舌黏膜前尿道成形术方法改良:从切口选择到长段取材

张楷乐; 傅强

doi:10.13201/j.issn.1001-1420.2020.08.004

舌黏膜前尿道成形术方法改良:从切口选择到长段取材

张楷乐^1,2,
傅强^1,2, ,

- 1. 上海市第六人民医院泌尿外科(上海, 200233);
- 2. 上海市东方尿路修复重建研究所
基金项目:
国家自然科学基金青年项目(No:81700590)

上海交通大学“医工交叉研究基金”(No:YG2017QN15)

上海市卫健委科研项目(No:20184Y0053)

详细信息

通讯作者: 傅强,E-mail:jamesqfu@aliyun.com

中图分类号: R693

收稿日期: 2020-06-03

Reformation of lingual mucosa for anterior urethroplasty: from incision choice to long segment harvesting

ZHANG Kaile^1,2,
FU Qiang^1,2, ,

- 1. Department of Urology, Shanghai Sixth People's Hospital, Shanghai, 200233, China;
- 2. Shanghai Eastern Institute of Urologic Reconstruction

More Information

Corresponding author: FU Qiang, E-mail: jamesqfu@aliyun.com

Received Date: 03 June 2020

摘要

摘要: 目的:长段尿道狭窄是泌尿外科的棘手问题,舌黏膜尿道成形术是治疗长段尿道狭窄的常用方法,然而,术中黏膜取材不足,术后狭窄复发,口腔和尿道并发症是亟需解决的问题。方法:我们对本中心诊断为前尿道狭窄的患者进行了一项回顾性观察性研究,根据主诉,尿流率,尿道造影结果以及尿道镜下尿道和膀胱的大体外观,所有患者均确诊为尿道狭窄。之后应用我院在舌黏膜尿道重建手术中的多项创新性操作,包括舌黏膜取材,切口选择,移植物替代方法,尿道外口处理。这些患者接受了LMG一期背侧覆盖尿道成形术,术后进行随访。结果:手术时间为2009年12月至2016年3月,随访终止时间为2020年3月,共获得128例患者术后随访数据,患者年龄14~78岁,平均47岁,随访时间45~132个月,平均(81±38)个月,尿道狭窄长度1.0~17.0 cm,平均(7.7±4.1) cm。获取舌黏膜长度2.0~18.0 cm,平均(7.9±4.1)cm,宽度1.0~2.0 cm,平均(1.6±0.4) cm。72例患者在手术前接受过手术或尿道扩张。总体无复发成功率为69.5%。狭窄复发患者的复发时间0.1~101个月,平均(12.4±23.9)个月。18例(17.5%)患者自述术后出现性功能下降。30例患者(28.9%)自诉存在舌疼痛、麻木,有发音改变。结论:本文介绍了4种舌黏膜尿道重建中的技术要点创新,从皮肤切口的选择,舌黏膜取材位置,舌黏膜缝合位置到尿道外口的处理。根据我院大量病例实践显示,以上创新能够显著提高手术成功率,降低并发症发生率。
- 尿道狭窄 /
- 尿道成形术 /
- 尿道重建 /
- 舌黏膜移植 /
- 口腔黏膜移植
Abstract: Objective: Long segmented urethral stricture is a difficult problem in urology. Urethroplasty with lingual mucosa is a popular method for the treatment of long segmented urethral stricture. However, insufficient mucosal materials, postoperative stenosis recurrence, oral and urethral complications are urgent problems. Method: We conducted a retrospective observational study of patients diagnosed with anterior urethral stricture in our center. All patients were diagnosed with urethral stricture according to chief complaint, urinary flow rate, urethrography, and general appearance of urethra and bladder under urethroscopy. After that, we applied a number of innovative operations in the urethra reconstruction with the tongue mucosa, including tongue mucosa sampling, incision selection, graft replacement method and urethra external oral treatment. These patients underwent LMG one-stage dorsal onlay urethroplasty and were followed up after surgery. Result: The operative time was from December 2009 to March 2016, and the follow-up was terminated in March 2020. A total of 128 patients were followed up, with an average age of 47 years(14-78 years), an average follow-up time of 81±38 months(45-132 months), and an average urethral stricture length of 7.7±4.1 cm(1.0-17.0 cm). The average length and width of tongue mucosa were 7.9±4.1 cm(2.0-18.0 cm) and 1.6±0.4 cm(1.0-2.0 cm). Seventy-two patients underwent surgery or urethral dilation before surgery. The overall recurrence free success rate was 69.5%. The mean recurrence time of patients with recurrent stenosis was 12.4±23.9 months(0.1-101 months). Eighteen(17.5%) patients reported sexual dysfunction after surgery. Thirty patients(28.9%) complained of tongue pain, numbness and altered pronunciation.Conclusion: This paper introduces the innovation of four kinds of techniques in the reconstruction of tongue mucosa urethra, from the selection of skin incision, the location of tongue mucosa, the suturing location of tongue mucosa to the treatment of urethra. According to the practice of a large number of cases in our hospital, the above innovations can significantly improve the success rate of surgery and reduce the incidence of complications.
- urethral stricture /
- urethroplasty /
- urethral reconstruction /
- lingual mucosa graft /
- oral mucosa graft

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参考文献(8)

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