Urethral replacement: a comparison between small intestinal submucosa grafts and spontaneous regeneration
Urethral replacement: a comparison between small intestinal submucosa grafts and spontaneous regeneration
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DOI：
10.1111/j.1464-410x.2004.05115.x
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发表时间：
2004-11-01
影响因子：
4.5
通讯作者：
Hafez, AT
中科院分区：
文献类型：
--
作者：
El-Assmy, A;El-Hamid, MA;Hafez, AT
评价市售单层小肠黏膜下层（SIS）在兔模型中作为衬垫和管状尿道替代物的应用。将36只雄性家兔分为4个实验组。1组切除阴茎尿道腹壁15mm；在第2组中，用SIS贴壁移植物修补所造成的缺损；3组完全切除阴茎尿道15 mm段；在第4组中，用SIS管移植物代替该缺损。所有家兔尿道支架放置2周。在手术后3、6和12周死亡前对所有家兔进行逆行尿道造影。然后暴露尿道，仔细检查并切除进行组织病理学检查。1、2组13只兔逆行尿道图正常，1组2只兔相对狭窄，2组3只兔相对狭窄。3、4组均出现尿道瘘或狭窄。尿道组织学检查显示，1组家兔尿道上皮均有平滑肌支持再生，2组家兔尿道上皮未见平滑肌再生。而第3、4组则表现为不完全再生和进行性纤维化。在该动物模型中，单层SIS不是合适的尿道替代品。当用作衬垫时，愈合不如自发尿道再生，因为SIS阻碍了平滑肌细胞的再生。当用作导管时，有完全的疤痕和尿道腔阻塞。
To evaluate the use of commercially available single-layer small intestinal submucosa (SIS) for urethral replacement, both as an onlay and as a tube, in a rabbit model.Thirty-six male rabbits were assigned to four experimental groups. Group 1 had the ventral wall of the penile urethra excised for 15 mm; in group 2 this created defect was patched with a SIS onlay graft; group 3 had complete excision of a 15 mm segment of the penile urethra; and in group 4, this created defect was replaced with a SIS tube graft. In all rabbits the urethra was stented for 2 weeks. A retrograde urethrogram was taken in all rabbits before death at 3, 6 and 12 weeks after surgery. The urethra was then exposed, examined carefully and excised for histopathological examination.In groups 1 and 2 the retrograde urethrograms were normal in 13 rabbits and there was relative narrowing in two rabbits in group 1 and three in group 2. In groups 3 and 4 all rabbits developed urethral fistulae or strictures. Histological examination of the urethra showed epithelial regeneration supported by smooth muscle backing in all rabbits in group 1, while rabbits in group 2 showed no regeneration of smooth muscle. By contrast, rabbits in groups 3 and 4 showed incomplete regeneration and progressive fibrosis.Single-layer SIS is not a suitable urethral substitute in this animal model. When used as an onlay, healing is inferior to spontaneous urethral regeneration, as SIS impedes smooth muscle cell regeneration. When used as a tube, there is complete scarring and urethral luminal occlusion.