脱细胞基质法治疗尿道狭窄的临床研究  

Clinical study of acellular matrix grafts therapy in the treatment of urethral stricture

作　　者：于田强[1,2] 洪翔 何佳[2] 曹林 徐庆康 段跃[3] YU Tianqiang;HONG Xiang;HE Jia;CAO Lin;XU Qingkang;DUAN Yue(Department of Urology,Chinese People’s Armed Police Force Sea Police Corps Hospital,Jiaxing 314000,China;Department of Urology,Zhejiang Rongjun Hospital,Jiaxing 314000,China;Department of Urology,the Second Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310005,China)

机构地区：[1]中国人民武装警察部队海警总队医院泌尿外科,浙江嘉兴314000 [2]浙江省荣军医院泌尿外科,浙江嘉兴314000 [3]浙江省中医药大学附属第二医院泌尿外科,浙江杭州310005

出　　处：《健康研究》2020年第2期201-204,F0003,共5页Health Research

基　　金：嘉兴市科技计划项目(2016AY23085)。

摘　　要：目的观察脱细胞基质法治疗尿道狭窄的的临床疗效,为临床手术治疗尿道狭窄提供新的思路。方法40例尿道狭窄患者分为A、B两组各20例,均行脱细胞基质修复尿道狭窄术,A组使用小肠粘膜脱细胞基质,B组使用牛心包脱细胞基质。术后6个月、12个月定时随访,统计术后并发症发生情况,术前及各随访时间点患者平均最大尿流率、膀胱残余尿量及影像学图片。结果术后6个月、12个月,A组的平均最大尿流速率高于术前、膀胱残余尿量低于术前;与术后6个月比较,术后12个月的平均最大尿流速率降低、膀胱残余尿量升高;差异均有统计学意义(P<0.05)。术后6个月、12个月,B组平均最大尿流速率均低于A组、膀胱残余尿量均高于A组,差异均有统计学意义(P<0.05)。术后2组并发症发生率差异无统计学意义(P>0.05)。膀胱镜尿道检查显示A组术后6个月植入的脱细胞基质补片剩余存在,与周围组织间限清楚,尿道畅通;术后12个月补片表面出现絮状物,絮状物占位尿道。B组术后6个月尿道狭窄再次形成。结论脱细胞基质法可以用于治疗尿道狭窄,小肠粘膜脱细胞基质疗效优于牛心包脱细胞基质,术后应定期随访防止后期再次出现狭窄。Objective To observe the clinical efficacy of acellular matrix graft(AMG)therapy in the treatment of urethral stricture,and to provide a new method for clinical operation of urethral stricture.Methods 40 patients with urethral stricture were divided into group A(n=20)and group B(n=20).Both groups were treated urethral stricture with AMG therapy.Group A used small intestinal mucosal AMGs,and group B used bovine pericardial AMGs.Regular follow-up at six months and 12 months postoperatively.Postoperative complications,mean maximum urinary flow rate,bladder residual urine volume and imaging pictures were analyzed.Results At six and 12 months after the operation,the mean maximum urine flow rate of group A was higher than that before the operation,and the bladder residual urine volume was lower than that before the operation.The differences were statistically significant(P<0.05).Compared with six months after the operation,the mean maximum urine flow rate decreased and the residual urine volume increased at 12 months after the operation.The differences were statistically significant(P<0.05).At six and 12 months after the operation,the mean maximum urinary flow rate of group B was lower than that of group A,and the residual urinary volume of group B was higher than that of group A.The differences were statistically significant(P<0.05).There was no significant difference in complications between the two groups(P>0.05).Cystoscopic urethrography showed that there were still AMGs implanted in group A at six months after the operation,with clear boundaries with surrounding tissues,and the urethra was unobstructed;at 12 months after operation,floccules appeared on the surface of the patch,and floccules occupied the urethra.At six months after the operation,the urethral stricture was formed again in group B.Conclusions AMG therapy can be used to treat urethral stricture.The effect of small intestinal mucosal AMGs is better than that of bovine pericardial AMGs.It is recommended to follow up regularly to prevent recurrence of st

关 键 词：小肠粘膜脱细胞基质 牛心包脱细胞基质 尿道狭窄 生物支架材料 

分 类 号：R45[医药卫生—治疗学]