人同种异体真皮脱细胞基质在尿道重建中的临床应用

Homologous dermal acellular matrix graft for urethral reconstruction in man (report of 16 cases)

目的观察人同种异体真皮脱细胞基质(AMG)在尿道重建中的临床应用,寻求理想的尿道修复材料。方法将组织工程学材料人同种异体真皮AMG作为尿道重建的替代材料,治疗男性尿道患者16例,年龄18～46岁,平均26.5岁,其中13例因骨盆骨折尿道断裂致后尿道狭窄,2例前尿道狭窄,1例尿道下裂。术时将AMG缝合成管状,替代缺损尿道,术中置F18～22尿管作支架,4～6周后拔除尿管。结果16位患者拔除尿管后均恢复排尿,尿道造影显示尿道连续性好,膀胱尿道镜示AMG腔表面已被尿路上皮细胞覆盖,与自体尿道几乎不可分辨。3例随后出现尿道再狭窄,其中2例行尿道扩张术,1例行尿道内切开术。所有患者均未发生排斥反应。随访12～72个月,平均45.6个月,患者可通过尿道正常排尿,4例患者定期行尿道扩张。结论人同种异体真皮AMG作为尿道修复材料,无排斥等不良反应,适合于长段的尿道狭窄或缺损,是较理想的尿道替代材料。

Objective To investigated the value of homologous dermal acellular matrix graft (AMG) for urethral reconstruction in man ,and found an ideal replacement material to simplify the urethroplastic surgery. Methods 16 male patients ,aged 18-46(mean 26.5),with urethral diseases were treated with allograft of tissue engineering material AMG. The causes of urethroplasty were complex urethral stricture followed by pelvic fracture(13 cases), anterior urethral stricture(2 cases), hypospadia(1 case). During the operation, AMG was sutured to a tubular graft and replaced the defect urethra. A 18-22 Fr silicone catheter was inserted in the reconstructed urethra for 4-6 weeks. Results All 16 patients were voiding well after removing the catheter, urethrography reveal excellent caliber of the reconstructed urethra. Urethroscopic examination showed the graft urethra was covered by epithelial tissue and grew into the native tissue. But stenosis was developed in 3 patients postoperatively, 1 patients received transurethral incision,another 2 needed urethral sounding. The patients were followed-up for 12-72 months(mean 45.6),no rejection was observed, all patients voided normally except 4 cases needed urethral dilatation ~periodically. Conclusion The homologous dermal acellular matrix graft may serve as an ideal replacement material for complex urethral stricture or defect, without concern of rejection.