同种异体脱细胞真皮基质修复输尿管及尿道狭窄的临床应用研究
摘要
目的:探讨新型组织工程学替代材料-人同种异体脱细胞真皮基质修复输尿管及尿道狭窄、缺损的临床经验,寻求理想的输尿管及尿道修复替代材料。
方法:采用天然细胞外基质-人同种异体脱细胞真皮基质作为输尿管或者尿道替代材料治疗输尿管长段狭窄11例及男性长段尿道缺损患者8例。其中:1.输尿管长段狭窄11例。男5例,女6例。平均年龄44.5岁。病程12～39个月,平均20.5个月。包括肾盂输尿管移行区狭窄5例,输尿管中上段狭窄3例,输尿管下段狭窄3例。狭窄长度3～10cm。2.男性长段尿道缺损患者8例。平均年龄56岁。病程3-60个月,平均16.7个月。其中陈旧性前尿道狭窄4例、球部尿道狭窄2例、狭窄段从前尿道延伸到后尿道2例。狭窄长度3～8cm,平均5cm。
结果:11例输尿管狭窄随访6～65个月,中位随访时间为19.5个月。术后4周拔除输尿管支架管4例,术后8周拔除支架管7例。术后6个月IVU检查:9例输尿管造影剂通过正常,无狭窄,无渗漏:2例术后出现再狭窄,狭窄段约1cm、1.5cm,二次行输尿管成形术治愈。8例男性尿道狭窄随访3～21个月,平均12.5个月。术后6周拔除尿管2例,术后8周拔除尿管6例。7例(87.5%)无狭窄、尿瘘,排尿通畅;排尿不畅1例,定期行尿道扩张。术后8周行尿道造影显示尿道通畅,未见吻合口狭窄。
结论:同种异体脱细胞真皮基质为机体提供了良好的供宿主细胞“爬行替代”的框架,在修补后可有效地与宿主组织融合,修补后的输尿管或尿道愈合良好。同种异体脱细胞真皮基质作为一种天然细胞外基质框架,生物相容性最好,能大量制备,在体内以及体外泌尿系统诱导组织再生的效果确切,尽管它的试验研究仍处于实验室阶段,但是脱细胞基质应用于输尿管及尿道临床研究的效果也令人满意,无排斥等不良反应,适合于治疗长段的输尿管、尿道狭窄或缺损,是较理想的尿路替代材料。
Objective:To evaluate the possibility of allodecellular extracellular matrix(ECM)- acellular dermal matrix allograft(ADMA) for the reconstruction of ureter or urethra and found an ideal replacement material to simplify the ureteroplastic and urethroplastic surgery.
Methods:ADMA was used to treat the stricture of ureter in 11 patients(male 5 and female 6;mean age,44.5 years).The mean disease course was 20.5 months(range,12-39months).Of the 11 cases,5 had stricture of pelviureteric transition zone;3 had stricture of upper and middle ureter;3 had stricture of lower ureter.The stricture lenth ranged from 3 to 10cm. ADMA was used to treat the long stricture of urethral in 8 patients(mean age 56 years).The mean disease course was 16.7 months(range, 3-60months).The stricture length ranged 3 to 8cm(mean 5cm).
Results:The procedure was performed successfully at one-stage in 11 cases of ureteral stricture without complication.The 11 cases were followed up for 6 months to 65 months(median,19.5 months).Postoperatively,the ureter stents were removed in 4 cases at 4 weeks and in other 7 cases at 8 weeks.The ureter functions of 9 patients were normal after operation.No stenosis,effusion and hydronephrosis were observed on IVU 6 months after operation.Ureteral stricture developed again in 2 cases and operation was performed again and succeed.The 8 cases of urethral stricture were followed up for an average 12.5 months(3-21months).Postoperatively,the Foley catheter were removed in 2 cases at 6 weeks and in other 6 cases at 8 weeks.Among the 8 patients,7(87.5%) voiled well.No stenosis and effusion were observed on excretory urogram(XU) 8 weeks after operation.
Conclusions:ADMA can provide a frame for the host cells' growth,and it can be mixed with host tissues to provide a good intensive potency,so it might be an ideal tissue-engineering material for the replacement of ureter and urethra,without concern of rejection.
方法:采用天然细胞外基质-人同种异体脱细胞真皮基质作为输尿管或者尿道替代材料治疗输尿管长段狭窄11例及男性长段尿道缺损患者8例。其中:1.输尿管长段狭窄11例。男5例,女6例。平均年龄44.5岁。病程12～39个月,平均20.5个月。包括肾盂输尿管移行区狭窄5例,输尿管中上段狭窄3例,输尿管下段狭窄3例。狭窄长度3～10cm。2.男性长段尿道缺损患者8例。平均年龄56岁。病程3-60个月,平均16.7个月。其中陈旧性前尿道狭窄4例、球部尿道狭窄2例、狭窄段从前尿道延伸到后尿道2例。狭窄长度3～8cm,平均5cm。
结果:11例输尿管狭窄随访6～65个月,中位随访时间为19.5个月。术后4周拔除输尿管支架管4例,术后8周拔除支架管7例。术后6个月IVU检查:9例输尿管造影剂通过正常,无狭窄,无渗漏:2例术后出现再狭窄,狭窄段约1cm、1.5cm,二次行输尿管成形术治愈。8例男性尿道狭窄随访3～21个月,平均12.5个月。术后6周拔除尿管2例,术后8周拔除尿管6例。7例(87.5%)无狭窄、尿瘘,排尿通畅;排尿不畅1例,定期行尿道扩张。术后8周行尿道造影显示尿道通畅,未见吻合口狭窄。
结论:同种异体脱细胞真皮基质为机体提供了良好的供宿主细胞“爬行替代”的框架,在修补后可有效地与宿主组织融合,修补后的输尿管或尿道愈合良好。同种异体脱细胞真皮基质作为一种天然细胞外基质框架,生物相容性最好,能大量制备,在体内以及体外泌尿系统诱导组织再生的效果确切,尽管它的试验研究仍处于实验室阶段,但是脱细胞基质应用于输尿管及尿道临床研究的效果也令人满意,无排斥等不良反应,适合于治疗长段的输尿管、尿道狭窄或缺损,是较理想的尿路替代材料。
Objective:To evaluate the possibility of allodecellular extracellular matrix(ECM)- acellular dermal matrix allograft(ADMA) for the reconstruction of ureter or urethra and found an ideal replacement material to simplify the ureteroplastic and urethroplastic surgery.
Methods:ADMA was used to treat the stricture of ureter in 11 patients(male 5 and female 6;mean age,44.5 years).The mean disease course was 20.5 months(range,12-39months).Of the 11 cases,5 had stricture of pelviureteric transition zone;3 had stricture of upper and middle ureter;3 had stricture of lower ureter.The stricture lenth ranged from 3 to 10cm. ADMA was used to treat the long stricture of urethral in 8 patients(mean age 56 years).The mean disease course was 16.7 months(range, 3-60months).The stricture length ranged 3 to 8cm(mean 5cm).
Results:The procedure was performed successfully at one-stage in 11 cases of ureteral stricture without complication.The 11 cases were followed up for 6 months to 65 months(median,19.5 months).Postoperatively,the ureter stents were removed in 4 cases at 4 weeks and in other 7 cases at 8 weeks.The ureter functions of 9 patients were normal after operation.No stenosis,effusion and hydronephrosis were observed on IVU 6 months after operation.Ureteral stricture developed again in 2 cases and operation was performed again and succeed.The 8 cases of urethral stricture were followed up for an average 12.5 months(3-21months).Postoperatively,the Foley catheter were removed in 2 cases at 6 weeks and in other 6 cases at 8 weeks.Among the 8 patients,7(87.5%) voiled well.No stenosis and effusion were observed on excretory urogram(XU) 8 weeks after operation.
Conclusions:ADMA can provide a frame for the host cells' growth,and it can be mixed with host tissues to provide a good intensive potency,so it might be an ideal tissue-engineering material for the replacement of ureter and urethra,without concern of rejection.
引文
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