复杂性尿道狭窄的外科实践：材料、术式与理念的变迁

Surgical practice for complex urethral stricture： evolution of materials，techniques， and concepts

SONG Lujie，HAO Tianzheng （Department of Urology，Medical School of Shanghai Jiao Tong University Affiliated Sixth People's Hospital，Shanghai Eastern Urological Reconstruction and Repair Institute，Shanghai 2O0233，China）

ABSTRACT：Urethral stricture is acommon and complex disease in urology，which seriously affects the qualityof life of patientsand poseschallenges toclinicaltreatment.Urethralreconstructivesurgeryhasevolvedfrompallativeapproachessuch as dilationand internalurethrotomytosystematicreconstructionbasedon flapsand mucosal grafts.Withtheintroductionof oral mucosaanditshistologicalcompatibilityautologous mucosahasbecomethemainstayurethralsubstitute，whileflapsremain indispensable inextensiveandcomplexcases due to theirrobust vascularity.Advances invarious fieldsof study havehada significantimpactonthephilosophyof surgery.Thenewapproach has placeda higher valueonanatomical structureand functional preservation alongside patencyrates.This shiftin focus has led toanincreased importanceof non-discontinuous anastomosis.Particularlyintherepairofurethralinjuriesfolowingpelvicfractures，Chinesescholars haveutilizedextensive case series topioneerinnovationsinpediatriccases，complexobstructions，andcombinedfistularepair，therebyenrichingglobal expertise.Concurrntly，thereisagrowinginterest intheexplorationof tssueengineeringandnovelbiomaterialsforurethral repair.Theseapproaches，rangingfromthesubmucosalmatrixof thesmalintestinetobiomimeticdegradablescafolds，ellloadedengineeredmucosa，and3D-printedmaterials，reprogresivelyeteringclinicalvalidationphases.Insummaryrthal reconstructionisundergoing ashift from“reconstructing anatomy”to“balancing function.”Driven by precision medicine and regenerative medicine，it is expected to achieve more optimal individualized treatments in the future.

KEY WORDS：urethral stricture;urethroplasty; flaps; oral mucosa;non-transecting anastomosis;tissue engineering

摘要：尿道狭窄是泌尿外科常见且复杂的疾病，严重影响患者生活质量，同时给临床治疗带来挑战。（剩余15616字）