口腔黏膜补片与脱细胞真皮基质补片治疗长段尿道狭窄的疗效和安全性对比

doi:10.19723/j.issn.1671-167X.2025.05.024

摘要/Abstract

摘要： 目的: 对比口腔黏膜(oral mucosa, OM)补片和脱细胞真皮基质(acellular dermal matrix, ADM)补片治疗长段尿道狭窄的疗效和安全性的差异。方法: 回顾性收集2010年5月至2023年9月就诊于北京大学第一医院的27例因长段尿道狭窄需接受补片尿道重建术的患者资料, 其中14例患者接受OM补片修补, 13例接受ADM补片修补。按照术中使用补片材料不同, 将患者分为OM组和ADM组, 两组患者平均年龄分别为(43.3±14.0)岁、(54.2±15.9)岁, 平均体重指数分别为(24.7±4.3) kg/m²、(25.4±4.8) kg/m²。OM组主要病因为特发性尿道狭窄, ADM组主要病因为硬化性苔藓样病。结果: 所有患者的手术均顺利完成, 两组的中位狭窄长度分别为4.5 (2.5, 9.0) cm、5.0 (2.0, 14.0) cm(P=0.555), 中位手术时间分别为160 (71, 221) min、134 (112, 274) min(P=0.065), 尿管留置时间分别为1.5 (1.0, 6.0) 个月、3.0 (1.0, 3.0) 个月, 术后中位随访时间分别为12.5 (1.0, 170.0)个月、59.0 (3.0, 142.0) 个月, 手术成功率分别为50.00%、53.85%。两组患者的术后末次随访生活质量(quality of life, QoL)和国际前列腺症状评分(international prostate symptom score, IPSS)差异无统计学意义, 两组术后无狭窄生存率的差异亦无统计学意义(HR=0.875, 95%CI: 0.507~1.511, P=0.6)。安全性方面, OM组有3例患者出现性功能障碍, 2例患者出现口腔并发症; ADM组有1例患者出现术后感染。结论: ADM补片在治疗长段尿道狭窄(包括由硬化性苔藓样病引起的复杂病例)中的疗效和安全性与OM补片相当, 但受限于研究样本量较小, 上述结论可能存在一定局限性, 未来需要更大样本量的队列研究以进一步验证。

关键词: 尿道狭窄, 尿道成形术, 脱细胞真皮基质, 口腔黏膜

Abstract: Objective: To investigate the differential efficacy and safety profiles of oral mucosa (OM) grafts compared with acellular dermal matrix (ADM) grafts in the surgical management of long-segment urethral strictures. Methods: A retrospective cohort study was conducted involving 27 patients who underwent graft urethroplasty for long-segment urethral strictures in Peking University First Hospital, spanning from May 2010 to September 2023. The patient cohort comprised 14 individuals who received OM grafts and 13 who underwent ADM grafts. The participants were stratified into two groups based on the type of grafts material utilized during surgery. The demographic and clinical baseline characteristics included an average age of (43.3±14.0) years in the OM group and (54.2±15.9) years in the ADM group. The mean body mass index (BMI) for the respective groups were (24.7±4.3) kg/m² for OM and (25.4±4.8) kg/m² for ADM. Etiological differences were noted, with idiopathic causes predominantly in the OM cohort and lichen sclerosus in the ADM cohort. Results: The surgical interventions were successfully executed for all the patients. The median stricture length was 4.5 (2.5, 9.0) cm for the OM group and 5.0 (2.0, 14.0) cm for the ADM group (P=0.555). The median operative duration was 160 (71, 221) min for the OM group and 134 (112, 274) min for the ADM group (P=0.065). The catheterization durations was 1.5 (1.0, 6.0) months for the OM group and 3.0 (1.0, 3.0) months for the ADM group. The median postoperative follow-up duration was 12.5 (1.0, 170.0) months for the OM group and 59.0 (3.0, 142.0) months for the ADM group. The surgical success rates were 50.00% in the OM group and 53.85% in the ADM group. No statistically significant differences were observed in postoperative quality of life (QoL) or international prostate symptom score (IPSS) at the final follow-up. The stricture-free survival rates did not differ significantly (HR=0.875, 95%CI: 0.507-1.511, P=0.6). In terms of safety, three patients in the OM group experienced sexual dysfunction, and two had oral complications, whereas the ADM group had one case of postoperative infection. Conclusion: The findings suggest that ADM grafts are comparable to OM grafts in terms of efficacy and safety for the treatment of long-segment urethral strictures, including complex cases attributed to lichen sclerosus. However, given the small sample size of this study, the above conclusions may have certain limitations. Larger cohort studies will be needed in the future to further validate these findings.

Key words: Urethral stricture, Urethroplasty, Acellular dermal matrix, Oral mucosa

中图分类号:

R699.6

冷汶远, 高端, 李晓宇, 左炜, 胡伟民, 朱振鹏, 徐纯如, 林健, 李学松. 口腔黏膜补片与脱细胞真皮基质补片治疗长段尿道狭窄的疗效和安全性对比[J]. 北京大学学报（医学版）, 2025, 57(5): 975-979.

Wenyuan LENG, Duan GAO, Xiaoyu LI, Wei ZUO, Weimin HU, Zhenpeng ZHU, Chunru XU, Jian LIN, Xuesong LI. Comparison of efficacy and safety of oral mucosa grafts and acellular dermal matrix grafts in the treatment of long-segment urethral stricture[J]. Journal of Peking University (Health Sciences), 2025, 57(5): 975-979.

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参考文献 15

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Characteristics	Group		P value
Characteristics	OM	ADM	P value
Patient number	14	13
Age/years, ${\bar x}$±s	43.3±14.0	54.2±15.9	0.071
BMI/(kg/m²), ${\bar x}$±s	24.7±4.3	25.4±4.8	0.717
Smoking history, n (%)	3 (21.43)	3 (23.08)	0.946
Alcohol use history, n (%)	2 (14.29)	0 (0)	0.181
Comorbidities, n (%)
Hypertension	2 (14.29)	1 (7.69)	0.624
Diabetes	0 (0)	3 (23.08)	0.068
Cardiovascular disease	2 (14.29)	0 (0)	0.181
Etiology, n (%)			0.035
Trauma	2 (14.29)	3 (23.08)
Lichen sclerosus	1 (7.14)	5 (38.46)
Iatrogenic	5 (35.71)	4 (30.77)
Idiopathic	6 (42.86)	1 (7.69)
Stricture site, n (%)			0.149
Anterior urethra	14 (100.00)	11 (84.62)
Posterior urethra	0 (0)	1 (7.69)
Entire urethra	0 (0)	1 (7.69)
Stricture length/cm, median (min, max)	4.5 (2.5, 9.0)	5.0 (2.0, 14.0)	0.555
Prior surgeries, n (%)			0.652
0	6 (42.86)	4 (30.77)
1	1 (7.14)	4 (30.77)
2	2 (14.29)	2 (15.38)
3	0 (0)	2 (15.38)
4	0 (0)	0 (0)
≥5	5 (35.71)	1 (7.69)
Operative duration/min, median (min, max)	160 (71, 221)	134 (112, 274)	0.065

Etiology (n)	Group (n)	Restricture rate, n (%)	Median restricture time/months	Complication (n)
Trauma (5)	OM (2)	1 (50.0)	3	Oral pain (1)
Trauma (5)	ADM (3)	1 (33.3)	6
Lichen sclerosus (6)	OM (1)	0 (0)
Lichen sclerosus (6)	ADM (5)	3 (60.0)	6	Postoperative infection (1)
Iatrogenic (9)	OM (5)	3 (60.0)	3	Dysgeusia (1)
Iatrogenic (9)	ADM (4)	2 (50.0)	4.5
Idiopathic (7)	OM (6)	3 (50.0)	3	Sexual dysfunction (3)
Idiopathic (7)	ADM (1)	0 (0)

Indicators	Group		P value
Indicators	OM	ADM	P value
Preoperative QoL, median (min, max)	5.0 (5.0, 6.0)	6.0 (4.0, 6.0)	0.275
Preoperative IPSS, median (min, max)	20.5 (9.0, 31.0)	20.0 (15.0, 32.0)	0.800
Catheterization duration/months, median (min, max)	1.5 (1.0, 6.0)	3.0 (1.0, 3.0)	0.018
Restricture rate, n (%)	7 (50.00)	6 (46.15)	0.867
Restricture time/months, median (min, max)	2.5 (1.3, 8.0)	5.0 (1.5, 12.0)	0.163
Postoperative QoL, median (min, max)	1.0 (0, 5.0)	1.0 (0, 5.0)	0.358
Postoperative IPSS, median (min, max)	5.5 (3.0, 14.0)	7.0 (2.0, 14.0)	0.547