口腔黏膜

  • 简介
  • 讲座
  • 论文
  • 常见问题
  • 临床成果
  • 调查问卷
  • 外科手术
“口腔黏膜获取术”是从口腔中取一块黏膜组织的手术。
分为两种类型:

  • 从颊粘膜获取黏膜移植物。这种技术是从口腔颊部的黏膜获取移植物(如图1,2,3,4),在本中心使用最为广泛。
  • 从舌获取黏膜移植物。这种技术是从舌体的腹侧获取黏膜移植物(如图5,6,7,8,9)。这种技术一般在颊粘膜无法获取的情况下使用。

口腔黏膜获取术一般是在有如下情况时使用:

  • 患者存在尿道球部或是阴茎部的狭窄,在进行扩大尿道成形术时需要自体材料。

一些患者可能需要从口腔取两处移植物(图10)。口腔取移植物的操作几乎没有并发症,并且根据我们对350位患者的问卷调查来看,患者的满意程度以及对操作的接受程度也很高(见调查问卷)。

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图 10

讲座 1:

Urethral stricture surgery – tips and tricks. Surgery of the bulbar urethra
Joint Meeting of the ESAU and the ESGURS
October 25 – 27, 2007
Madrid – Spain
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讲座 2:
Evaluation of early, late complications and patient satisfaction in 300 patients who underwent oral graft harvesting from a single cheek using a standard technique in a referral center experience
AUA 2009
Chicago, Illinois – USA
April 25 – 30, 2009
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讲座 3:
One-stage substitution urethroplasty
24th Annual EAU Congress
Stockholm – Sweden
March 17 – 21, 2009
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讲座 4:
The Use of Oral Mucosa for Anterior Urethroplasty
Training Course on “Techniques in Reconstructive Urology”
Mansoura – Egypy
January 23 – 29, 2010
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论文 1
Guido Barbagli, Michele De Angelis, Giuseppe Romano, Pier Guido Ciabatti, Massimo Lazzeri,
The Use of Lingual Mucosal Graft in Adult Anterior Urethroplasty: Surgical Steps and Short-Term Outcome
Eur Urol 2008; 54:671 – 676

Objective: Investigate the tolerability, safety, and efficacy of using the lingual mucosal graft (LMG) for anterior urethroplasty.
Methods: Ten patients (average age, 41 yr) underwent substitution urethroplasty LMG. Harvesting the graft from the tongue was performed by either the oral surgeon or the urologist. In five patients with penile urethral strictures, the grafts were placed on the dorsal urethral surface as a “dorsal inlay.” In five patients with bulbar urethral strictures, the grafts were used as a “dorsal inlay” (3 cases) or “ventral onlay” (2 cases). The average follow-up was 5 mo (range: 3–12 mo)..
Results: Nine cases (90%) were successful and one (10%) was a failure. Three patients who underwent bulbar urethroplasty showed prior failed repair using buccal mucosal grafts harvested from a single cheek (1 case), from both cheeks (1 case), or from the lip (1 case). The length of the lingual grafts was 4–6cm (mean: 4.5cm) with a width of 2.5cm. No patient developed early or late postoperative complications on the harvest site related to the tongue surgery. No difference was observed in patients in whom the graft harvesting was performed by the oral surgeon compared to the patients in whom the procedure was performed by the urologist..
Conclusions: The surgical technique for harvesting a graft from the tongue is simple and safe. The tongue may be the best alternative donor site to the lip when a thin graft is required for urethroplasty or when the cheek harvesting is not possible.

论文° 2
Lu-Jie Song; Yue-Min Xu; Massimo Lazzeri; Guido Barbagli
Lingual mucosal grafts for anterior urethroplasty: a review
BJU International, 2009: 104, 1052-1056

We critically reviewed recent reports of lingual mucosal grafts (LMGs) for substitution urethroplasty, to determine the efficacy and complications of this approach. Only a few centres have published the short or interim outcome of LMG urethroplasty. These studies dealt mainly with surgical techniques and harvesting LMGs, emphasizing the comparison of different intra-oral donor sites. The preliminary results seem to be encouraging for the safety and efficacy of LMG urethroplasty. When compared with other substitute materials, LMG give equally good results with much easier harvesting and minimal donor site morbidity. Thus, lingual mucosa is most likely to become an alternative to oral mucosa for substitution urethroplasty and longer term results of its use are awaited with interest.

论文 3
Barbagli G, Vallasciani S, Romano G, Fabbri F, Guazzoni G, Lazzeri M.
Morbidity of Oral Mucosa Graft Harvesting from a Single Cheek
Eur Urol, 2010: 58, 33 – 41

Background: The oral mucosa (OM) is a popular substitute for urethroplasty.
Objective: The aim of this study was to investigate oral morbidity and patient satisfaction in a homogeneous group of patients who underwent OM harvesting.
Design, Setting, and Participants: This study is a prospective analysis of 350 patients who underwent OM harvesting from a single cheek.
Intervention: The graft was harvested in an ovoid shape with closure of the wound. Standard graft size was 4cm in length and 2.5cm in width.
Measurements: Self-administered, nonvalidated semiquantitative (0, absence of complications or symptoms; 3, the worst complication or symptom) questionnaire consisting of six questions was used to investigate early complications, with 13 questions designed to investigate late complications and patient satisfaction.
Results and limitations: Early complications included bleeding, which occurred in 15 patients (4.3%); two patients required immediate surgical revision of the harvesting site. The majority of patients (85.2%) showed no pain, and only 3.7% of patients required use of anti-inflammatory drugs. The majority of patients (65.8%) showed slight or moderate swelling. With respect to late complications, most of the patients (73.4%) reported oral numbness for 1 wk, 22.9% for 1 mo, and 3.77% for 3 mo. Numbness resulting from scarring was absent or slight in most of patients. Changes in oral sensitivity occurred in 2.3% of patients. No difficulties opening the mouth or smiling was found in 98.3% and 99.7% of patients, respectively. Slight or moderate dry mouth was found in 97.1% of patients. In response to the question, “Would you undergo oral mucosa graft harvesting using this technique again,” 343 patients (98%) replied “yes,” and 7 patients (2%) replied “no.”
Conclusions: The harvesting of an OM ovoid graft from a cheek with closure of the wound is a safe procedure with a high patient satisfaction rate.

论文 4
Guido Barbagli , Salvatore Sansalone , Giuseppe Romano and Massimo Lazzeri
Ventral onlay oral mucosal graft bulbar urethroplasty
BJU Int 2011; 108: 1218-1231

The current surgical approach to the uncomplicated bulbar urethral stricture began in 1993 when El-Kasaby et al . described the repair of anterior urethral strictures using an oral mucosa graft, including eight patients who underwent bulbar urethroplasty. In 1996, Morey and McAninch first described ventral onlay oral mucosa urethroplasty, suggesting suturing of the oral graft in the ventral surface of the urethra. In 1996, Barbagli et al . described the dorsal free-graft urethroplasty, suggesting suturing the graft in the dorsal surface of the urethra, over the albuginea of the underlying corpora cavernosa. The location of the graft on the ventral or dorsal urethral surface has become a contentious issue, dating from the time these two techniques were described. Success with bulbar oral mucosal grafts has been high with dorsal or ventral graft location and the different graft positions have shown no differences in success rates. Recently, we developed a new muscle and nerve-sparing bulbar urethroplasty, avoiding fully opening the bulbo-spongiosum muscle, thus better preserving ejaculatory function. The selection of a surgical technique for bulbar urethra reconstruction, in addition to respecting the status of the genitalia tissue and components, must also be based on the proper anatomical characteristics of the bulbar urethra, to ensure graft take and survival. Further, sexual function can be placed at risk by any surgery on the genitalia, and dissection must avoid interference with the neurovascular supply to the penis and genitalia. Bulbar urethroplasty using grafts should not compromise penile length or cause penile chordee, and certainly should not untowardly affect penile and genitalia appearance.

论文 5
Guido Barbagli, Salvatore Sansalone, Massimo Lazzeri
Oral Mucosa and Urethroplasty: It’s Time to Change
EUROPEAN UROLOGY 6 2 ( 2 0 1 2 ) 1 0 7 1 – 1 0 7 5

In this issue of European Urology, Kero and colleagues reported on the Finnish Family HPV Study, a longitudinal cohort study looking at the prevalence and incidence of oral human papillomavirus (HPV) infection in healthy men followed for 7 yr [1]. The most relevant findings they reported were a high prevalence of male oral HPV, ranging from15% to 31%, and the confirmation that themost frequent genotype was HPV-16. In their conclusion, they advise the reader that oral mucosa is an important reservoir for the virus. These data raise the following questions, which we will address below: (1) What does oral mucosa HPV infection have to do with urology? (2) Why should European Urology readers be interested in it? (3) What was the European Urology editor thinking when he decided to cover this topic?.
1. 问题:: 问:手术费是否可以由国家保健系统(意大利)全额负担?
回答: 是的。


2. 问题:: 此项手术使用什么麻醉方式?
回答: 经鼻插管的全身麻醉。


3. 问题:: 手术时间多长?
回答: 颊粘膜取移植物手术大约半小时。


4. 问题:: 手术后是否有咀嚼功能障碍、流涎问题或者容貌改变的风险?
回答: 没有。


5. 问题: 手术后住院时间是多长?
回答: 口腔黏膜尿道成形术一般5到7天


6. 问题:从口腔取移植物术后是否很痛?
回答: 不痛。仅仅3.7%的患者需要解热镇痛药物来消除口腔的疼痛感。


7. 问题: 术后多长时间才能恢复正常饮食?
回答: 患者一般首先进食纯流食和冰激凌,然后慢慢过度到软食和正常饮食。


8. 问题: 术后饮食需要注意些什么?
回答: 避免过热的食物。


9. 问题: 术后是否马上可以进行正常饮食?
回答: 所有患者都可以在术后一个月之内恢复到正常饮食。


10. 问题: 是否存在口干、张口困难、饭后肿胀或是不能微笑等风险?
回答: 没有。

“口腔黏膜获取术”问卷调查表

350位患者的调查结果
Barbagli G. et al, Eur Urol, 2010: 58,33 – 41


术后早期并发症

 
1. 是否有口腔黏膜取移植物手术后3天内出血情况?

是 4.3%
未出现 95.7%

2. 对于口腔黏膜取移植物手术后的口腔疼痛如何评价?

不痛 49.2%
轻度疼痛 36%
中度疼痛 13.7%
非常痛 1.1%

3. 口腔黏膜取移植物手术后3天口腔肿胀情况是怎样的?

无肿胀 33.7%
轻度肿胀 41.2%
中度肿胀 24.6%
重度肿胀 0.5%

4. 术后多长时间开始正常饮食?

3天后 58.6%
6天后 31.4%
10天后 10%

5. 在术后早期最困扰您的是什么?

口腔内的伤口 27.7%
会阴部的伤口 52.6%
两者都有 1.4%
都没有 18.3%

6. 您是否在口腔黏膜取移植物手术后3天内服用止痛药?

是 3.7%
不是 96.3%

术后晚期并发症

 
1. 术后多长时间口腔内的麻木感消失?

一周 73.4%
一个月 22.9%
3个月 2.7%

2. 由于口腔内的缝合所致的口腔麻木您如何分级?

无麻木感 48%
轻度麻木 40.3%
中度麻木 10.9%
重度麻木 0.8%

3. 由于口腔内的缝合所致的口腔麻木术后多长时间消失?

1个月 93.9%
2个月 4.4%
3个月 1.7%

4. 由于口腔内的疤痕所致的口腔麻木如何分级?

无麻木感 82.8%
轻度麻木 14.6%
中度麻木 2.6%
重度麻木 0%

5. 术后是否出现口腔感染情况?

有 1.7%
没有 98.3%

6. 术后数月,您是否还有如下情况?

口腔内的感觉异常 2.3%
口腔麻木 10.3%
口腔疼痛 0%
没有不适感 87.4%

7. 术后数月,您是否存在张口困难?

不是 98.3%
轻度 1.4%
中度 0.3%
重度 0%

8. 术后数月,您是否存在不能微笑?

不存在 99.7%
轻度 0.3%
中度 0%
重度 0%

9. 术后数月,您是否存在口干?

不存在 97.1%
轻度 2.6%
中度 0.3%
重度 0%

10. 术后数月,您是否存在进食后口腔肿胀?

不存在 98.3%
轻度 1.7%
中度 0%
重度 0%

11. 术后您最终是否恢复了正常饮食?

是 100%
否 0%

12. 术后恢复饮食一般需要经过多长时间?

最多一个月 94%
2个月 4.3%
3个月 1.7%

13. 您是否愿意再次接受此项手术?

是 98%
不愿意 2%

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Harvesting oral mucosal graft from the cheek:
Surgical technique: step by step



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Harvesting oral mucosal graft from the tongue:
Surgical technique: step by step