会阴阴囊岛状双皮管重建尿道治疗全程尿道狭窄

目的：探讨利用会阴阴囊岛状双皮管重建尿道治疗全程尿道狭窄的应用价值及疗效。方法：本院1999～2010年采用会阴阴囊岛状双皮管一期尿道成形治疗16例全程尿道狭窄。术前先进行尿路无菌化及会阴阴囊毛发处理,术后第2天拔除橡皮引流片,并用抗生素行膀胱冲洗1次/d,术后2周拔除导尿管和膀胱造瘘管排尿。术后随访分别用逆行尿道造影、尿道镜和尿流率检查。结果：16例全程尿道狭窄患者均一期手术成功,术后随访6～36个月,平均16.3个月,1例术后3个月并发尿道外口狭窄,2例术后并发尿瘘,经再次手术矫正后均排尿通畅。1例术后尿线稍细,经定期尿扩后排尿顺畅。3例术后会阴部切口皮肤裂开并轻度感染,经换药后自行愈合。16例患者均无阳萎、尿失禁等并发症发生。尿道镜检查显示重建尿道内无毛干生长,无结石、囊袋及憩室形成。结论：会阴阴囊岛状双皮管治疗长全程尿道狭窄,是一种可行而有效的方法;该方法手术操作简单,取材方便,术中不需用特殊器械和设备,具有临床推广价值。

Urethral reconstruction with double island skin flap graft in treatment of whole urethral stricture

Objective： To investigate the application and effect of urethral reconstruction with double island skin flap graft. Methods： From 1999 to 2010, 16 patients with whole urethral stricture were treatment with double island skin flap graft urethroplasty. The urinary canal must be asepticized and the hairs must be pulled out before operation. The drainage strip can be pulled out and bladder washout 1/d with antibiotics after operation. The urethral catheter and man-mad syrinx of bladder would be pulled out two weeks after operation. Follow-up included retrograde urethrography, urethroscopy and uroflowmetry. Results： 16 patients with whole urethral stricture were cured by urethroplasty. The whole patients were followed up 6-36 months postoperatively （mean 16.3 months）. Meatal stenosis developed in one patient 3 months after operation and urinary fistula developed in two patients, but they were voided very well by reoperation. Another patient had weak urinary stream after operation and then voided smoothly by regular urethral sounding and the urinary peak flow was greater than 15 ml per second. The incisal opening of perineal position split and had low-grade infection in three patients, but then being healed by changing dressings. At urethroscopy, there wasn’t hair shaft, calculus, bladder and diverticula in reconstructed urethra. Conclusion： The operative procedure of double island skin flap graft urethroplasty is simple and the materials can be gain easily. The technique need not special appliance and equipment, so it is feasible for treatment of whole urethral stricture and can be applied extensively.