带蒂腹直肌瓣包绕缩窄回肠输出道增强控尿机制的实验研究  

Reinforcing the continent mechanism of continent cutaneous diversions by wrapped rectus abdominis muscle flap：an experimental study

作　　者：张心如[1] 徐月敏[1] 俞建军[1] 费肖芳[1] 

机构地区：[1]上海交通大学附属第六人民医院泌尿外科,200233

出　　处：《中华泌尿外科杂志》2009年第4期254-257,共4页Chinese Journal of Urology

摘　　要：目的改良可控输出道术式，增强可控输出道的长期控尿能力。方法1～2岁杂种犬10只，雄性2只，雌性8只。分别截取30～40cm末端回肠U形折叠制成储尿囊，另取2段6cm回肠段缩窄为可通过12F导管的输出通道。切取6cm×3cm腹直肌，保留神经血管束，自1条缩窄回肠输出道的肠系膜血管间穿过，包绕于输出道外作为控制管；另1条输出道直接连接腹壁皮肤作为对照管。术后1、3、6个月分别测定储尿囊空虚和充盈时输出道压力（MIP）及功能性压力段长度（FPL）。分析储尿囊充盈前后控制管与对照管MIP与FPL的差异。结果1条犬术后6个月储尿囊充盈中液体经对照管溢出，无法完成实验。其余9条均行3次测压。储尿囊充盈前后，控制管MIP均〉70cmH2O（1cmH2O=0．098kPa）；对照管分别为〈30、〉40〈45cmH2O，均明显低于控制管。术后1、3、6个月，储尿囊充盈前后，控制管MIP平均值分别为（73．51±24．01）与（77．68±25．15）、（71．16±19．35）与（79．78±21．25）、（70．28±18．30）与（75．93±17．53）cmH2O，FPL平均值分别为（4．78±0．78）与（4．60±0．75）、（4．71±0．61）与（4．61±0．54）、（4．49±0．65）与（4．24±0．97）cm，充盈前后差异均无统计学意义（P〉0．05）；对照管MIP平均值分别为（29．04±7．02）与（42．90±7．66）、（28.10±8．09）与（41．63±8．98）、（26．63±6．89）与（43．36±9．79）cmH2O，FPL平均值分别为（5．04±0．44）与（4．59±0．53）、（4．98±0．82）与（4．42±0．85）、（4．63±0．69）与（3．97±0．53）cm，充盈前后差异均有统计学意义（P〈0．05）。术后6个月造影显示输出管与对照管形态无明显差异，无扭曲、狭窄或瘘道形成；组织学检查可见控制管回肠浆膜层外明显横纹肌组织结构。结论带蒂腹直肌肌瓣翻转包绕输出道可有效提高输出道的控尿能�Objective To develop a new continent cutaneous diversion using a tapered ileum wrapped by rectus abdominis muscular flap. Methods Ten dogs underwent a procedure in which two 6 cm ileal segments were tapered and connected to the U-shaped reservoir which was detubularized by a 30-40 cm ileal segment with end-to-side anastomosis. A continent tube was created by a 6 cm length and 3 cm width rectus ahdominis muscular flap with its blood supplied which was penetrated be tween the mesenteric vessels of one tapered ileum （study tube） and wrapped around its periphery. The other tapered ileum （control tube） was brought out into the abdominal skin directly without any extramural support. Urodynamic studies were carried out at 1, 3 and 6 months postoperatively. The data of maximum inner pressure （MIP） and functional pressure length （FPL） of every study and control tubes at every study phase were recorded and statistics analysis were taken. Retrograde radiograms of the efferent tubes were performed prior to sacrifice and histological examinations of study group were carried out after sacrificed. Results The average MIP in experimental group was significantly higher than that in control group at 1, 3 and 6 months post-operatively （P〈0. 01）. However, no significant differences in MIP or FPL were found in study group between empty and full reservoir. In the control group, MIP was found rising significantly （P〈0. 001） and FPL （P〈0. 05） decreased sharply compared with empty and full reservoir. Retrograde radiograms confirmed that all efferent tubes were patent and positioned straightly beneath the abdominal wail. Histological examination of study group at 6 months postoperatively demonstrated a layer of striated muscle around the serosa of the ileum. Conclusions The continent mechanism of tapered ileum could be enhanced by extramural support from wrapped rectus abdominis muscular flap. This technique could setup a reliable, easy catheterization continent cutaneous efferent tube.

关 键 词：尿流改道 可控输出道 腹直肌 动物实验 

分 类 号：R686[医药卫生—骨科学]