Abrate Alberto, Gregori Andrea, Simonato Alchiede
Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy.
Department of Urology, ASST Rhodense, G. Salvini Hospital, Garbagnate Milanese, Milan, Italy.
Asian J Urol. 2019 Jul;6(3):230-241. doi: 10.1016/j.ajur.2019.01.001. Epub 2019 Jan 9.
To evaluate the functional results and complications of the lingual mucosal graft (LMG) urethroplasty and to sum up the current state of the art of this surgical technique.
A systematic search of PubMed and Scopus electronic databases was performed, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies involving male patients treated with LMG urethroplasty for urethral stricture were included. Complete protocol is available at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080121. A meta-analysis comparing functional and long-term oral complication outcomes of LMG and buccal mucosal graft (BMG) was performed, calculating the odds ratio (OR) and 95% confidence interval (CI).
Twenty original articles were included in the qualitative analysis. Strictures of 1.5-16.5 cm have been treated with LMG urethroplasty, due to the improvement of harvesting technique and very low rate of long-term oral complications. Very good functional results have been reported by different authors for LMG urethroplasty, with lower rate of oral complications than BMG. The meta-analysis included six comparative studies involving 187 and 178 patients treated with LMG and BMG urethroplasty, respectively. An OR of 1.65 (95% CI [0.95-2.87], = 0%) and 0.18 (95% CI [0.03-1.26], = 68%) were found for LMG . BMG urethroplasty, in terms of success and oral complication rate, respectively.
LMG urethroplasty can be reasonably considered a first choice technique for urethral stricture with very good results. Oral complications are temporary and minimally disabling, basically less than those for BMG, and depend mainly on the graft extent.
评估舌黏膜移植（LMG）尿道成形术的功能效果及并发症，并总结该手术技术的当前发展状况。
根据系统评价和Meta分析的首选报告项目（PRISMA）声明，对PubMed和Scopus电子数据库进行系统检索。纳入采用LMG尿道成形术治疗男性尿道狭窄患者的研究。完整方案可在http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080121获取。进行了一项Meta分析，比较LMG和颊黏膜移植（BMG）的功能及长期口腔并发症结局，计算比值比（OR）和95%置信区间（CI）。
定性分析纳入20篇原始文章。由于取材技术的改进及长期口腔并发症发生率极低，1.5 - 16.5 cm的狭窄已采用LMG尿道成形术进行治疗。不同作者报道LMG尿道成形术功能效果良好，口腔并发症发生率低于BMG。Meta分析纳入6项比较研究，分别涉及1８7例和178例接受LMG和BMG尿道成形术的患者。在成功率和口腔并发症发生率方面，LMG尿道成形术的OR分别为1.65（95%CI[0.95 - 2.87]，P = 0%）和0.18（95%CI[0.03 - 1.26]，P = 68%）。
LMG尿道成形术可被合理地视为治疗尿道狭窄的首选技术，效果良好。口腔并发症是暂时的，致残程度极低，基本上少于BMG尿道成形术，且主要取决于移植范围。
