目的 探讨口腔黏膜游离移植,治疗严重尿道下裂和长段前尿道狭窄的手术适应证及疗效.方法 2006年5月至2010年4月期间我科共进行口腔黏膜游离代尿道治疗严重尿道下裂及长段前尿道狭窄50例,年龄5-48岁.其中尿道下裂28例,有过一次手术史15例,多次手术史10例.前尿道狭窄22例,狭窄段4～7cm长.结果 28例尿道下裂患者,26例成功;22例尿道狭窄患者,20例成功,手术成功率92.00%(46/50),尿道下裂患者术后阴茎外观满意,尿道开口于阴茎前端,排尿通畅.尿道狭窄患者术后1个月最大尿流率为14～40ml/s,平均29ml/s.所有手术成功患者术后随访1～10个月无尿道狭窄,无尿瘘.尿道下裂和尿道狭窄患者中各有2例失败,术后出现阴茎皮肤切口感染发生尿瘘,6个月行补瘘手术治愈.结论 对于多次手术,局部组织缺乏的尿道下裂及长段前尿道狭窄,应用口腔黏膜游离移植修复尿道,手术疗效好,值得推广.%Objective To investigate the indications and efficacy ofurethroplasty using oral mucosa as graft for repairing complicated hypospadias and anterior urethral stricture.Methods During the last four years, 50 cases with complicated hypospadias and urethral stricture were treated by urethroplasty using oral mucosa as graft.Results Operation treatment for 46 patients was successful and the success rate of operation was 92.00％.They had a satisfied penile appearance with urethral opening at the original site of glans, moreover had almost normal urine streaming.No difficulty in voiding, and no urinary fistula were found.After 1～10 months following-up, no anterior urethral stricture was found for all patients.The maximum uroflow rate was 14～40ml/s(average 29 ml/s).But 4 cases developed urethral fistula because of postoperative wound infection, and they got a successful repair after 6 months.Conclusion Applying oral mucosa as graft to reconstruct the neo-urethra showed a good clinical efficacy for patients with complicated hypospadias and anterior urethral stricture.
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