组织工程技术在尿道重建中的应用

Tissue engineering technology in urethral reconstruction

背景:多种疾病或创伤可导致尿道组织的缺损或狭窄,需用其他组织来修复与重建。传统应用包皮、口腔黏膜,或者其他自体移植物修复会带来较多并发症,而组织工程的兴起为尿道修复与重建开辟了新的治疗思路。目的:总结并探讨组织工程支架材料的选择、种子细胞的选择,以及目前组织工程在尿道修复中的临床应用情况。方法:由第一作者应用计算机检索PubMed数据库及万方全文数据库1994年1月至2012年5月有关尿道组织工程的文章,英文检索词为"Tissue engineering,urethra,scaffold materials,stem cells,Vascularization",中文检索词为"组织工程;尿道;支架材料;干细胞"。排除重复性研究,共保留57篇文献进行综述。选择文章内容主要为组织工程支架在尿道修复中的应用情况,同一领域文献则选择近期发表或发表在权威杂志文章。结果与结论:目前组织工程研究的主要目标仍旧是以下几点:选择最佳支架、最佳干细胞来源,促进移植物新生血管和神经长入。泌尿系统组织工程已经报道,在临床上,使用复合或者不复合种子细胞的脱细胞支架可以重建尿道。虽然在大规模应用于临床前,还需要进一步的研究和创新,有理由期待组织工程会在尿道疾病中发挥越来越大的作用。

BACKGROUND： Many congenital and acquired anomalies can lead to a defect or stenosis of the urinary tract that ultimately need to be rebuilt. Past surgical repair often utilizes skin, oral mucosa or autologous graft, which may lead to many postoperative complications. The development of tissue engineering technology has opened up a new treatment approach for urethral repair and reconstruction. OBJECTIVE： To summarize the current development of scaffold materials, cell sources, and the clinica applications of tissue engineering technology in urethral repair and reconstruction.METHODS： A computer-based online search of literatures related to urethral tissue engineering from January 1994 to may 2012 was performed by the first author in PubMed database and Wanfang database using the key words of ＂tissue engineering, urethra, scaffold materials, stem cells, vascularization＂ in English and in Chinese. Literatures published in the authorized journals or recently were preferred. A total of 57 literatures were chosen in result analysis. RESULTS AND CONCLUSION： The main goals underlying the most current research in tissue engineering remain the following： the determination of the optimal scaffold for cell seeding, the best source of stem cells, and the promotion of neovascularization and nerve regeneration into the implant. Studies addressing urethral tissue engineering have demonstrated that acellular scaffolds with or with no seed cells can be used for urethral reconstructions in clinical trials. While continued development and additional innovation are necessary before potential broad applications are realized, there is cautious optimism that tissue engineering technology will play an increasing role in the management of urethral diseases.