CAJ | 학술논문

目的总结15例带蒂环带状包皮皮瓣法尿道成形术治疗复杂性前尿道狭窄的经验.方法采用包皮环形带状裁取一周,切开后带蒂旋转至阴茎腹侧,长段前尿道狭窄处切开,行皮瓣尿道腹侧加盖的术式.术后定期随访及行尿流率、尿道造影检查,观察排尿情况.结果 2006年11月至2012年10月,临床治疗15例,年龄20 ～ 76岁,平均45岁,其中尿道感染致狭窄4例,术后长期留置尿管致狭窄6例,经尿道灌注化疗药物致狭窄3例,尿道下裂术后尿道狭窄2例.狭窄段长度3.5 ～12.0 cm,平均7.0 em,均采用包皮瓣尿道腹侧狭窄段切开加盖术式.术后随访3个月至3年,平均18个月.手术成功12例,出现尿道狭窄2例,成形尿道憩室样扩张1例.结论环形带状包皮皮瓣的裁取,可以获得足够的带蒂皮瓣来治疗复杂性前尿道狭窄.带蒂包皮瓣具有弹性好、无毛发、获取较易、循环好、组织成活率高等特点.腹侧加盖术式尿道成形创伤小,手术成功率高,外形美观,是治疗复杂性尿道狭窄的良好术式.
목적 총결15례대체배대상포피피판법뇨도성형술치료복잡성전뇨도협착적경험.방법 채용포피배형대상재취일주,절개후대체선전지음경복측,장단전뇨도협착처절개,행피판뇨도복측가개적술식.술후정기수방급행뇨류솔、뇨도조영검사,관찰배뇨정황.결과 2006년11월지2012년10월,림상치료15례,년령20 ～ 76세,평균45세,기중뇨도감염치협착4례,술후장기류치뇨관치협착6례,경뇨도관주화료약물치협착3례,뇨도하렬술후뇨도협착2례.협착단장도3.5 ～12.0 cm,평균7.0 em,균채용포피판뇨도복측협착단절개가개술식.술후수방3개월지3년,평균18개월.수술성공12례,출현뇨도협착2례,성형뇨도게실양확장1례.결론 배형대상포피피판적재취,가이획득족구적대체피판래치료복잡성전뇨도협착.대체포피판구유탄성호、무모발、획취교역、순배호、조직성활솔고등특점.복측가개술식뇨도성형창상소,수술성공솔고,외형미관,시치료복잡성뇨도협착적량호술식.
Objective To summarize the experience of urethral reconstruction using circular fasciocutaneous flap for the treatment of complex anterior urethral strictures.Method The circular fasciocutaneous flap was harvested from the distal penile shaft or foreskin.Then the circular configuration was converted into longitudinal strip of skin which was rotated to ventral side to repair the exposured urethral strictures using the ventral onlay method.The surveillance protocol after urethroplasty was urination observation,regularly uroflowmetry and urethrography examination.Results From Nov.2006 to Oct.2012,15 cases were treated.The mean age was 45 years (20-76 years) and mean follow-up period was 18 months(3 months-3 years).Stricture was caused by chronic urethritis in 4 cases,long-term urethral catheterization in 3 cases,transurethral perfusion chem other aphy in 3 cases,transurethral prostatectomy in 3 cases and hypospadias after surgery in 2 patients.The mean stricture length was 7.0 cm (3.5-12.0 cm).The overall success rate was 80.0％ (12/15).Recurrence stenosis was noted in 2 cases and diverticulum formation in 1 case.Conclusions The penile circular fasciocutaneous flap can be used for anterior urethral stricture in nearly any length.The flap has the characteristics of hairless,adequate mobile and length,well-vascularized pedicle and easy to harvest.The onlay reconstruction provides excellent cosmetic results,less trauma,higher success rate.Therefore it should be one of the preferred techniques for complex anterior urethral stricture repair.