CAJ | 학술논문

目的评估阴茎皮瓣尿道成形术治疗前尿道狭窄的长期疗效. 方法 2006年1月至2012年12月采用阴茎皮瓣尿道成形术治疗前尿道狭窄患者138例,年龄7～82岁,平均38岁.尿道狭窄病因:外伤性78例,医源性41例,感染性17例,原因不明2例.尿道狭窄部位:尿道悬垂部110例,球部28例.尿道狭窄段长3～ 14 cm,平均6.5 cm,其中≥10 cm者48例.根据尿道狭窄段的长度、部位和阴茎皮肤的条件选择不同类型的皮瓣:①带蒂纵形皮瓣;②带蒂环形皮瓣;③倒L形带蒂皮瓣;④Q形阴茎皮瓣,采用3种尿道成形方法:①侧面补片尿道成形(1组)80例;②背腹侧联合镶嵌成形(2组)42例;③管状重建尿道(3组)16例. 结果本组138例中4例失访,余134例随访8～ 84个月,平均39个月.29例出现并发症:尿道再狭窄17例,其中1组12例,2组2例,3组3例;尿道皮肤瘘7例,1组5例,2组和3组各1例;尿道憩室5例,1组4例,3组1例.105例排尿通畅,最大尿流率13 ～49 ml/s,平均25 mL/s,总成功率78.4％(105/134). 结论阴茎皮肤薄、血运丰富、取材操作简单,是重建尿道较理想的材料之一;L形或Q形阴茎皮瓣重建尿道是治疗超长段(≥10 cm)前尿道狭窄的有效方法.
목적 평고음경피판뇨도성형술치료전뇨도협착적장기료효. 방법 2006년1월지2012년12월채용음경피판뇨도성형술치료전뇨도협착환자138례,년령7～82세,평균38세.뇨도협착병인:외상성78례,의원성41례,감염성17례,원인불명2례.뇨도협착부위:뇨도현수부110례,구부28례.뇨도협착단장3～ 14 cm,평균6.5 cm,기중≥10 cm자48례.근거뇨도협착단적장도、부위화음경피부적조건선택불동류형적피판:①대체종형피판;②대체배형피판;③도L형대체피판;④Q형음경피판,채용3충뇨도성형방법:①측면보편뇨도성형(1조)80례;②배복측연합양감성형(2조)42례;③관상중건뇨도(3조)16례. 결과 본조138례중4례실방,여134례수방8～ 84개월,평균39개월.29례출현병발증:뇨도재협착17례,기중1조12례,2조2례,3조3례;뇨도피부루7례,1조5례,2조화3조각1례;뇨도게실5례,1조4례,3조1례.105례배뇨통창,최대뇨류솔13 ～49 ml/s,평균25 mL/s,총성공솔78.4％(105/134). 결론 음경피부박、혈운봉부、취재조작간단,시중건뇨도교이상적재료지일;L형혹Q형음경피판중건뇨도시치료초장단(≥10 cm)전뇨도협착적유효방법.
Objective To evaluate the long-term efficacy of using penile skin flaps for urethroplasty in the treatment of anterior urethral strictures.Methods Between Jan 2006 and Dec 2012,138 patients with anterior urethral stricture were treated by using penile skin flaps for urethroplasty.The mean age was 38 years (range,7-82 year).The etiology of stricture included trauma in 78 cases,iatrogenicity in 41 cases,infection in 17 cases,unknown reason in 2 cases.The penile urethral stricture was found in 110 cases and the bulbourethral stricture was found in 28 cases.The mean length of anterior urethral stricture was 6.5 cm (range 3-14 cm).Among them,the length of urethral stricture was more than 10 cm in 48 patients.Basing on location,length of stricture and condition of penile skin,different penile skin flaps were chosen,including vertical pedicle skin flap,pedicle circular flap,L-flap,Q-flap.Three different techniques were used for urethroplasty,such as lateral patch flap urethroplasty (group1,n=80),dorsal and ventral inlaid flap urethroplasty (group 2,n =42) and tubularized flap urethroplasty (group 3,n =16).Results 4 patients were lost during follow-up.The mean duration of follow-up in the remaining 134 patients was 39 months (range,8-84 months).Complications developed in 29 of 134 patients (21.6％),including strictures recurrence in 17 (group 1,n =12,group 2,n=2 and group 3,n =3),urethrocutaneous fistulas in 7 (group 1,n =5,group 2,n=1 and group 3,n =1) and urethral diverticulum in 5 (group1,n =4,and group 3,n =1).105 cases voided well and the urinary peak flows ranged from 13-49 ml/s (mean 25 ml/s),The overall success rate was 78.4％ (105/134).Conclusions Penile skin is thinner,rich in blood supply and easy to be manipulated,which is one of the excellent materials for the urethral reconstruction.Q-flap or L-flap urethroplasty is an effective technique for the treatment of long-segment urethral strictrues (≥ 10 cm).