上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (9): 1203-.doi: 10.3969/j.issn.1674-8115.2012.09.015

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复杂性尿道狭窄及并发症诊治的实验研究与临床运用

徐月敏, 傅 强, 撒应龙, 张 炯, 金三宝, 谢 弘, 谷保军, 冯 超   

  1. 上海交通大学附属第六人民医院泌尿外科 上海交通大学医学院尿道疾病诊治中心 上海东方泌尿修复与重建研究所, 上海 200233
  • 出版日期:2012-09-28 发布日期:2012-09-29
  • 作者简介:徐月敏（1952—）, 男, 教授, 博士, 博士生导师, 现任上海交通大学附属第六人民医院泌尿外科主任；电子信箱: xueyuemin@263.net。
  • 基金资助:

    国家自然科学基金面上项目（81170641, 30772159, 30973016）

Basic research and clinical study of diagnosis and treatment of complex urethral stricture and its complications

XU Yue-min, FU Qiang, SA Ying-long, ZHANG Jiong, JIN San-bao, XIE Hong, GU Bao-jun, FENG Chao   

  1. Department of Urology, the Sixth People´s Hospital, Shanghai Jiaotong University, Center for Diagnosis and Treatment of Urethral Diseases, Shanghai Jiaotong University School of Medicine, Eastern Institute for Urologic Repair and Reconstruction, Shanghai 200233, China
  • Online:2012-09-28 Published:2012-09-29

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摘要：

复杂性尿道狭窄或闭锁的处理一直是泌尿外科最棘手的难题之一，尤其是对初次或再次治疗失败后的复杂性超长段尿道狭窄或闭锁（>14 cm）患者的治疗，作者在治疗复杂性尿道狭窄及其并发症中取得了一系列的原创性成果。与国内外的同类研究比较，主要有以下发现和创新点。① 在国际上首次提出并证实结肠黏膜可作为尿道替代物；临床治疗55例超长段尿道狭窄（平均15.2 cm）的结果提示结肠黏膜具有材源丰富、易于剥离、抗感染力强、皱缩率低等优点，适于14 cm 以上尿道的重建，尤其是多次治疗失败的复杂性超长段尿道狭窄。②在国际上首次建立新型分期手术治疗复杂性超长段狭窄或闭锁，临床应用11例，疗效显著，为难治性前后尿道间长段狭窄或闭锁提供了一个新的思路。③在国际上首次阐述舌黏膜尿道重建的病理学特征及转归，建立大面积舌黏膜取材新技术；在国内率先开展舌黏膜尿道成形术，样本量为国内外最大。④在国际上首次建立了尿道压客观量化指标（90 cmH2O 或较基础压提高40～50 cmH2O），用于评估球部尿道悬吊术中尿道压力。从而提高了手术成功率，减少了并发症，取得了显著治疗效果。该系列研究成果先后获省部科技进步一等奖和多项二等奖。

关键词: 尿道狭窄, 尿失禁, 结肠黏膜, 口腔黏膜, 治疗

Abstract:

Complex urethral stricture or obliteration is always a great challenge to most urologists. It is very difficult to treat those patients suffered from panurethral stricture or obliteration (>14 cm). To patients with previous failure in urethroplasty, the strategy selection will become a dilemma. In this field, we have obtained several original achievements in recent years. Comparing with those similar investigations in the world, many creative ideas or conceptions can be concluded in our study. Firstly, we have proved that the colonic mucosa could be an alterative material for urethroplasty. Up till now, 55 patients have undergone this procedure. The mean length of stricture in those patients was 15.2 cm. The clinic results demonstrated that the colonic mucosa has several advantages, such as abundant resource, easy to harvest, strong ability of anti-infection and low contractive rate. Therefore, this material is suitable for patients with panurethral stricture (>14 cm), especially for those with previous failure in operation. Secondly, we established the new conception of treating panurethral stricture or obliteration using three stages operation. Totally, 11 cases accepted this procedure, all of them obtained satisfied results. The strategy provides a new idea to treat patients with ultra-long segment of urethral stricture and obliteration between anterior and posterior urethra. Thirdly, we firstly described the pathologic characteristics and transformation rule of urethra in patients who accepted the lingual mucosa substitution in the world. And, we have invented the new technique to harvest the large area lingual mucosa. After that, we firstly performed the clinical lingual mucosa urethroplasty in China. With the effort over 10 years, we have collected the largest database about lingual mucosa urethroplasty in the world. Fourthly, we have established the objective quantitative criteria of urethral pressure (90 cmH2O or 40-50 cmH2O over baseline) in the world, which is to evaluate the effectiveness of bulbar urethral sling procedure during the operation. After using this criterion during the operation, the operative successive rate obviously increased. The related complications could be minimized. The results were encouragement. Due to those achievements, we have obtained several first prize and second prize of provincial and ministerial scientific and technical progress rewards.

Key words: urethral stricture, urinary incontinence, colonic mucosa, oral mucosa, treatment