兔阑尾黏膜预制尿道行阴茎再造的实验研究  

Experimental research of penial reconstruction with prefabricated urethra of appendiceal mucous membrane in rabbit

作　　者：朱鴷[1] 芦立轩[1] 江华[1] 朱晓海[1] 赵耀忠[1] 李宾[1] 刘安堂[1] 张盈帆[1] 

机构地区：[1]第二军医大学附属长征医院整形外科,上海200003

出　　处：《中国美容整形外科杂志》2014年第2期117-121,共5页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：上海市自然科学基金青年项目（10ZR1439200）;上海市市级医院新兴前沿技术联合攻关项目（SHDC12010105）

摘　　要：目的 探讨以兔阑尾黏膜预制尿道行阴茎再造的可行性.方法 60只雄性新西兰兔随机分为两组,分别利用阑尾黏膜和皮片预制尿道,术后3个月行阴茎再造术.观察阑尾黏膜预制尿道后2周,1、2、3个月及阴茎再造术后1、3个月时尿道的组织学变化;对比两组阴茎再造术后1、3个月阴茎大体形态变化和逆行尿道造影改变;对比两组阴茎再造术后3个月时,尿道并发症发生率的差异.结果 阑尾黏膜预制尿道移植后,单层柱状上皮经历了早期脱落、再生,到后期逐渐萎缩凋亡,并被复层鳞状上皮逐渐移行、化生及取代的过程;阴茎再造术后 1个月,尿道已无单层柱状上皮存留,均被覆复层鳞状上皮,但上皮较薄,而再造术后3个月时,尿道复层鳞状上皮进一步增生增厚;两组再造阴茎大体形态无明显差异;逆行尿道造影显示,两组尿道早期吻合口处均存在管腔狭窄,逐渐趋于减轻;两组尿道狭窄及尿瘘并发症发生率差异具有统计学意义,阑尾黏膜组无尿路结石的发生,而皮片组由于毛发生长,6例出现毛石症,差异具有统计学意义（P ＜0.05）.结论利用阑尾黏膜预制尿道行阴茎再造术,方法可行;为避免尿道狭窄并发症的发生,宜根据尿道内上皮化生程度,调整合适的尿道预制时间.Objective To investigate the feasibility of penial reconstruction with prefabricated urethra of appendiceal mucous membrane in rabbit. Methods Sixty male New Zealand rabbits were randomly divided into two groups which urethras were separately prefabricated with appendiceal mucous membrane and flap, penial reconstruction was performed at 3 months after urethral prefabrication. Histological changes of the reconstructed penis was observed with HE staining at 2 weeks, 1 month, 2 months, 3 months after urethral prefabrication with appendiceal mucous membrane and at 1 month, 3 months after penia｜ reconstruction. Morphological differences and retrograde urethrogram of reconstructed penis were analyzed at 1 and 3 months after penial reconstruction and urethral complications were compared between two groups. Results There was no difference on gross mor- phology of reconstructed penis between two groups. After appendiceal mucous membrane was transplanted for prefabricated urethra, simple columnar epithelium of mucous membrane had gone through early falling off, re- generation, atrophy and apoptosis finally. Meanwhile, stratified squamous epithelium gradually migrated, meta- plasiaed and replaced simple columnar epithelium during this period. There was almost no simple columnar epi- thelium left on the surface of reconstructed urethra, which was fully covered by thin stratified squamous epitheli- um at 1 month after penial reconstruction. This alternative epithelium gradually proliferated and thickened in the following 2 months. Retrograde urethrogram of two groups showed that anastomotic stenosis existed in the early postoperative stage but gradually mitigated as times went on. There was no obvious difference between two groups on urethral stricture and urinary fistula. However, because of the hair growth in the reconstructed urethra, there were 6 cases with urinary stones in the control group, which was obviously different from the experi- mental group without occurrence （ P 〈 0.05）. Conclusion It is feasible to u

关 键 词：阑尾黏膜 尿道预制 阴茎再造术 

分 类 号：R697[医药卫生—泌尿科学] R318[医药卫生—外科学]