背景:近年来,组织工程学的发展为尿道损伤修复提供了更多的选择.目的:探讨骨髓间充质干细胞联合脱细胞真皮基质修复尿道损伤的效果.方法:取第3代新西兰大白兔骨髓间充质干细胞,接种于脱细胞真皮基质材料表面,构建组织工程尿道.将36只新西兰大白兔随机分3组,每组12只.实验组于尿道损伤处植入骨髓间充质干细胞-脱细胞真皮基质复合物,对照组于尿道损伤处植入单纯脱细胞真皮基质材料,正常组既无损伤也不做任何处理.术后4,8,12周,尿道修复组织进行苏木精-伊红染色,术后12周,进行免疫组织化学染色和尿动力学检查.结果与结论:①术后4周,实验组尿道缺损区可见有少许薄层上皮再生,连续性较好;对照组修复段尿道新生黏膜尚不连续.术后8-12周,实验组修复段尿道上皮层逐渐变厚,与正常尿道上皮连续性良好,黏膜逐渐增厚,尿道黏膜光滑连续;对照组修复段尿道新生黏膜连续性较好,再生上皮层次较少;②术后12周,免疫组化可见实验组修复尿道标本uroplakin Ⅲa,CK AE1/AE3,α-SMA表达阳性;③实验组手术前后的最大尿道压比较差异无显著性意义;对照组术后最大尿道压高于术前,差异有显著性意义(P <0.05);④结果表明,骨髓间充质干细胞联合脱细胞真皮基质修复尿道损伤的效果优于单纯脱细胞真皮基质材料.%BACKGROUND: In recent years, the development of tissue engineering provides more choices for the repair of urethral injury.OBJECTIVE: To investigate the effect of bone marrow mesenchymal stem cells (BMSCs) combined with acellular dermal matrix in the repair of urethral injuries. METHODS: Passage 3 BMSCs from New Zealand white rabbits were inoculated on the acellular dermal matrix to construct tissue-engineered urethra grafts. Thirty-six New Zealand rabbits were randomized into three groups (n=12 per group). Experimental group was implanted with BMSCs-acellular dermal matrix complex at urethral injury. Control group was implanted with acellular dermal matrix material at urethral injury. Normal group had neither injury nor treatment. At postoperative 4, 8 and 12 weeks, the repaired urethral tissue was subjected to hematoxylin-eosin staining. At postoperative 12 weeks, immunohistochemical staining and urodynamic study were performed. RESULTS AND CONCLUSION: At postoperative 4 weeks, thin-layer epithelial regeneration was visible in the urethra defect area of the experimental group, and the continuity was better. The urethra mucosa of the control group was discontinuous. At postoperative 8-12 weeks, the urethral epithelial layer in the experimental group became thickened, exhibiting a good continuity with the normal urethral epithelium, thickened mucosa, and smooth and continuous urethral mucosa; the regenerated urethral mucosa of the control group exhibited good continuity, but less regenerated epithelial layers. At postoperative 12 weeks, immunohistochemical results showed the repaired urethra in the experimental group was positive for uroplakin IIIa, CK AE1/AE3, and α-smooth muscle actin. The maximum urethral pressure in the experimental group showed no significant difference before and after operation, while the postoperative pressure in the control group showed a significant increase (P < 0.05). Overall findings indicate that the combination of BMSCs and acellular dermal matrix has better efficacy than the acellular dermal matrix alone.
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