Duckett J W, Coplen D, Ewalt D, Baskin L S
Division of Urology, Children's Hospital of Philadelphia, Pennsylvania, USA.
J Urol. 1995 May;153(5):1660-3.
Graft substances, such as skin and bladder mucosa, have been previously used for urethral replacement when local epithelial tissue was not available. However, these substances have been associated with meatal prolapse, stricture and fistula formation. We have used buccal mucosa as a tissue for urethral substitution in these situations during the last 8 years. We review our clinical experience in 18 urethral reconstructions performed for urethral replacement in 4 cases of exstrophy/epispadias, 12 complex hypospadias repairs and 2 cases of complex bulbar urethral strictures. There have been 5 cases of meatal stenosis (2 requiring operative revision) but none of meatal eversion. There has also been 1 urethrocutaneous fistula and 1 mid graft stricture. Mean followup was 27 months and minimum followup was 6 months. Histological examination of the buccal mucosal graft compared to grafts of skin showed that the full thickness of the dermis or lamina propria is thinnest while the native vascular supply is greatest in the buccal mucosa. These 2 factors are associated with improved graft take and may explain the encouraging clinical results.
当局部上皮组织无法获取时，移植材料，如皮肤和膀胱黏膜，此前已被用于尿道重建。然而，这些材料与尿道口脱垂、狭窄和瘘管形成有关。在过去8年中，我们在这些情况下使用颊黏膜作为尿道替代组织。我们回顾了我们对18例尿道重建的临床经验，这些重建手术用于4例膀胱外翻/尿道上裂、12例复杂型尿道下裂修复和2例复杂型球部尿道狭窄的尿道替代。有5例尿道口狭窄（2例需要手术矫正），但无尿道口外翻病例。还有1例尿道皮肤瘘和1例移植物中段狭窄。平均随访27个月，最短随访6个月。与皮肤移植物相比，颊黏膜移植物的组织学检查显示，真皮或固有层的全层最薄，而颊黏膜的天然血供最丰富。这两个因素与移植物的更好存活相关，可能解释了令人鼓舞的临床结果。
