神经吻合促进大鼠膀胱功能恢复的研究  

Nerve coaptation on bladder function recovery in rats with end-to-side neurorrhaphy

作　　者：王利辉[1] 李云龙[1] 张一帆[1] 乔保平[1] 文建国[1] Wang Lihui;Li Yunlong;Zhang Yifan;Qiao Baoping;Wen Jianguo(Department of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]郑州大学第一附属医院泌尿外科,450052

出　　处：《中华实验外科杂志》2019年第2期286-288,共3页Chinese Journal of Experimental Surgery

摘　　要：目的 探讨神经端侧吻合对神经源性膀胱大鼠膀胱功能恢复的作用。方法 40只健康成年雄性SD大鼠,体重240~280 g,按随机数字表法分为神经端侧吻合组(ETS,n=15),未吻合组(NC,n=15)和空白对照组(BC,n=10)。ETS组大鼠先离断左侧腰6(L6)和骶1(S1)脊神经前后根,然后将左侧L6前根端侧吻合到左侧L4前根;NC组大鼠只离断左侧L6和S1脊神经前后根,不进行神经吻合;BC组大鼠不做任何处理,作为空白对照组。术后4个月,3组大鼠行尿动力学测定和神经根电刺激膀胱压力测定,比较不同组大鼠的膀胱功能。结果 电刺激ETS和BC组大鼠神经根膀胱压力升高分别为(18.3±2.1) mmHg(1 mmHg=0.133 kPa)和(34.9±3.1) mmHg,差异有统计学意义(t=15.317,P<0.01)。ETS组大鼠的充盈期最大膀胱测压容积[(2.09±0.26) ml]、残余尿量[(1.12±0.21) ml]和膀胱顺应性[(0.249±0.101) ml/mmHg]较NC组大鼠[充盈期最大膀胱测压容积(3.13±0.44) ml、残余尿量(2.69±0.33) ml和膀胱顺应性(0.348±0.127) ml/mmHg]小(t=7.184,P<0.01;t=14.130,P<0.01;t=2.128,P<0.05),但较BC组大鼠[充盈期最大膀胱测压容积(0.33±0.07) ml、残余尿量(0.06±0.02) ml和膀胱顺应性(0.022±0.012) ml/mmHg]大(t=20.733,P<0.01;t=15.821,P<0.01;t=7.031,P<0.01)。ETS和BC组大鼠排尿期最大逼尿肌压[(28.2±2.9) mmHg和(30.3±2.8) mmHg]大于NC组大鼠[(18.8±1.7) mmHg](t=9.446,P<0.01;t=11.504,P<0.01),ETS和BC组大鼠排尿期最大逼尿肌压差异无统计学意义(t=1.747,P>0.05)。结论 神经端侧吻合可以部分恢复大鼠膀胱的神经支配以及受损的膀胱功能。Objective To investigate the effect of end-to-side nerve coaptation on bladder function recovery in rats with neurogenic bladder.Methods Forty male Sprague-Dawley (SD) rats [mean weight (240-280) g] were randomly divided into end-to-side nerve coaptation group (ETS group, n=15), no coaptation group (NC group, n=15) and blank control group (BC group, n=10). In the ETS group, the left ventral root (VR) and dorsal root (DR) of L6 and S1 were transected, and the distal stump of L6VR was sutured to the lateral face of L4VR. In the NC group, the left VR and DR of L6 and S1 were transected, but coaptation was not performed. In the BC group, no operation was performed. Four months later, bladder function was evaluated by cystometry and electrical stimulation.Results When the spinal nerves were stimulated, the increased maximum intravesical pressure was (34.9±3.1) mmHg (1 mmHg=0.133 kPa) in BC group and (18.3±2.1) mmHg in ETS group. The difference was statistically significant (t=15.317, P<0.01). Maximum cystometric capacity, postvoid residual volume, and bladder compliance were less in the ETS group [(2.09±0.26) ml, (1.12±0.21) ml and (0.249±0.101) ml/mmHg] than in the NC group [(3.13±0.44) ml, (2.69±0.33) ml and (0.348±0.127) ml/mmHg (t=7.184, P<0.01;t=14.130, P<0.01;t=2.128, P<0.05)], but higher than in the BC group [(0.33±0.07) ml, (0.06±0.02) ml and (0.022±0.012) ml/mmHg (t=20.733, P<0.01;t=15.821, P<0.01;t=7.031, P<0.01). There was no significant difference in maximum detrusor voiding pressure between the ETS and BC groups [(28.2±2.9) mmHg vs. (30.3±2.8) mmHg;t=1.747, P>0.05], and that in the ETS and BC groups was greater than in the NC group [(18.8±1.7) mmHg;t=9.446, P<0.01;t=11.504, P<0.01].Conclusion The bladder can be reinnervated and the bladder function can be partially improved by end-to-side nerve coaptation in rats.

关 键 词：神经源性膀胱 神经端侧吻合 尿动力学 大鼠 

分 类 号：R694.5[医药卫生—泌尿科学]