阴茎纵形带蒂皮瓣与环形带蒂皮瓣在前尿道狭窄手术中的应用体会

Experience with the application of longitudinal versus circular pedicled penile skin flap in anterior urethral stricture surgery

摘要

目的 分析总结阴茎纵形带蒂皮瓣与环形带蒂皮瓣修复不同类型前尿道狭窄的临床经验与疗效，明确其各自的适应证与优势。方法 回顾性分析2017-2024年上海交通大学医学院附属新华医院泌尿外科收治的42例前尿道狭窄患者的临床资料。根据手术方式将患者分为纵形带蒂皮瓣组（n=27），环形带蒂皮瓣组（n=15）。比较两组患者在手术效果、术后阴茎外观、勃起功能变化及围手术期并发症等方面的差异，并总结分析其各自的临床适应证。结果 术后3个月复查，纵形带蒂皮瓣组中有25例（92.59%）患者排尿通畅，平均最大尿流率（Qmax）为（16.09±2.78）mL/s；2例患者术后出现尿道再狭窄；该组患者修整后阴茎外观基本正常。术后3个月复查，环形带蒂皮瓣组中有13例（86.67%）患者排尿通畅，平均Qmax为（16.18±3.83）mL/s；1例患者出现再次排尿困难，Qmax为8 mL/s；1例患者伴有尿道憩室形成，Qmax为9.8 mL/s；该组术后阴茎外观类似包皮环切后。两组术前及术后3个月的Qmax及国际勃起功能指数-5（IIEF-5）评分比较，差异均无统计学意义（P＞0.05）。结论 阴茎纵形带蒂皮瓣与环形带蒂皮瓣均是修复前尿道狭窄的有效术式。纵形带蒂皮瓣更适用于局限、短段的阴茎部尿道狭窄，覆盖长度通常≤6 cm，手术操作相对直接，但需注重外观的精细修整。环形皮瓣因其取材长度大、转移灵活是修复长段或多部位复杂狭窄的优选方案，适用于阴茎、阴囊段及球膜部尿道，覆盖长度通常≤12 cm。二者均可实现带蒂、原位取材是可靠的尿道重建方式，临床应根据尿道狭窄的解剖特点，个体化选择具体术式。

Abstract

Objective To conduct a comparative analysis of the clinical experience and outcomes of repairing various types of anterior urethral strictures using longitudinal and circular pedicled penile skin flaps, and to clarify the indications and advantages of the techniques. Methods A retrospective clinical study was conducted on the clinical data of 42 patients with anterior urethral strictures admitted to our department during 2017 and 2024. Patients were divided into the longitudinal flap group (n=27) and circular flap group (n=15) according to the technique used for the harvest of pedicled flaps. Comparisons were performed regarding surgical efficacy, postoperative penile appearance, erectile function, and perioperative complications. Clinical indications for the techniques were analyzed. Results At the 3-month follow-up, in the longitudinal flap group, 25 patients (92.59%) voided smoothly, with a mean maximum urinary flow rate (Qmax) of (16.09±2.78) mL/s; complications included recurrent stricture in 2 cases; and penile appearance after minor revision was essentially normal. In the circular flap group, 13 patients (86.67%) voided smoothly, with a mean Qmax of (16.18±3.83) mL/s, complications included recurrent dysuria (Qmax=8 mL/s) in 1 case and urethral diverticulum formation (Qmax=9.8 mL/s) in 1 case, and the postoperative penile appearance resembled that after circumcision. Preoperative and 3-month postoperative Qmax and international index of erectile function 5 (IIEF-5) scores showed no statistically significant differences between the two groups (P＞0.05). Conclusion Both of the longitudinal and circular pedicled penile flaps are effective for the repair of anterior urethral strictures. The longitudinal flap is better suited for localized, short-segment strictures of the penile urethra (used for penile urethral strictures ≤6 cm); the procedure is relatively straightforward, but meticulous refinement is required to achieve an optimal cosmetic appearance. Owing to the greater available harvest length and flexible transfer, the circular flap is a preferred option for long-segment or multifocal complex strictures (used for penile, scrotal, and bulbar/membranous urethral strictures ≤12 cm). Both methods provide reliable urethral reconstruction using a pedicled, in-situ tissue flap. The choice of technique should be individualized according to the anatomical characteristics of the strictures.

关键词

前尿道狭窄 / 阴茎纵形带蒂皮瓣 / 环形带蒂皮瓣 / 尿道重建

Key words

anterior urethral stricture / longitudinal pedicled penile skin flap / circular pedicled penile skin flap / urethral reconstruction

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