预制自体组织皮管在尿道修复与重建中的应用

目的：总结预制自体组织皮管治疗尿道狭窄、尿道下裂、尿道下裂术后严重并发症的效果。 方法：选择24例应用自体阴囊、阴茎包皮、睾丸鞘膜缝合预制形成的皮管，原位包埋,治疗尿道狭窄、尿道下裂、尿道下裂术后严重并发症的男性患者，年龄5~56岁，平均14岁。应用预置包皮皮管二期尿道成形术11例，应用预制鞘膜管治疗尿道下裂术后严重并发症9例，应用预制阴囊皮管治疗前尿道长段狭窄4例。观察应用预制自体组织皮管治疗尿道狭窄、尿道下裂、尿道下裂术后并发症。 结果：全部病例获得随访，随访6~12个月。预置包皮皮管二期尿道成形术11例，并发尿道口狭窄1例，吻合口轻度狭窄1例，经扩张后治愈；预制鞘膜管治疗尿道下裂术后严重并发症9例，阴茎略显臃肿2例；预制阴囊皮管治疗前尿道长段狭窄4例，并发吻合口轻度狭窄1例。其余均排尿通畅，尿流率达到或接近同龄人水平，无尿瘘、尿道憩室发生。 结论：借鉴整形外科手术经验，应用临近尿道的阴茎包皮、睾丸鞘膜、阴囊皮肤组织预置成皮管，二期转移成形或修复缺损的尿道，恢复尿道功能,尿瘘、尿道狭窄并发症少，是重建及修复尿道的较好方法。

Prefabricated skin tube of autologous tissue in the repair and reconstruction of urethra

OBJECTIVE: To explore the effect of prefabricated skin tube of autologous tissue on treating congential hypospadias, long-segment urethral stricture, and severe complications following hypospadias surgery. METHODS: Twenty-four male patients, who underwent treatment with prefabricated skin tube which was sutured from autologous scrotum, the penis foreskin, and testes sheath, and embedded in situ, for urethral stricture, hypospadias, severe complications following hypospadias, were selected and analyzed retrospectively. The age range was 5 to 56 years old, and the average was 14 years old. Of the 24 cases, 11 cases underwent urethroplasty for secondary hypospadias repair using skin tubes preset in the prepuce, nine cases of post-hypospadias complications were treated with prefabricated sheath canal, and four cases received prefabricated scrotal skin tube to treat long-segment stricture of the anterior urethral. The application of autologous tissue-prefabricated skin tube in the treatment of urethral stricture, hypospadias, and postoperative complications of hypospadias was observed. RESULTS: All the cases received a follow-up of 6 to 12 months. Of the 11 cases receiving urethroplasty for secondary hypospadias repair using skin tubes preset in the prepuce, one case was complicated with urethrostenosis, one was with anastomosis stricture and they were both cured following urethra dilatation. Of the nine cases of post-hypospadias complications treated with prefabricated sheath canal, there were 2 cases of bulky of penis. Of the four cases receiving prefabricated scrotal skin tube to treat long-segment stricture of the anterior urethral, one case was found complicated with anastomosis stricture. No other complications such as urethrocutaneous fistula and urethral diverticulum were found, and the flow rate was at or near the level of the peers. CONCLUSION: Learning from the experience of plastic surgeries, skin tubes prefabricated with autologous tissues, such as penis foreskin, testis sheath, scrotal skin near the urethral, is beneficial to the recover of urethral function through urethroplasty for secondary hypospadias repair or repair of urethral defect. The incidence of urethrostenosis and anastomosis stricture is less by this way. It is a better surgical method to repair and reconstruct the urethra.