Metro M J, Wu H Y, Snyder H M, Zderic S A, Canning D A
Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
J Urol. 2001 Oct;166(4):1459-61. doi: 10.1016/s0022-5347(05)65809-0.
We evaluated our 8-year experience with buccal mucosal grafts in complex hypospadias and epispadias repair.
We reviewed the records of 29 patients in whom a total of 30 buccal mucosal grafts were placed as part of urethral reconstruction between 1991 and 1999. At surgery 16 tubes and 14 onlays were constructed and 24 of 30 repairs involved the meatus. All patients were followed at least 6 months postoperatively (median 5.3 years). Beginning in 1995 meatal design was enlarged to a racquet handle shape and patients were asked to perform meatal self-dilation for 6 months postoperatively.
Complications developed in 17 of our 30 cases (57%) and reoperation was done in 10 (33%). All complications were evident by 11 months postoperatively except 1 that presented as recurrent stricture disease at 3 years. Complications developed in 5 and 12 of 15 patients who underwent surgery between 1995 and 1999, and before 1995, respectively (p = 0.027). No patient has had meatal stenosis since 1995. Complications included meatal stenosis in 5 cases, stricture in 7, glanuloplasty, meatal and complete graft breakdown in 1 each, and fistula in 2. Onlays were more likely to result in stricture than tube grafts (6 of 14 cases versus 1 of 16, p = 0.034).
The complication and reoperation rates of buccal mucosal grafts are 57% and 33% at 5 years of followup. Changes in meatal design and temporary postoperative meatal dilation have improved the outcome in the last 5 years. Buccal mucosa remains a good choice in patients who require extragenital skin for urethral reconstruction.
我们评估了在复杂尿道下裂和尿道上裂修复中应用颊黏膜移植物的8年经验。
我们回顾了1991年至1999年间29例患者的记录，这些患者共接受了30次颊黏膜移植物置入作为尿道重建的一部分。手术时构建了16个管状移植物和14个覆盖式移植物，30次修复中有24次涉及尿道口。所有患者术后至少随访6个月（中位随访时间5.3年）。从1995年开始，尿道口设计扩大为球拍柄形状，并要求患者术后进行6个月的尿道口自我扩张。
30例患者中有17例（57%）出现并发症，10例（33%）接受了再次手术。除1例在3年时出现复发性狭窄疾病外，所有并发症均在术后11个月内出现。1995年至1999年间接受手术的15例患者中有5例出现并发症，1995年之前接受手术的患者中有12例出现并发症（p = 0.027）。自1995年以来，没有患者出现尿道口狭窄。并发症包括5例尿道口狭窄、7例狭窄、1例龟头成形术、1例尿道口及移植物完全破裂和2例瘘管形成。覆盖式移植物比管状移植物更容易导致狭窄（14例中有6例，16例中有1例，p = 0.034）。
颊黏膜移植物在5年随访中的并发症发生率和再次手术率分别为57%和33%。在过去5年中，尿道口设计的改变和术后临时尿道口扩张改善了治疗效果。对于需要使用生殖器外皮肤进行尿道重建的患者，颊黏膜仍然是一个不错的选择。
