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

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

空军军医大学第一附属医院全军烧伤中心，烧伤与皮肤外科，西安　　710032

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

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出版历程
- 收稿日期: 2022-10-21

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

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

Funds:

General Program of National Natural Science Foundation of China 82272268

More Information

Corresponding author: Guan Hao, Email: guanhao@hotmail.com

摘要

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。
- 皮肤移植 /
- 尿道疾病 /
- 阴茎疾病 /
- 外科皮瓣 /
- 尿道重建
Abstract: Objective To investigate the clinical effects of autologous split-thickness skin grafting for prefabricating urethra combined with scrotal flap in repairing middle urethral defect with penile defect. Methods The retrospective observational study was conducted. Eight male patients (aged 14 to 58 years) with middle urethral defect and penile defect caused by various injuries who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University from January 2015 to January 2022. The length of urethral defect was 3 to 5 cm, and the wound area of penile defect after debridement was 5.0 cm×2.5 cm to 7.0 cm×5.5 cm. All the patients underwent autologous split-thickness skin grafting for prefabricating defect urethra in stage Ⅰ, and urethral anastomosis was performed and unilateral scrotal flap was transferred to reconstruct urethra and penis in stage Ⅱ. The area of scrotal flap was 6.0 cm×3.0 cm to 8.0 cm×6.0 cm. The wound in the donor area of skin graft was covered by oil gauze, and the wound of flap donor area was sutured directly. On the 7 ^th day after the operation of stage Ⅱ, the survival of the flap was observed. In 3 weeks after the operation of stage Ⅱ, the urinary flow rate was measured by the urinary flow rate detector (urinary flow rate >15 mL/s was regarded as unobstructed urination), the urinary fistula and erectile function were observed, and the self-made therapeutic satisfaction questionnaire was used to investigate the therapeutic satisfaction degree of patients. During follow-up, the appearance of the flap recipient area was observed, the Vancouver scar scale (VSS) was used to evaluate the scar situation in the donor areas of skin graft and flap, the urinary flow rate was detected as before, the urethral stricture, urinary fistula, and erectile function were observed, and the therapeutic satisfaction degree of patients was investigated. Results On the 7 ^th day after the operation of stage Ⅱ, the flaps survived completely in 8 patients. In 3 weeks after the operation of stage Ⅱ, the urinary flow rate was 25.3 (18.0, 38.5) mL/s, with unobstructed urination, without urinary fistula and with erectile function, and the score of therapeutic satisfaction degree was 14.3 (14.0, 15.0). During follow-up of 1 to 7 years, the flap recipient area of 8 patients was full in appearance and not swollen, with similar color to the surrounding tissue; the VSS scores of the donor areas of skin graft and flap were 11.5 (10.0, 13.0) and 10.5 (9.3, 12.0), respectively, the urinary flow rate was 24.6 (17.7, 34.1) mL/s, with no urethral stricture, urinary fistula, and erectile dysfunction, and the score of therapeutic satisfaction degree was 13.5 (13.3, 14.8). Conclusions Autologous split-thickness skin grafting for prefabricating urethra combined with scrotal flap in repairing the urethral and penile defects not only reconstructs the structure of urethra and the shape of penis, but also restores the sensation and erectile function of penis, with few postoperative complications, no obvious scar hyperplasia, and high satisfaction degree of patients, which is worthy of clinical promotion.
- Skin transplantation /
- Urethral diseases /
- Penile diseases /
- Surgical flaps /
- Urethral reconstruction
佟琳：采集数据，分析数据和撰写论文；张万福：整理数据，对文章的知识性内容作批评性审阅；韩飞、徐志刚：采集数据，整理数据和统计学分析；胡大海：研究指导，对文章的知识性内容作批评性审阅；官浩：研究指导，实施手术，对文章的知识性内容作批评性审阅，获取研究经费

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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

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