏膜代尿道手术.年龄2岁3个月至14岁,平均7.2岁.其中以往手术失败14例,表现为阴茎周围残留大量不规则瘢痕,或膀胱黏膜代尿道后严重尿道狭窄和憩室.或严重阴茎海绵体弯曲残留,或尿道大段缺损伴膀胱造瘘术后等,尿道周围无其他组织如尿道板、皮肤等可用替代尿道.手术方法为先行阴茎整形,包括包皮和阴茎头,完全矫正海绵体弯曲,6个月后行下唇黏膜代尿道手术.会阴型尿道下裂10例,方法为先完全矫正阴茎弯曲和阴茎阴囊转位,同时利用原始尿道板将尿道外口从会阴延长至阴茎根部,6个月后行下唇黏膜代尿道.结果 所有病例均获满意效果,包括阴茎外观,即阴茎勃起时无明显弯曲、尿道开口位于阴茎头顶端、无包皮不规则瘢痕堆积、无排尿困难等.术后9例出现尿瘘,其中2例术后自愈,7例经一次修补后治愈.出现尿道狭窄6例,均经尿道扩张后痊愈.下唇取黏膜处均无术后出血.结论 下唇黏膜代尿道可作为尿道下裂治疗中最后选择的方法之一,具有黏膜切取方便,易存活,新尿道组织黏膜接近正常组织的优点,但并发症发生率仍较高.

Application of lower lip mncosa for hypospadias repair

Objective To investigate the efficacy of using lower lip mucosa as graft in complex hypospadias repair.Methods Between Mar 2006 and Oct 2009,24 patients aged 2.2 to 14 years old (mean age:7.2 years)with complex hypospadias underwent urethra reconstruction using lower lip mucosa.Of the 24 patients,14 patients had a history of failed previous hypospadias repair and presented with bulk irregular scar around penile shaft,severe urethral stricture or diverticulum,and severe cordee remaining or long distance urethral defect with cystostomy.On these patients,glans,foreskin and correct penile cordee reconstruction was performed at the first stage;6 months later,neourethra was reconstructed with lower lip mucosa at the second stage.The 10 patients with perineal hypospadias underwent orthopedic operation for severe cordee.scrotal translocation and partial urethral reconstruction using urethral plate.Neourethra was reconstructed 6 months later with lower lip mucosa. Results The satisfactory cosmetic results such as normal penis appearance,no visible curvature of shaft,meatus opened at top of glans without irregular scar and voiding difficulty,were achieved in all patients.Fistula was noted in 9 cases,and 2 of them closed spontaneously,the Other 7 closed by operation 6 months later.Urethral stricture was resolved by urethral dilation in 6 patients.No lower lip bleeding was found after the operation.Conclusions It can achieve satisfactory outcome using lower lip mucosa to reconstruct neourethra for complex hyposioadias repair.