Patterson Jacob M, Chapple Christopher R
Section of Female and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Eur Urol. 2008 Jun;53(6):1162-71. doi: 10.1016/j.eururo.2007.10.011.
Since the resurgence in the use of buccal mucosa (BM) in substitution urethroplasty in the late 1980s and early 1990s, there has been controversy as to which surgical technique is the most appropriate for its application.
The authors performed an updated literature review. Several centres have published widely on this topic, and the points considered include the use BM in dorsal onlay grafts, ventral onlay grafts, and tubularised grafts and the role of two-stage procedures.
In experienced hands, the outcomes of both dorsal onlay grafts and ventral onlay grafts in bulbar urethroplasty are similar. The dorsal onlay technique is, however, possibly less dependent on surgical expertise and therefore more suitable for surgeons new to the practice of urethroplasty. The complications associated with ventral onlay techniques can be minimised by meticulous surgical technique, but in series with longer follow-up, complications still tend to be more prevalent. In penile urethroplasty, two-stage dorsal onlay of BM (after complete excision of the scarred urethra) still provides the best results, although in certain circumstances a one-stage dorsal onlay procedure is possible. In general, ventral onlay of BM and tube graft procedures in the management of penile strictures are associated with much higher rates of recurrence and should therefore be avoided.
In experienced hands the results of the ventral and dorsal onlay of BM for bulbar urethroplasty are equivalent. Two-stage procedures are preferable in the penile urethra, except under certain circumstances when a one-stage dorsal onlay is feasible.
自20世纪80年代末90年代初颊黏膜（BM）在替代尿道成形术中再度应用以来，关于哪种手术技术最适合应用该材料一直存在争议。
作者进行了一次更新的文献综述。多个中心已就该主题发表了大量文章，所考虑的要点包括BM在背侧镶嵌移植、腹侧镶嵌移植和管状移植中的应用以及两阶段手术的作用。
在经验丰富的医生手中，球部尿道成形术中背侧镶嵌移植和腹侧镶嵌移植的效果相似。然而，背侧镶嵌技术可能对手术专业知识的依赖较小，因此更适合刚接触尿道成形术的外科医生。通过精细的手术技术可将腹侧镶嵌技术相关的并发症降至最低，但在随访时间较长的系列研究中，并发症仍往往更为普遍。在阴茎尿道成形术中，BM的两阶段背侧镶嵌（在完全切除瘢痕化尿道后）仍能提供最佳效果，尽管在某些情况下单阶段背侧镶嵌手术也是可行的。一般来说，BM的腹侧镶嵌和管状移植手术在阴茎狭窄的治疗中复发率要高得多，因此应避免使用。
在经验丰富的医生手中，BM用于球部尿道成形术的腹侧和背侧镶嵌效果相当。阴茎尿道手术两阶段手术更为可取，除非在某些情况下单阶段背侧镶嵌可行。
