种植自体尿道上皮细胞的生物可降解非编织网状尿道内支架修复战伤性尿道狭窄

Effect of nonwoven mesh biodegradable urethral stents seeded with autologous urethral epithelial cells on repairing rabbit war injured urethral stricture

背景:利用人工合成生物可降解材料制备组织工程化尿道支架修复尿道狭窄有广泛临床应用前景。目的:观察种植自体尿道上皮细胞的生物可降解非编织网状尿道内支架修复战伤性尿道狭窄的效果及实用性。设计、时间及地点:随机对照动物体内实验,于2006-03/2007-03在解放军总医院试验动物中心完成。材料:钳取兔自体尿道黏膜组织,体外培养尿道上皮细胞,种植于L型聚乳酸为原料制备的生物可降解非编织网状尿道内支架上。方法:将成年新西兰雄兔28只随机分成2组,尿道内支架置入组建立战伤性尿道狭窄模型,然后切除狭窄瘢痕组织,置入植细胞的尿道内支架;正常对照组不造模,仅手术,不置入支架。主要观察指标:尿道镜和尿道造影观察支架及尿道通畅情况;尿流动力学检测观察排尿情况;苏木精-伊红染色观察细胞生长及组织相容性。结果:培养的尿路上皮细胞在尿道支架上生长、增殖状态良好,具有较好的组织相容性。植细胞支架置入后,无排尿困难和其他并发症。尿道镜、逆行尿道造影检查发现狭窄段尿道通畅;两组尿流动力学检测结果无显著性差异;组织学观察证实支架置入部位尿道能完全上皮化。结论:植自体尿路上皮细胞的可降解的非编织网状尿道内支架能成功修复爆震伤性狭窄段尿道,无并发症,具有临床可行性。

BACKGROUND： It is potentially in clinics to prepare tissue-engineered urethral stent by using biodegradable materials in the repair of urethral stricture. OBJECTIVE： To assess the effect and practicability of war injured urethral stricture repaired with biodegradable stents seeded autologous urethral epithelial cells. DESIGN, TIME AND SETTING： Randomized control animal study in vivo was performed in the Experimental Animal Center of Chinese PLA from March 2006 to March 2007. MATERIALS： Rabbit autologous urethral mucous membrane was harvested, urethral epithelial cells were cultured in vitro and transplanted onto the nonwoven mesh biodegradable stents prepared with L-polylactic acid. METHODS： The 28 New Zealand male rabbits bulbar urethra were divided into two groups, stent group was used to develop an model of war injured urethral stricture. Then the stricture scar tissues were excised and seeded to the biodegradable stents. Control group was processed to the operation without modeling or transplanting. MAIN OUTCOME MEASURES： Repaired effect was evaluated by video-urethroscopy and retrograde urethrography. Urination was detected by urodynamic determination. Cellular growth and histocompatibility were observed through hematoxylin-eosin stain. RESULTS： The cultured rabbit＇s urethral epithelial cells adhered to the stents and grew very well. Its biocompatibility was acceptable and no cytotoxic. There was no evidence of voiding difficulty or other complication. Video-urethroscopy and retrograde urethrography showed no evidence of stricture recurrence. Urodynamic determination showed that there was no difference between stent group and control group. Histological examination demonstrated complete re-epithelialization. CONCLUSION： The nonwoven mesh biodegradable stents seeded autologous urethral epithelial cells could have a good clinical effect in reconstruction of urethral stricture caused by war injury with few adverse events.