阴茎纵行皮瓣尿道成形术治疗前尿道狭窄14例报告

摘要

目的 观察带蒂阴茎皮瓣尿道成形术治疗前尿道狭窄的临床效果.方法 采用带蒂阴茎皮瓣尿道成形术治疗14例前尿道狭窄患者,年龄(38.14±12.63)岁;尿道狭窄病史(26.71±62.06)个月;尿道扩张治疗史12例(85.71％),尿道内切开史9例(64.29％),膀胱造瘘术10例(71.43％);狭窄病因为创伤性10例(71.43％)、医源性3例(21.42％)、炎症性1例(7.14％);尿道狭窄长2～1o cm,平均长度(3.35±2.07)cm.结果 14例患者手术顺利.术后随访3～30个月,平均(15.71±8.25)个月,12例术后排尿顺畅,最大尿流率(21.92±6.47)mL/s;1例术后尿道轻度狭窄经尿道扩张后排尿满意,余1例长段尿道狭窄术后合并尿道旁感染致严重尿道狭窄,术后3个月行尿道切开术,待二期成形术.结论 阴茎皮肤薄、血运丰富、取材操作简单,是修补≤10 cm的前尿道狭窄较理想的材料之一.%Objective To explore the clinical efficacy of preputial pedicle flap urethroplasty in the treatment of anterior urethral stricture.Methods A total of 14 patients with anterior urethral stricture were treated with preputial pedicle flap urethroplasty.The patients aged (38.14 ± 12.63) years (range 24～62),with a history of urethral stricture of (26.71 ± 62.06) months (range 3～24).Transurethral dilation was applied in 12 cases (85.71％),transurethral incision in 9 cases (64.29％),and bladder stoma in 10 cases (71.43％).The stricture was caused by trauma in 10 cases (71.43％),by iatrogenic lesion in 3 cases (21.42％),and by inflammation in 1 case (7.14％).The length of urethral stricture was 2～10 cm,average (3.35± 2.07) cm.Results All operations were successful.After a follow-up of 3 to 30 months (mean 15.71±8.25),12 patients voided smoothly,with Qmax of 16～35 mL/s (mean 21.92±6.47).Mild urethral stricture occurred in 1 case,which was cured by urethral dilatation.One case suffered severe urethral stricture due to postoperative urethral infection,received transurethral urethrotomy after 3 mouths,and waited for the second-stage operation.Conclusion Preputial skin flap is convenient and simple for the treatment of anterior urethral stricture less than 10 cm,which has the advantages of few complications and high success rate.