口腔黏膜补片修复输尿管狭窄的可行性、安全性和疗效  

Analysis of the feasibility and safety of repair of ureteral stricture with oral mucosal graft

作　　者：肖行远 周辉霞 王毅[3] 张雪培[4] 杨昆霖 李恭会[6] 傅强[7] 葛京平 包胜军 罗光恒 叶雄俊 廖义翔 徐玉节 张沂南[14] 李学松[5] 李兵[1] Xiao Xingyuan;Zhou Huixia;Wang Yi;Zhang Xuepei;Yang Kunlin;Li Gonghui;Fu Qiang;Ge Jingping;Bao Shengjun;Luo Guangheng;Ye Xiongjun;Liao Yixiang;Xu Yujie;Zhang Yinan;Li Xuesong;Li Bing(Department of Urology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Pediatric Urology,Affiliated Seventh Medical Center of PLA General Hospital,Beijing 100700,China;Department of Urology,The Second Hospital of Anhui Medical University,Hefei 230601,China;Department of Urology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Urology,Peking University First Hospital,Beijing 100034,China;Department of Urology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Department of Urology,Shanghai Sixth People's Hospital,Shanghai 200233,China;Department of Urology,General Hospital of Estern Theater Command,Nanjing 210002,China;Department of Urology,Lanzhou University Second Hospital,Lanzhou 730030,China;Department of Urology,Guizhou Province People's Hospital,Guiyang 550002,China;Department of Urology,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Urology,Jingzhou First People's Hospital,Jingzhou 424099,China;Department of Urology,the First Affiliated Hospital of Wannan Medical College,Wuhu 241001,China;Department of Urology,Shandong Provincial Hospital,Jinan 250021,China)

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430022 [2]解放军总医院第七医学中心儿童泌尿外科,北京100700 [3]安徽医科大学第二附属医院泌尿外科,合肥230601 [4]郑州大学第一附属医院泌尿外科,郑州450052 [5]北京大学第一医院泌尿外科,北京100034 [6]浙江大学医学院附属邵逸夫医院泌尿外科,杭州310016 [7]上海市第六人民医院泌尿外科,上海2200233 [8]东部战区总医院泌尿外科,南京210002 [9]兰州大学第二医院泌尿外科,兰州730030 [10]贵州省人民医院泌尿外科,贵阳550002 [11]中国医学科学院北京协和医学院肿瘤医院泌尿外科,北京100021 [12]荆州市第一人民医院泌尿外科,荆州434099 [13]皖南医学院第一附属医院泌尿外科,芜湖241001 [14]山东省立医院泌尿外科,济南250021

出　　处：《中华泌尿外科杂志》2023年第2期121-127,共7页Chinese Journal of Urology

基　　金：武汉市科学技术局科研基金(2020020601012222)。

摘　　要：目的探讨口腔黏膜补片(OMG)技术修复输尿管狭窄的可行性、安全性和疗效。方法回顾性分析国内14家医学中心2015年6月至2022年2月收治的175例输尿管狭窄患者的病例资料,华中科技大学同济医学院附属协和医院49例,解放军总医院第七医学中心32例,安徽医科大学第二附属医院3例,郑州大学第一附属医院6例,北京大学第一医院56例,浙江大学医学院附属邵逸夫医院3例,上海市第六人民医院3例,东部战区总医院4例,兰州大学第二医院4例,贵州省人民医院2例,北京大学人民医院2例,荆州市第一人民医院5例,皖南医学院第一附属医院5例,山东省立医院1例。男133例,女42例。年龄(35.0±17.2)岁。体质量指数(BMI)(23.1±4.1)kg/m^(2)。输尿管狭窄原因分别为内镜手术后88例(50.3%),先天性狭窄55例(31.4%),既往输尿管成形手术失败29例(16.6%),体外冲击波碎石史13例(7.4%),放疗史3例(1.7%),其他6例(3.4%)。输尿管狭窄位于左侧116例(66.3%),右侧58例(33.1%),双侧1例(0.6%)。狭窄长度(4.7±1.8)cm。狭窄位于输尿管上段108例(61.7%),肾盂输尿管连接处63例(36.0%),输尿管中段4例(2.3%)。所有患者均使用OMG修复输尿管狭窄,其中采用舌黏膜127例(72.6%),唇黏膜32例(18.3%),颊黏膜16例(9.1%)。手术方式为机器人辅助腹腔镜手术(机器人组)84例(48.0%),传统腹腔镜手术(腹腔镜组)87例(49.7%),开放手术4例(2.3%)。对机器人组和腹腔镜组进行亚组分析,两组的年龄[(32.0±18.3)岁与(37.0±15.9)岁,P=0.040]、BMI[(22.5±4.3)kg/m^(2)与(23.7±3.6)kg/m^(2),P=0.028]、狭窄病因中的内镜手术损伤例数[34例(40.5%)与53例(60.9%),P=0.012]差异有统计学意义,其他一般资料比较差异均无统计学意义(P>0.05)。比较机器人组和腹腔镜组的手术时间和所需口腔黏膜长度。术后7~9周行输尿管造影检查示重建段通畅,或肾积水未复发定义为手术成功。结果本研究175例,手术总成功率97.7%(171/17Objective To summarize and analyze the current application status of oral mucosal graft(OMG)technique in the repair of ureteral strictures in China,and clarify the feasibility,safety and effectiveness of this technique.Methods The 175 patients who underwent repair of ureteral stricture using oral mucosal patches from June 2015 to February 2022 were etrospectively analyzed in 14 medical centers in China,including 49 cases in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,32 cases in Affiliated Seventh Medical Center of PLA General Hospital,3 cases in The Second Hospital of Anhui Medical University,6 cases in The First Affiliated Hospital of Zhengzhou University,56 cases in Peking University First Hospital,3 cases in Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,3 cases in Shanghai Sixth People's Hospital,4 cases in General Hospital of Estern Theater Command,4 cases in Lanzhou University Second Hospital,2 cases in Guizhou Province People's Hospital,2 cases in Peking University People's Hospital,5 cases in Jinzhou First People's Hospital,5 cases in The First Affiliated Hospital of Wannan Medical College,1 case in Shandong Provincial Hospital.In this study,127 patients(72.6%)used lingual mucosal patches,32(18.3%)labial mucosa,and 16(9.1%)buccal mucosa.The surgical approach for OMG ureteral reconstruction was mainly minimally invasive,with robot-assisted laparoscopy in 84 patients(48.0%),traditional laparoscopic surgery in 87 patients(49.7%),and open surgery in only 4 patients(2.3%).There were 133 males and 42 females with an average age of(35.0±17.2)years.The mean body mass index(BMI)and stenosis length were(23.1±4.1)kg/m^(2) and(4.7±1.8)cm,respectively.The stricture was located in the left ureter in 116 patients,right ureter in 58 case and bilateral ureter in 1 case.The most common causes of ureteral stricture were endoscopic surgery in 88(50.3%)patients,congenital stricture in 55(31.4%)patients,failed ureteroplasty in 29(16.6%)patients,history of extracorpo

关 键 词：输尿管狭窄 口腔黏膜补片 输尿管重建 机器人辅助腹腔镜手术 并发症 

分 类 号：R699.4[医药卫生—泌尿科学]