带血管肋间神经转位与骶2神经根吻合和腓肠神经桥接阴部神经行截瘫犬膀胱功能重建  

Functional Reconstruction of Bladder Functions in Paraplegic Dogs by Vascularized Intercostal Nerves Transfering to $2 Nerve Roots or to Pundental Nerves Serving as a Bridge to Connect Sural Nerve

作　　者：曹述铁[1] 申小青[2] 韩伟[1] 胡祥上[1] 柳洁[1] 贺显玉[1] 易传安[1] 张绪华[2] 尹立[1] 

机构地区：[1]怀化医专基础医学部,湖南怀化418000 [2]怀化医专附属医院

出　　处：《怀化医专学报》2007年第2期5-8,共4页

基　　金：湖南省教育厅科学技术研究项目（编号03C040）.

摘　　要：目的评价带血管肋间神经转位与骶2神经根吻合和自体腓肠神经桥接阴部神经对截瘫犬膀胱功能重建的作用。方法8只犬随机分为三组：实验1组（A1）3只、实验2组（A2）3只、对照组（B）2只。所有实验对象均经L平面造成截瘫，其中A1组行带血管肋间神经转位与骶2神经根吻合，A2组行带血管肋间神经转位和腓肠神经桥接阴部神经。观测所有犬在术前、术后以及处死前的排尿情况并测定膀胱容积压力、残余尿量和肛门括约肌肌电图的情况。结果8只犬术前排尿量120-150ml／次，残余尿量10～15ml，膀胱容积压力平均71cmH2O／150ml。实验A1组和A2组术后3个月，部分出现不同程度的逼尿肌反射。A1组术后6个月排尿量80～90mL／次，残余尿量45～55ml，膀胱容积压力平均55cmH2O／280ml，术后12个月排尿量90～110ml／次，残余尿量15-30ml，膀胱容积压力平均65ecmH2O／280ml；A，组术后6个月排尿量80～100ml／次，残余尿量55～65ml，膀胱容积压力平均50cmH2O／300ml，术后12个月排尿量100～110mL／次，残余尿量20～40ml，膀胱容积压力平均62emil，0／250ml；对照组无主动排尿，膀胱容积压力平均18～20cmH2O／400ml。术前3组所有犬肛门括约肌肌电图平均为145μV±5μV，术后3个月A1、A2组平均为30μV±7μV，术后6个月A1、A2组平均为50μV±5μV，术后12个月A1、A2组平均为100μV±6μV；对照组为静息电位。结论带血管肋间神经转位与骶2神经根吻合和腓肠神经桥接阴部神经对脊髓损伤重建截瘫犬膀胱的储尿和排尿功能是可行的。Objective To evaluate the effect of vascularized intercostal nerves transferring to 52 nerve roots or to pundendal nerves serving as a bridge to connect sural nerve on functional reconstruction of bladder functions in paraplegic dogs.Methods 8 dogs were chosen and divided into 3 groups randomly （Group A1 , Group A2 and Control group） . All the dogs were transected at L1 spinal cord. 3 dogs in Group A1 were operated with the method of vascularized intercostal nerves transferring to S2 nerve roots~ And the other 3 dogs in Group A2 were operated with the method of vascularized intercostal nerves transferring to pudendal nerves serving as a bridge to connect sural nerve. All the dogs＇ mlcturition and electromyogram of sphincter anus were observed, and their bladder volume and pressure, residual urine volume were measured both before and after operation. Results The micturition of 8 dogs before operation were 120 - 150 ml per time, residual urine volume were 10 - 15 ml and mean volume pressure were 71 cmH2O/150 ml. 3 moths after the operation, all the dogs in Group A1 and A2 took reflextion of etrusor muscle. After 6 months, urine volume in Group A1 and A2 were 80 - 90 ml per time vs 80 - 100 ml per time, and residualurine volume were 45 - 55 ml vs 55 - 65 ml, bladder vol- ume pressure were 55 cmH2O/280 ml vs 50 cmH20/300 ml; After 12 months, urine volume in Group A1 and A2 was 90 - 110 ml per time vs 100 - 110 ml per time, and residual urine volume was 15 - 30 ml vs 20 -40 ml, bladder volume pressure was 65 cmH2O/250 ml vs 62 cmH2O/250 ml. There was no active micturition in control group, bladder volume pressure was 62 cmH2O/250 ml. Conclusion The methods of vascularized intercostal nerves transferring to S2 nerve roots and vascularized intercostal nerves transferring to pudendal nerves serving as a bridge to connect sural nerve can reconstruct bladder functions in paraplegic dogs.

关 键 词：膀胱 脊髓损伤 截瘫 功能重建 

分 类 号：R322.8[医药卫生—人体解剖和组织胚胎学]