组织工程补片在重度尿道下裂分期手术中的应用

Two-staged urethroplasty with tissue-engineered graft for proximal hypospadias with severe chordee

目的对于重度尿道下裂,阴茎发育不良,并发严重阴茎下弯的患儿,阴茎矫直后多数会伴有阴茎腹侧白膜的缺损。本研究采用异体组织工程皮肤脱细胞基质(Decellularized Matrix)材料来修补阴茎腹侧白膜横断后的缺损,探讨其改善阴茎矫直的效果,为二期手术提供良好的基础。方法本研究收集2011年6月至2016年9月由本院收治的82例需要分期手术的重度尿道下裂患儿作为研究对象。常规脱鞘后,横断尿道板,松解腹侧尿道瘢痕组织,腹侧白膜切开后根据大小裁剪合适的异体组织工程皮肤脱细胞基质修复白膜缺损,根据情况取背侧包皮内板横裁岛状皮瓣预留尿道板,二期行Snodgrass手术。结果 82例均为重度尿道下裂,经染色体检查和/或SRY基因检查证实为男性。阴茎发育不良,伴有严重的阴茎下弯,一期手术均取得成功,无皮瓣坏死,无严重并发症。二期手术人工勃起实验均证实阴茎伸直状态,手术中未见有明显皮肤补片残留,术后尿道口狭窄6例(7. 3%),尿瘘9例(11%),尿道憩室2例(2. 4%),术后尿道开口位于龟头,排尿通畅,阴茎外观良好。结论采用组织工程皮肤补片可以简化手术操作,容易掌握,手术并发症少,而且修复后阴茎外观饱满,可以获得类似包皮环切术后样外观,取得满意的手术效果,是一种可以选择的方法。

Objective To explore the efficacy of xenogenous grafts as substitution for urethroplasty inproximal hypospadia with severe chordee and report the feasibility and shortterm outcomes of penile straightening using tissue engineered decellularized matrix. Methods A total of 82 patients were recruited for twostage urethroplasty between June 2011 and September 2016. Penile curvature was straightened with decellularized matrix graft for repairing tunica albuginea defects after skin degloving and urethral plate transaction.Transverse island preputial flaps were preserved for secondstage urethroplasty at least 6 months apart. ResultsAll of them with severe chordee received chromosome or SRY gene test. Ventral curvatures were corrected successfully without severe complications during the firststage reconstruction. And artificial erection was inducedfor confirming straightening maneuvers during the secondstage operation. The shortterm complications included urethral meatal stricture （n = 6, 7. 3%）,urethrocutaneous fistula （n = 9, 11%） and urethral diverticulum（ n = 2, 2. 4%）. Postoperative functional and cosmetic appearances were satisfactory during the followup period. Conclusion Tissueengineered matrix grafting for straightening chordee of proximal hypospadias is efficacious for select patients.