结肠粘膜重建尿道的动物实验与临床应用

An experimental and clinical study of colic mucosa graft for urethral reconstruction

目的 探讨结肠粘膜代尿道治疗复杂性前尿道长段狭窄或闭锁的可行性。 方法 6条雌性杂种成年狗在全麻下切开尿道 ,剥离全段尿道粘膜 ,取相等长度的结肠粘膜替代尿道粘膜 ,12周后将狗处死 ,取尿道组织作病理检查。采用结肠粘膜替代尿道一期尿道成形术治疗 1例复杂性前尿道长段狭窄患者 ,术后 3个月分别行逆行尿道造影 ,尿道镜和尿流率检查。 结果 6条狗移植于尿道的结肠粘膜全部成活 ,部分腺上皮转变为移行上皮细胞。采用结肠粘膜替代尿道的患者术后排尿通畅 ,移植段尿道无狭窄 ,最大尿流率 30ml/s。 结论 结肠粘膜代尿道是治疗复杂性前尿道长段狭窄或闭锁的一种有效方法 。

Objective To investigate the possibility of urethroplasty with a free graft of colic mucosa for the treatment of complex anterior urethral stricture of long length. Methods Six dogs underwent a procedure in which the urethral mucosa was totally removed and replaced with a free graft of colic mucosa. All the dogs were sacrificed 12 weeks after the procedure for histological examination of urethra.Besides, a patient with complex anterior urethral stricture was treated by urethroplasty with the use of a colic mucosal graft.Retrograde urethrography,urethroscopy and uroflowmetry were carried out 3 months after operation. Results Histological examination revealed that all the grafted colic mucosa have survived in the urethra of the experimental dogs and some of the glandular epithe lium has been transformed into urethelium. Clinically,the patient voided well after removal of the urethral stent.Neither necrosis of the neourethral mucosa nor stenosis at the anastomosis sites has been observed on urethroscopy. Retrograde urethrogram demonstrated a wide urethral caliber with no significant graft sacculation. Uroflowmetry examination showed the maximum flow rate was 30 ml/s. Conclusions Colic mucosa graft urethroplasty is an effective one stage procedure for the treatment of complex anterior urethral stricture. The technique is useful for urethral reconstruction when local or preputial skin and buccal or bladder mucosa are not available.