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自体刃厚皮移植预制尿道联合阴囊皮瓣修复尿道中段缺损伴阴茎缺损的临床效果

佟琳 张万福 韩飞 徐志刚 胡大海 官浩

佟琳, 张万福, 韩飞, 等. 自体刃厚皮移植预制尿道联合阴囊皮瓣修复尿道中段缺损伴阴茎缺损的临床效果[J]. 中华烧伤与创面修复杂志, 2023, 39(3): 215-220. DOI: 10.3760/cma.j.cn501225-20221021-00465.
引用本文: 佟琳, 张万福, 韩飞, 等. 自体刃厚皮移植预制尿道联合阴囊皮瓣修复尿道中段缺损伴阴茎缺损的临床效果[J]. 中华烧伤与创面修复杂志, 2023, 39(3): 215-220. DOI: 10.3760/cma.j.cn501225-20221021-00465.
Tong L,Zhang WF,Han F,et al.Clinical effects of autologous split-thickness skin grafting for prefabricating urethra combined with scrotal flap in repairing middle urethral defect with penile defect[J].Chin J Burns Wounds,2023,39(3):215-220.DOI: 10.3760/cma.j.cn501225-20221021-00465.
Citation: Tong L,Zhang WF,Han F,et al.Clinical effects of autologous split-thickness skin grafting for prefabricating urethra combined with scrotal flap in repairing middle urethral defect with penile defect[J].Chin J Burns Wounds,2023,39(3):215-220.DOI: 10.3760/cma.j.cn501225-20221021-00465.

自体刃厚皮移植预制尿道联合阴囊皮瓣修复尿道中段缺损伴阴茎缺损的临床效果

doi: 10.3760/cma.j.cn501225-20221021-00465
基金项目: 

国家自然科学基金面上项目 82272268

详细信息
    通讯作者:

    官浩,Email:guanhao@hotmail.com

Clinical effects of autologous split-thickness skin grafting for prefabricating urethra combined with scrotal flap in repairing middle urethral defect with penile defect

Funds: 

General Program of National Natural Science Foundation of China 82272268

More Information
  • 摘要:   目的   探讨自体刃厚皮移植预制尿道联合阴囊皮瓣修复尿道中段缺损伴阴茎缺损的临床效果。   方法   采用回顾性观察性研究方法。2015年1月—2022年1月,空军军医大学第一附属医院收治8例符合入选标准的各种外伤致尿道中段缺损伴有阴茎缺损的男性患者,年龄14~58岁,尿道缺损长度为3~5 cm,清创后阴茎缺损创面面积为5.0 cm×2.5 cm~7.0 cm×5.5 cm。患者均于Ⅰ期行自体刃厚皮移植预制缺损段尿道,Ⅱ期行尿道吻接及单侧阴囊皮瓣转移重建尿道及阴茎。阴囊皮瓣面积为6.0 cm×3.0 cm~8.0 cm×6.0 cm。将供皮区创面用油纱覆盖,供瓣区创面直接缝合。观察Ⅱ期术后7 d皮瓣成活情况;Ⅱ期术后3周,采用尿流率检测仪测定患者尿流率(尿流率>15 mL/s为排尿通畅),观察有无尿瘘及勃起功能,采用自行设计的疗效满意度调查表对患者进行疗效满意度调查。随访时观察皮瓣受区外观,采用温哥华瘢痕量表(VSS)评估供皮区及供瓣区瘢痕情况,同前检测尿流率,观察有无尿道狭窄、尿瘘、勃起功能,调查患者对疗效的满意度。   结果   8例患者Ⅱ期术后7 d皮瓣完全成活;Ⅱ期术后3周,尿流率为25.3(18.0,38.5)mL/s,排尿通畅,无尿瘘,有勃起功能,对疗效的满意度评分为14.3(14.0,15.0)分。随访1~7年,8例患者皮瓣受区外形饱满、不臃肿,颜色与周围组织相近,供皮区VSS评分为11.5(10.0,13.0)分,供瓣区VSS评分为10.5(9.3,12.0)分,尿流率为24.6(17.7,34.1)mL/s,无尿道狭窄、尿瘘及勃起功能受限,对疗效的满意度评分为13.5(13.3,14.8)分。   结论   自体刃厚皮移植预制尿道联合阴囊皮瓣修复缺损尿道及阴茎,不仅重建了尿道结构及阴茎外形,而且恢复了阴茎的感觉及勃起功能,术后并发症少、瘢痕增生不明显、患者满意度高,值得临床推广。

     

  • 1  自体皮移植预制尿道联合阴囊皮瓣修复烧伤患者尿道中段缺损伴阴茎缺损。1A.伤后1个月,下腹部至双大腿仅有少量正常皮肤,会阴周围均为Ⅲ度烧伤创面;1B.Ⅰ期术前(伤后2个月)会阴周围瘢痕形成,尿道中段缺损伴阴茎部分缺损;1C.用自体刃厚皮制备卷管,植入单侧阴囊前;1D.预制尿道植入阴囊并缝合后;1E.Ⅱ期术前(伤后3个月),会阴周围瘢痕增生明显,阴囊术区愈合良好;1F.Ⅱ期术中寻找并游离预制自体刃厚皮卷管;1G.Ⅱ期术中将自体刃厚皮卷管两端与原尿道缺损断端吻合;1H.Ⅱ期术后7 d,皮瓣存活良好,创面愈合良好;1I.术后1年随访,阴囊皮瓣存活良好,站立式排尿,排尿通畅,无尿道狭窄;1J.术后7年随访,勃起功能正常,阴茎、阴囊发育正常

  • [1] 马善金,张克英,李瑞晓,等.阴茎癌患者阴茎部分切除术后性功能状态的研究进展[J].临床泌尿外科杂志,2021,36(7):587-590.DOI: 10.13201/j.issn.1001-1420.2021.07.017.
    [2] ChenY,ZhangJ,JiC,et al.Modification of the Koyanagi technique for the single-stage repair of proximal hypospadias[J].Ann Plast Surg,2016,76(6):693-696.DOI: 10.1097/SAP.0000000000000345.
    [3] SrivastavaRK,TandaleMS,PanseN,et al.Management of urethrocutaneous fistula after hypospadias surgery - an experience of thirty-five cases[J].Indian J Plast Surg,2011,44(1):98-103.DOI: 10.4103/0970-0358.81456.
    [4] KimSJ,LeeJ,ParkCH,et al.Urethral defect due to periurethral abscess treated with a tunica vaginalis flap: a case report[J].Medicine (Baltimore),2018,97(46):e13249.DOI: 10.1097/MD.0000000000013249.
    [5] SaY,WangL,LvR,et al.Transperineal anastomotic urethroplasty for the treatment of pelvic fracture urethral distraction defects: a progressive surgical strategy[J].World J Urol,2021,39(12):4435-4441.DOI: 10.1007/s00345-021-03789-0.
    [6] AndrichDE,MundyAR.What is the best technique for urethroplasty?[J].Eur Urol,2008,54(5):1031-1041.DOI: 10.1016/j.eururo.2008.07.052.
    [7] PetersonAC,WebsterGD.Management of urethral stricture disease: developing options for surgical intervention[J].BJU Int,2004,94(7):971-976.DOI: 10.1111/j.1464-410X.2004.05088.x.
    [8] WongSS,AboumarzoukOM,NarahariR,et al.Simple urethral dilatation, endoscopic urethrotomy, and urethroplasty for urethral stricture disease in adult men[J].Cochrane Database Syst Rev,2012,12:CD006934.DOI: 10.1002/14651858.CD006934.
    [9] MoreyAF,WatkinN,ShenfeldO,et al.SIU/ICUD consultation on urethral strictures: anterior urethra--primary anastomosis[J].Urology,2014,83(3 Suppl):S23-26.DOI: 10.1016/j.urology.2013.11.007.
    [10] PalmerDA,MarcelloPW,ZinmanLN,et al.Urethral reconstruction with rectal mucosa graft onlay: a novel, minimally invasive technique[J].J Urol,2016,196(3):782-786.DOI: 10.1016/j.juro.2016.03.002.
    [11] XuYM, FuQ, SaYL, et al. Treatment of urethral strictures using lingual mucosas urethroplasty: experience of 92 cases[J]. Chin Med J (Engl), 2010, 123(4): 458-462.
    [12] ChappleC,AndrichD,AtalaA,et al.SIU/ICUD Consultation on Urethral Strictures: the management of anterior urethral stricture disease using substitution urethroplasty[J].Urology,2014,83(3 Suppl):S31-47.DOI: 10.1016/j.urology.2013.09.012.
    [13] HusseinMM,MoursyE,GamalW,et al.The use of penile skin graft versus penile skin flap in the repair of long bulbo-penile urethral stricture: a prospective randomized study[J].Urology,2011,77(5):1232-1237.DOI: 10.1016/j.urology.2010.08.064.
    [14] 杨宇,仇雄文,丁力,等.以胶原蛋白生物工程海绵为支架的自体微粒皮复合口腔黏膜移植在阴道狭窄再造中的应用[J].中国美容医学,2018,27(5):49-51.DOI: 10.15909/j.cnki.cn61-1347/r.002371.
    [15] 木拉提·热夏提,王文光,拜合提亚·阿扎提,等.转移口腔粘膜治疗尿道下裂(附19例报告)[J].中华男科学杂志,2009,15(11):1017-1020.DOI: 10.13263/j.cnki.nja.2009.11.011.
    [16] DoganS.Comparison of self-conducted and assistant-super‐vised uroflowmetry methods[J].Cureus,2022,14(2):e22030.DOI: 10.7759/cureus.22030.
    [17] 佟琳,胡晓龙,张万福,等.腹部带蒂皮瓣修复上肢软组织缺损创面术后应用桥梁式持续负压吸引固定的临床效果[J].中华烧伤杂志,2021,37(11):1048-1053.DOI: 10.3760/cma.j.cn501120-20210204-00050.
    [18] 蔡景龙.现代瘢痕学[M].2版.北京:人民卫生出版社,2008:342.
    [19] XuYM,SongLJ,WangKJ,et al.Changing trends in the causes and management of male urethral stricture disease in China: an observational descriptive study from 13 centres[J].BJU Int,2015,116(6):938-944.DOI: 10.1111/bju.12945.
    [20] BarbagliG,SansaloneS,DjinovicR,et al.Current controversies in reconstructive surgery of the anterior urethra: a clinical overview[J].Int Braz J Urol,2012,38(3):307-316; discussion 316.DOI: 10.1590/s1677-55382012000300003.
    [21] SharmaAK,ChandrashekarR,KeshavamurthyR,et al.Lingual versus buccal mucosa graft urethroplasty for anterior urethral stricture: a prospective comparative analysis[J].Int J Urol,2013,20(12):1199-1203.DOI: 10.1111/iju.12158.
    [22] 任祯涛,张潍平.尿道下裂手术中覆盖材料的研究进展[J].临床小儿外科杂志,2022,21(1):30-35.DOI: 10.3760/cma.j.cn101785-202009034-006.
    [23] 李养群,李森恺,刘晓吉,等.口腔黏膜卷管分期修复幼儿期先天性尿道下裂[J].中华整形外科杂志,2011,27(1):4-7.DOI: 10.3760/cma.j.issn.1009-4598.2011.01.002.
    [24] ZhaoM,LiY,TangY,et al.Two-stage repair with buccal mucosa for severe and complicated hypospadias in adults[J].Int J Urol,2011,18(2):155-161.DOI: 10.1111/j.1442-2042.2010.02684.x.
    [25] MundyAR.Failed hypospadias repair presenting in adults[J].Eur Urol,2006,49(5):774-776.DOI: 10.1016/j.eururo.2006.02.015.
    [26] 陈雷振.预制自体组织皮管在尿道修复与重建中的应用[J].中国组织工程研究与临床康复,2009,13(28):5571-5574.DOI: 10.3969/j.issn.1673-8225.2009.28.036.
    [27] ArnaudA,HarperL,AulagneMB,et al.Choosing a technique for severe hypospadias[J].Afr J Paediatr Surg,2011,8(3):286-290.DOI: 10.4103/0189-6725.91668.
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  • 收稿日期:  2022-10-21

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