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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">urovest</journal-id><journal-title-group><journal-title xml:lang="ru">Вестник урологии</journal-title><trans-title-group xml:lang="en"><trans-title>Urology Herald</trans-title></trans-title-group></journal-title-group><issn pub-type="epub">2308-6424</issn><publisher><publisher-name>Rostov State Medical University</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.21886/2308-6424-2022-10-1-70-83</article-id><article-id custom-type="elpub" pub-id-type="custom">urovest-525</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL ARTICLES</subject></subj-group></article-categories><title-group><article-title>Новый подход к применению слизистой полости рта в реконструктивной хирургии уретры: микрографты</article-title><trans-title-group xml:lang="en"><trans-title>A new approach to use of oral mucosa in reconstructive urethral surgery: micrografts</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5568-3342</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шибаев</surname><given-names>А. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Shibaev</surname><given-names>A. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Андрей Николаевич Шибаев — кандидат медицинских наук; ведущий научный сотрудник урологического отделения</p><p>г. Москва</p></bio><bio xml:lang="en"><p>Andrew N. Shibaev — M.D., Cand.Sc.(Med); Leading Researcher, Urology Division</p><p>Moscow</p></bio><email xlink:type="simple">anshibaev@rambler.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3042-8708</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Павлова</surname><given-names>Ю. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Pavlova</surname><given-names>Yu. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Юлия Викторовна Павлова — кандидат медицинских наук; научный сотрудник урологического отделения</p><p>г. Москва</p></bio><bio xml:lang="en"><p>Yulia V. Pavlova — M.D., Cand.Sc.(Med); Researcher, Urology Division</p><p>Moscow</p></bio><email xlink:type="simple">9250659260@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5421-8900</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Базаев</surname><given-names>В. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Bazaev</surname><given-names>V. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Владимир Викторович Базаев — доктор медицинских наук, профессор; ведущий научный сотрудник урологического отделения</p><p>г. Москва</p></bio><bio xml:lang="en"><p>Vladimir V. Bazaev — M.D., Dr.Sc.(Med); Full Prof.; Leading Researcher, Urology Division</p><p>Moscow</p></bio><email xlink:type="simple">vvbazaev@rambler.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9739-6248</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Подойницын</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Podoinitsyn</surname><given-names>A. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Алексей Алексеевич Подойницын — доктор медицинских наук; руководитель урологического отделения</p><p>г. Москва</p></bio><bio xml:lang="en"><p>Alexey A. Podoinitsin — M.D., Dr.Sc.(Med); Head, Urology Division</p><p>Moscow</p></bio><email xlink:type="simple">a4955145801@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4270-3305</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Султанов</surname><given-names>Д. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Sultanov</surname><given-names>D. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Дмитрий Ибрагимович Султанов — ординатор кафедры урологии</p><p>г. Москва</p></bio><bio xml:lang="en"><p>Dmitry I. Sultanov — Resident, Urology Division</p><p>Moscow</p></bio><email xlink:type="simple">dimastj1@rambler.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4883-4026</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шинкарев</surname><given-names>А. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Shinkarev</surname><given-names>A. D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Артём Дмитриевич Шинкарёв — курсант</p><p>г. Санкт-Петербург</p></bio><bio xml:lang="en"><p>Artem D. Shinkarev — Cadet</p><p>St. Petersburg</p></bio><email xlink:type="simple">metrash98@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0534-0472</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сулейманов</surname><given-names>Р. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Suleimanov</surname><given-names>R. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Руслан Сулейманович Сулейманов — врач-уролог хирургического отделения университетской клиники</p><p>г. Тверь</p></bio><bio xml:lang="en"><p>Ruslan S. Suleymanov — M.D.; Urologist, Surgery Division</p><p>Tver</p></bio><email xlink:type="simple">rusuromed@gmail.com</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Vladimirskiy Moscow Regional Research Clinical Institute</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» МО РФ</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Kirov Military Medical Academy</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ФГБОУ ВО «Тверской государственный медицинский университет» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Tver State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2022</year></pub-date><pub-date pub-type="epub"><day>30</day><month>03</month><year>2022</year></pub-date><volume>10</volume><issue>1</issue><fpage>70</fpage><lpage>83</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Шибаев А.Н., Павлова Ю.В., Базаев В.В., Подойницын А.А., Султанов Д.И., Шинкарев А.Д., Сулейманов Р.С., 2022</copyright-statement><copyright-year>2022</copyright-year><copyright-holder xml:lang="ru">Шибаев А.Н., Павлова Ю.В., Базаев В.В., Подойницын А.А., Султанов Д.И., Шинкарев А.Д., Сулейманов Р.С.</copyright-holder><copyright-holder xml:lang="en">Shibaev A.N., Pavlova Y.V., Bazaev V.V., Podoinitsyn A.A., Sultanov D.I., Shinkarev A.D., Suleimanov R.S.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.urovest.ru/jour/article/view/525">https://www.urovest.ru/jour/article/view/525</self-uri><abstract><p>Введение. Лечение пациентов со «сложными стриктурами» уретры является актуальной проблемой реконструктивной урологии. После неоднократных операций возможности повторного использования собственных тканей ограничены. Ведётся поиск новых источников пластического материала (различные ауто-, алло- и ксенотрансплантаты) для реконструктивных операций на уретре.Цель исследования. Изучить возможность применения микрографтов слизистой полости рта для формирования уретральной площадки при многоэтапном лечении больных с протяжёнными стриктурами уретры.Материалы и методы. В экспериментальной части исследования оценивали возможность приживления микрографтов слизистой полости рта и формирования эпителиальной площадки при гетеротопической трансплантации в условиях экспериментальной модели. Cамцам крыс Wistar (22 особи) массой 300 – 400 г после в/м седации выполняли кожную рану. Для ограничения контракции раны использовали раневую камеру диаметром 12 мм. Производили забор трансплантата слизистой полости рта диаметром 6 мм. После префабрикации трансплантат измельчали до фрагментов &lt; 1 мм2. Полученные микрографты с компонентами фибрин-тромбинового клея наносили на рану. На 45-е сутки сформировавшуюся площадку иссекали для гистологического исследования. В клинической части исследования 4 пациентам с рецидивными стриктурами пенильного отдела уретры выполнены реконструктивные операции с формированием уретральной площадки с использованием микрографтов слизистой полости рта. Средняя протяжённость стриктур составляла 7,5 ± 1,2 см с участками выраженного сужения и облитерации просвета. На первом этапе лечения формировали уретральную площадку. Подготовку ложа уретральной площадки и забор трансплантата слизистой полости рта осуществляли по стандартной методике. Подготовку микрографтов слизистой полости рта и их имплантацию проводили на основе методики, разработанной в экспериментальной части исследования. Через 6 месяцев выполняли тубуляризацию неоуретры. Результаты лечения оценивали каждые 3 месяца (урофлоуметрия, ультразвуковое исследование, рентгенография, PROM-USS) после завершающего этапа оперативного лечения. Медиана наблюдения составила 9 месяцев (3 – 18 месяцев).Результаты. К 15-м суткам у 16 из 22 (72,7%) крыс наблюдались очаговые разрастания многослойного неороговевающего эпителия. К 45-м суткам наблюдалось полное заживление раны в основном за счёт эпителия полости рта. Площадь полученной площадки составила 78 ± 12 мм2. В клинической части исследования к 6-му месяцу после первого этапа лечения у всех больных (n = 4) сформировалась уретральная площадка, покрытая многослойным плоским неороговевающим эпителием полости рта без выраженных рубцовых деформаций, достаточная для формирования неоуретры. Всем пациентам выполнена тубуляризация уретры. После удаления катетера у всех мужчин восстановилось самостоятельное мочеиспускание. Через 9 месяцев (медиана наблюдения, n = 3) максимальная скорость мочеиспускания составила 22,7 ± 4,2 мл/с, объём остаточной мочи — 34,8 ± 2,2 мл, суммарный балл PROM-USS — 7,4 ± 1,2, сохраняется достаточный просвет уретры. Все пациенты отметили высокую удовлетворённость результатами лечения.Заключение. Микрографты слизистой полости рта хорошо приживаются при гетеротопической трансплантации (72,7%) с формированием эпителиального пласта на поверхности раны по площади, превышающего исходную площадь всех микрографтов в 3 раза. Первый клинический опыт использования микрографтов слизистой полости рта показывает возможность применения данной технологии в реконструктивной хирургии уретры, особенно при «сложных» стриктурах уретры при дефиците пластического материала.</p></abstract><trans-abstract xml:lang="en"><p>Introduction. Treatment of patients with complex urethral strictures is an actual problem of reconstructive urology. After multi-staged urethral surgery with multiple revisions the new reconstruction is limited by paucity of plastic material (for grafts and flaps). In-thing, new materials for urethral reconstruction (various auto, allo and xenografts) are still being developed in reconstructive urethral surgery.Purpose of the study. To study the possibility of using oral mucosa micrografts to form the urethral plate in the multi-stage surgery for patients with extended urethral strictures.Materials and methods. In the experimental study, male Wistar rats (22 individuals) weighing 300 – 400 g underwent a full-thickness skin wound after intramuscular sedation. We used the wound chamber (12 mm diameter) to exclude the wound contraction. The oral mucosa graft was harvested (6 mm in diameter). After pre-fabrication, the graft was minced to fragments &lt; 1 mm2. Micrografts with fibrin-thrombin glue were applied to the wound. By day 45, the epithelial plate was excised for histological examination. In the clinical study, 4 patients with recurrent penile urethral strictures were treated with staged urethroplasty with urethral plate formation using oral mucosa micrografts. The average length of the stricture was 7.5 ± 1.2 cm (with extremely narrow and obliteration sites). The urethral plate was formed as the first stage. The preparation of the graft bed and oral mucosa grafts harvesting was carried out according to the standard procedure. Micrografts preparation and implantation was carried out as in experimental part of this study. After 6 months, neourethra tubularization was performed. The patients were evaluated every 3 months after the final stage of urethroplasty (uroflowmetry, ultrasound, X-ray, PROM-USS). The median follow-up was 9 months (3 – 18 months).Results. On day 15, in the experimental study, in 16 of 22 (72.7%) rats, the wound chambers had focal growth of the oral mucosa epithelium. On day 45, the wounds healed completely healed with oral mucosa. The final area of the plate was 78 ± 12 mm2. In the clinical study, 6 months after the first stage, all patients (n = 4) had a urethral plate covered with an oral mucosa epithelium without scar formation and sufficient for neurethra tubularization. All patients underwent urethral tubularization. After catheter removal, all men urinated. After 9 months (median follow-up, n = 3), the Qmax was 22.7 ± 4.2 ml/s, the post-void residual urine was 34.8 ± 2.2 ml, the total PROM-USS score was 7.4 ± 1.2, urethral lumen is preserved. All patients showed high satisfaction with the treatment.Conclusion. The oral mucosa micrografts showed good take in heterotopic transplantation (72.7%) with the formation of an epithelial layer on the wound surface. The final mucosal plate area 3 times exceeded the initial micrografts area. This initial clinical experience of using oral mucosa micrografts shows the new possibility of this technology in reconstructive urethral surgery, especially in patients with complex urethral strictures.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>стриктура уретры</kwd><kwd>заместительная пластика уретры</kwd><kwd>слизистая оболочка полости рта</kwd><kwd>микрографты</kwd></kwd-group><kwd-group xml:lang="en"><kwd>urethral stricture</kwd><kwd>urethral replacement plastic surgery</kwd><kwd>oral mucosa</kwd><kwd>micrografts</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Коган М.И., Красулин В.В., Митусов В.В., Шангичев В.А., Аметов Р.Э., Наранов С.В. Эффективность хирургического лечения протяженных и субтотальных стриктур уретры у мужчин. 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