不同重建方法治疗犬输尿管黏膜剥脱的实验观察  

Effects of different reconstruction methods in treatment of avulsion of ureterai mucosa: experiment with dogs

作　　者：夏术阶[1] 吕伯东[2] 荆翌峰[1] 孙宏斌[1] 唐孝达[1] 

机构地区：[1]上海交通大学附属第一人民医院泌尿外科,200080 [2]浙江中医药大学附属第二医院泌尿外科

出　　处：《中华医学杂志》2006年第32期2271-2274,共4页National Medical Journal of China

基　　金：上海市卫生局科技发展基金项目(024013)

摘　　要：目的观察不同重建方法对输尿管黏膜剥脱的疗效,探索治疗输尿管黏膜剥脱的新方法。方法选择成年杂种犬20条,随机分为4组,制作输尿管黏膜剥脱模型后。黏膜缺损处分别予膀胱黏膜或腹膜植入、输尿管黏膜原位回置处理,对照组仅留置支架管。术后10周行静脉肾盂造影(IVP)和病理检查。结果对照组均产生输尿管腔闭锁或严重狭窄。输尿管黏膜原位回置组和腹膜替代组输尿管腔均无明显狭窄及扩张,重建段新生黏膜生长良好,接近正常输尿管结构。膀胱黏膜组死亡1条,2条重建段上段输尿管轻度扩张,2条输尿管腔无明显狭窄。结论输尿管黏膜原位回置或采用腹膜重建并留置支架管充分引流治疗输尿管黏膜剥脱疗效理想;膀胱黏膜可作为输尿管黏膜剥脱后重建可选择的修复材料。Objective To investigate the curative effects of different reconstruction methods in the treatment of avulsion of ureteral mucosa. Methods Twenty adult dogs were randomly divided into 4 equal groups： Group Ⅰ Ⅱ （ control group in which the ureter was incised and a ureteral stent was placed therein）, Group Ⅱ （the ureter was incised and a ureteral mucosal avulsion about 5 cm in length was created and the avulsed mucosa was replaced to the original position and a ureteral stent was placed in addition） , Group m （ a piece of bladder mucosa was incised and grafted to the avulsed ureter mucosa and a ureteral stent was placed in addition） , and Group Ⅳ （a tabularized peritoneal free graft and a ureteral stent were placed in the avulsed ureter）. Ten weeks later intravenous pyelography （IVP） was conducted to observe the images of ureter. Then the dogs were killed and pathological examination of the reconstructed ureter was conducted. Results IVP showed atresia and stenosis in all control group dogs. No obvious stenosis was observed in Groups Ⅱ and IV Pathological examination showed that the newly grown mucosa was similar to the normal ureter structure in Groups Ⅱ and Ⅳ. In Group Ⅲ one dog died, slight distension of ureter superior to the reconstructed part was found in 2 dogs, and no obvious stenosis was observed in 3 dogs. Conclusion Orthotopic replacement and tabularized peritoneal free grafting with placement of ureter stent are effective in treatment of avulsion of ureter mucosa. Bladder mucosa can be used as selectable material.

关 键 词：输尿管 膀胱 腹膜 黏膜 重建 

分 类 号：R699[医药卫生—泌尿科学]