异种真皮去细胞基质在尿道重建中的临床应用

Heterogeneous dermal acellular matrix graft for clinical urethroplasty

目的观察异种真皮来源的去细胞基质移植物（acellular matrix graft，ACMG）作为尿道狭窄重建手术替代材料应用于临床的安全性与有效性。方法将ACMG作为尿道重建的替代材料，观察尿路上皮细胞能否长入并形成通畅的新尿道以及有无排斥反应。采用ACMG治疗尿道狭窄病例10例，年龄20～62，平均36岁。狭窄长度3．0～15．0cm，平均6．9cm。术时采用狭窄段切除后ACMG尿道套入术或狭窄段切开后ACMG补片尿道修补术，术后6个月拔除尿管，观察该ACMG在人体中有无排斥反应及ACMG辅助尿道重建术的治疗效果。结果10例患者拔除尿管后均恢复排尿，尿道造影及尿道镜检查可见术后尿道连续性好，腔内黏膜连续。随访至术后18个月，出现尿道狭窄2例，经尿道内切开扩张后恢复正常排尿，其余患者均可通过尿道正常排尿。结论异种真皮ACMG应用于尿道成形术中具有生物相容性良好、能从解剖上和功能上修复尿道的优点，适用于复杂、长段尿道狭窄病例的成形手术。

Objective To investigate the clinical safety and validity of heterogeneous dermal acellular matrix graft （ACMG） for urethral reconstruction in patients. Methods Ten male patients aged 36 （range, 20 -62） , stricture length 6.9 cm （range, 3.0 -15.0 cm） , were treated with the ACMG material. During the operation, ACMG was sutured to a tubular graft or as a patch and replaced the defect urethra. Urinary catheter was inserted in the reconstructed urethra for 6 months. Then the outcomes of this operation method and whether there were rejections against the material were observed. Results All 10 patients could void through normal urethral, and no rejection was observed. Retrograde urethral visualization and ure- throscope gave evidences of smooth urethral and continuous mucosa. The patients were followed up for 18 months, and all patients voided normally except 2 cases needed urethral dilatation. Conclusions Heterogeneous dermal ACMG for urcthroplasty in men has the excellence of good biocompatibility, constructing the functional urethra. Additionally, this material could be manufactured with greater scale and advanced technology, which made it appropriate for operation of harder and longer urethral stricture diseases, serving as an ideal replacement material of urethra.