目的 分析应用舌黏膜镶嵌分期尿道成形术治疗多次手术失败的尿道下裂术后尿道狭窄患者的疗效及并发症。方法 2015年7月至2017年2月本院收治的多次尿道下裂手术失败,术后尿道狭窄的患者21例,阴茎局部皮肤瘢痕严重,弹性差,应用舌黏膜作为修复材料行分期手术,观察其疗效及相关并发症。结果 所有患者手术顺利,一期手术伤口均愈合良好。2例因二期尿道成形术后出现严重感染而多次换药、冲洗,后出现尿道瘘,6个月后行尿道瘘修补术,愈合良好,排尿通畅。5例出现了不同程度的尿道狭窄,经过尿道扩张(2～4个月)狭窄解除。所有患者随访6个月以上,以阴茎外观满意,伸直满意,排尿通畅,连续3个月以上不需尿道扩张为随访终点。结论 多次手术失败的尿道下裂患者,阴茎局部皮肤条件差,应用舌黏膜分期行尿道修复重建,辅以必要的尿道扩张,效果肯定,有临床推广价值。
Objective To observe the efficacy and complications of using periglottis for urethrostenosis after multiple operative failures of hypospadia by stages. Methods A total of 21 patients of urethrostenosis after multiple operative failures of hypospadia were enrolled.Local conditions of penile skin were poor with severely inflexible scar.Periglottis was used as a repair material for staged operations to observe the efficacy and complications.Urinating smoothly finally occurred. Results All phase Ⅰ operations were uneventful.Two cases developed urethral fistula due to serious infection after phase Ⅱ surgery.After repairing at 6 months,both could urinate smoothly.Five cases of urethral stricture were successfully cured after urethral dilatation for 2-4 months.All follow-ups lasted at least 6 months.At the end of follow-up,there were satisfactory penile appearance,decent straightening,smooth urination and no urethral dilatation for over 3 consecutive months. Conclusion Using periglottis for urethrostenosis by staged surgery followed by urethra dilatation is effective and efficacious.
