中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2015年
6期
446-449
,共4页
朱再生%付强%叶敏%陈良佑%刘全启%张春霆%罗荣利%杨庆%吴汉%李瑞阳
硃再生%付彊%葉敏%陳良祐%劉全啟%張春霆%囉榮利%楊慶%吳漢%李瑞暘
주재생%부강%협민%진량우%류전계%장춘정%라영리%양경%오한%리서양
前尿道狭窄%外科皮瓣%外科手术,整形
前尿道狹窄%外科皮瓣%外科手術,整形
전뇨도협착%외과피판%외과수술,정형
Urethral stricture%Surgical flaps%Surgical procedures,plastic
目的：探讨带蒂环形包皮瓣尿道成形一期修复复杂性前尿道狭窄的临床效果。方法2006年1月至2013年1月采用带蒂环形包皮瓣一期尿道成形术治疗37例复杂性前尿道狭窄患者，年龄22～71岁，平均41岁。病因：尿道损伤13例，医源性13例，淋病反复发作2例，不明原因9例。尿道狭窄部位：尿道悬垂部22例，球部9例，狭窄从尿道悬垂部延伸到后尿道6例。狭窄尿道长度5．0～14．0 cm，平均8．1 cm。采用筋膜瓣解剖技术切取带血管蒂的环形岛状包皮瓣；该血管蒂包括Buck筋膜及肉膜两层组织结构；皮瓣在阴茎腹侧或背侧无血管区纵行剖开形成直皮瓣用以尿道成形。其中背腹侧镶嵌成形术27例；管状替代成形术10例。结果37例手术时间2．5～3．5 h，平均3．1 h。环形包皮瓣长度9．0～14．0 cm，平均10．4 cm。随访3～51个月，平均22个月。排尿通畅32例，最大尿流率15．0～29．0 ml／s，平均22．3 ml／s。一期成功率为86．5％（32／37）。尿道狭窄复发4例，尿道口狭窄1例。均再次手术，4例治愈，1例排尿欠通畅，现在定期尿道扩张。总成功率97．3％（36／37）。结论带蒂环形包皮瓣具有血供丰富、尿道成形材料天然的优点，是一期修复复杂性前尿道狭窄（≥5 cm）较理想方法。
目的：探討帶蒂環形包皮瓣尿道成形一期脩複複雜性前尿道狹窄的臨床效果。方法2006年1月至2013年1月採用帶蒂環形包皮瓣一期尿道成形術治療37例複雜性前尿道狹窄患者，年齡22～71歲，平均41歲。病因：尿道損傷13例，醫源性13例，淋病反複髮作2例，不明原因9例。尿道狹窄部位：尿道懸垂部22例，毬部9例，狹窄從尿道懸垂部延伸到後尿道6例。狹窄尿道長度5．0～14．0 cm，平均8．1 cm。採用觔膜瓣解剖技術切取帶血管蒂的環形島狀包皮瓣；該血管蒂包括Buck觔膜及肉膜兩層組織結構；皮瓣在陰莖腹側或揹側無血管區縱行剖開形成直皮瓣用以尿道成形。其中揹腹側鑲嵌成形術27例；管狀替代成形術10例。結果37例手術時間2．5～3．5 h，平均3．1 h。環形包皮瓣長度9．0～14．0 cm，平均10．4 cm。隨訪3～51箇月，平均22箇月。排尿通暢32例，最大尿流率15．0～29．0 ml／s，平均22．3 ml／s。一期成功率為86．5％（32／37）。尿道狹窄複髮4例，尿道口狹窄1例。均再次手術，4例治愈，1例排尿欠通暢，現在定期尿道擴張。總成功率97．3％（36／37）。結論帶蒂環形包皮瓣具有血供豐富、尿道成形材料天然的優點，是一期脩複複雜性前尿道狹窄（≥5 cm）較理想方法。
목적：탐토대체배형포피판뇨도성형일기수복복잡성전뇨도협착적림상효과。방법2006년1월지2013년1월채용대체배형포피판일기뇨도성형술치료37례복잡성전뇨도협착환자，년령22～71세，평균41세。병인：뇨도손상13례，의원성13례，임병반복발작2례，불명원인9례。뇨도협착부위：뇨도현수부22례，구부9례，협착종뇨도현수부연신도후뇨도6례。협착뇨도장도5．0～14．0 cm，평균8．1 cm。채용근막판해부기술절취대혈관체적배형도상포피판；해혈관체포괄Buck근막급육막량층조직결구；피판재음경복측혹배측무혈관구종행부개형성직피판용이뇨도성형。기중배복측양감성형술27례；관상체대성형술10례。결과37례수술시간2．5～3．5 h，평균3．1 h。배형포피판장도9．0～14．0 cm，평균10．4 cm。수방3～51개월，평균22개월。배뇨통창32례，최대뇨류솔15．0～29．0 ml／s，평균22．3 ml／s。일기성공솔위86．5％（32／37）。뇨도협착복발4례，뇨도구협착1례。균재차수술，4례치유，1례배뇨흠통창，현재정기뇨도확장。총성공솔97．3％（36／37）。결론대체배형포피판구유혈공봉부、뇨도성형재료천연적우점，시일기수복복잡성전뇨도협착（≥5 cm）교이상방법。
Objective To evaluate the efficacy of 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap for the treatment of complex anterior urthral strictures.Methods Between January 2006 and January 2013, 37 patients with complex anterior urethral stricture were treated by 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap.The mean age was 41 years ( 22 -71 years) .The etiology of stricture included trauma of 13 cases, iatrogenieity of 13 cases, gonorrhea infection of 2 cases, unknown reason of 9 cases.The penile urethral stricture was found in 22 cases, the bulbourethral stricture in 9 cases, and stricture extending from penile to posterior urethra in 6 cases.The mean length of anterior urethral stricture was 8.1 cm (range 5.0-14.0 cm).A circumferential island of the preputial/distal penile skin was mobilized by the technique of preserving penile fasciocutaneous wide vascular pedicle. The pedicle is composed of two layers of the dartos and the superficial lamella of Buck′s fascia, and the flap was divided in the midventral/middorsal plane back to the penoscrotal junction to convert the circular configuration to a longitudinal trip for urethral reconstruction.The dorsal and ventral inlaid flap urethroplasty was performed in 27 cases and tubularized flap urethroplasty was performed in 10 cases.Results The mean operative duration was 3.1 h (2.5-3.5 h).The mean length of the circular fascioctaneous preputial flap was 10.4 cm (range 9.0 -14.0 cm).All the patients were followed up for mean 22 months (3 -51 months).Thirty-two cases voided well and the mean peak urinary flow rate was 22.3 ml/s (15.0-29.0 ml/s).One-stage healing achieved in 32 cases (86.5%).Recurrent stenosis was noted in 4 cases, and meatal stenosis occurred in 1 patient, who required re-operation.Re-repair succeeded in 4 cases and total success rate was 97.3% (36/37).Conclusions The pedicle circular fascioctaneous preputial flap has advantage of good blood supply and autograft for new meatus.It could be a reliable and durable method for the treatment of complex anterior urthral strictures(≥5 cm) in 1-stage urethroplasty.
