腹侧口腔黏膜移植物扩大吻合修复术

  • 介绍
  • 论文
  • 常见问题与解答
  • 成果展示
“端端吻合”技术是将尿道狭窄段切开,切除疤痕组织再行尿道端端吻合,是最早开展的尿道狭窄修复手术之一。

图 1

图 2

图 3

图 4

一般来讲,手术有两种方式:

  • 端端吻合。完全切除狭窄段尿道,将剩余正常尿道直接进行吻合,保证内径(图1,2)。
  • 借助皮肤和口腔黏膜的端端吻合。完全切除狭窄尿道,借助移植物对尿道进行吻合,保证内径(图3,4)。

 

端端吻合手术适用于以下人群:

  • 外伤性尿道球部损伤造成的狭窄,长度不超过2cm;
  • 接受过前期尿道狭窄手术,但由于瘢痕增生导致失败,狭窄长度不超过2cm。
论文 1
Barbagli G., Guazzoni G., Lazzeri M.
One-Stage bulbar urethroplasty: Retrospective analisys of the results in 375 patients
Eur Urol 2008; 53:828 – 33

Objective: To review the outcome of bulbar urethroplasty using one-stage surgical techniques.
Methods: Of 375 patients, who underwent one-stage bulbar urethroplasties, 165 patients (44%) underwent anastomotic repair (AR), 40 (10.7%) underwent augmented anastomotic repair (AAR) using penile skin grafts (PSGs) or oral mucosal grafts (OMGs), and 170 (45.3%) underwent onlay grafting techniques (OGTs) using PSGs or OMGs. Clinical outcome was considered a failure when any postoperative instrumentation was needed. The chi(2) and Fisher’s exact test for categorical data were used. The sample size of 375 patients provides a statistical power (1-beta) of 99% at alpha=0.05; p<0.05 was set as significant.
Results: The average follow-up was 53 mo. Of 375 cases, 313 (83.5%) were successful and 62 (16.5%) failures. Of 165 ARs, 150 (90.9%) were successful and 15 (9.1%) failures. Of 40 AARs, 24 (60%) were successful and 16 (40%) failures. Of 170 OGTs, 139 (81.8%) were successful and 31 (18.2%) failures. The AR showed statistically significant higher success rate compared to OGT (p=0.023) and AAR (p=0.0001). Of 47 PSGs, 28 (59.6%) were successful and 19 (40.4%) failures. Of 163 OMGs, 135 (82.8%) were successful and 28 (17.2%) failures. This difference was statistically significant (p=0.002).
Conclusions: One-stage bulbar urethroplasties showed an overall 83.5% success rate. The AR showed the higher success rate compared to the OGT or AAR. OMGs (82.8% success rate) perform statistically better than PSGs (59.6% success rate).
1. 问: 此项手术使用什么麻醉方式?
答: 经鼻的全身麻醉。


2. 问: 手术时间多长?
答: 约2小时。


3. 问: 手术后是否有勃起、生育问题或者尿失禁的风险?
答: 没有。


4. 问: 手术后住院时间是多长?
答: 一般来讲,5到7天


5. 问: 术后多长时间可以拔除尿管?
答: 至少保留至术后4周,待术后首次尿路造影结果正常后拔除。


6. 问: 恢复期有什么特别需要注意的问题么?
答: 在恢复期,抗生素的使用一般持续到尿管拔除以后。同时,长途坐车旅行,重体力劳动、性生活以及运动是暂时需要避免的。


7. 问: 术后什么时候可以恢复工作、性生活以及运动?
答: 在拔除尿管的一个月后,根据情况逐步恢复即可。


8. 问: 手术以后是否可以立即骑自行车或摩托车?
答: 不建议术后立即进行骑车、骑马等运动。


9. 问: 术后饮食需要注意些什么?
答: 避免啤酒以及烈性酒精饮品,巧克力,可可,坚果和贝类不要多吃。