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目的探讨利用游离黏膜一期尿道成形治疗复杂性尿道狭窄或闭锁的疗效。方法2000年8月至2004年7月采用2种游离黏膜一期尿道成形术治疗73例复杂性尿道狭窄。术前42例已行耻骨上膀胱造瘘,余31例最大尿流率1.2～6.5ml/s。用游离结肠黏膜(n=22)重建尿道长10～18cm,平均13cm;用口腔黏膜(n=51)重建尿道长3～11cm,平均5cm。术后随访分别行逆行尿道造影及尿流率,部分患者行尿道镜检查。结果随访2～48个月,平均19个月。术后排尿通畅67例(91.8%)。发生再次狭窄4例,其中结肠黏膜重建者1例,口腔黏膜重建者3例;排尿欠畅2例,定期行尿道扩张;尿道皮肤瘘2例;结肠腹壁瘘1例。1例结肠黏膜重建尿道者术后47个月移植物活检示结肠黏膜的组织形态学基本无变化。结论口腔与结肠黏膜均可作为较理想的尿道替代物,口腔黏膜较适合狭窄段不长的尿道修复,结肠黏膜较适合复杂性超长段尿道狭窄或缺损的治疗。
Objective To investigate the curative effect of complicated urethral stricture or atresia by using free mucosal phase I urethroplasty. Methods From August 2000 to July 2004, two kinds of free mucosa stage Ⅰ urethroplasty were used to treat 73 cases of complicated urethral stricture. 42 cases of preoperative suprapubic cystostomy, the remaining 31 cases of the maximum flow rate of 1.2 ~ 6.5ml / s. The urethra was reconstructed with free colon mucosa (n = 22) for 10 ~ 18cm with an average of 13cm. The urethra was reconstructed with oral mucosa (n = 51) for 3 ~ 11cm with an average of 5cm. Follow-up were retrograde urethrography and urine flow rate, some patients underwent urethral examination. The results were followed up for 2 ~ 48 months, an average of 19 months. Postoperative urination patency 67 cases (91.8%). There were 4 cases of restenosis, including 1 case of colon mucosal reconstruction, 3 cases of oral mucosa reconstruction; 2 cases of voiding dysfunction, regular urethral dilatation; 2 cases of urethral skin fistula; 1 case of abdominal wall fistula. One case of colonic mucosa reconstruction of the urethra at 47 months after transplantation biopsy showed no change in histomorphology of colonic mucosa. Conclusion Oral and colonic mucosa can both be used as an ideal urethral substitute. Oral mucosa is more suitable for urethral repair with less stenosis and colonic mucosa is more suitable for the treatment of complex long urethral stricture or defect.