输尿管远端Caja1细胞及平滑肌肌纤维表达对Cohen术后反流影响的研究  

The analysis of interstitial cells of Cajal and smooth muscle fiber in the distal ureters affecting the postoperative reflux after cohen reimplantationin

作　　者：韩文文[1] 张潍平[1] 孙宁[1] 何乐建[1] 宋宏程[1] Han Wenwen Zhang Weiping Sun Ning He Lejian Song Hongcheng(Department of Urology, Beijing Children＇s Hospital Affiliated to Capital Medical University, Beijing Engineering Research Center of Pediatric Surgery, Beijing 100045, China)

机构地区：[1]首都医科大学附属北京儿童医院泌尿外科,北京市儿童外科矫形器具工程技术研究中心(BG0109),100045

出　　处：《中华小儿外科杂志》2017年第5期365-369,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨原发性膀胱输尿管反流（VUR）及膀胱输尿管交界处梗阻（POM）远端Cajal间质细胞（ICC）、平滑肌肌纤维（SMF）变化，探讨ICC、SMF是否与Cohen再植术后反流有关。方法选择2008年1月至2013年12月首都医科大学附属北京儿童医院泌尿外科收治的VUR、POM患儿作为研究对象，排除继发反流及梗阻患儿。对照组选取肾母细胞瘤术后的远端输尿管（病理提示输尿管远端肿瘤细胞未浸润）。利用SPSS软件随机选取对照组20例，手术成功VUR组、POM组各30例，全部术后反流病例。对所选病例远端输尿管进行Masson染色及c-kit免疫组化染色，全部术后反流病例分为VUR术后反流组及POM术后反流组，分析VUR术后反流组与手术成功组平滑肌肌纤维SMF、ICC有无差异，分析POM术后反流组与手术成功组有无差异。统计学分析对照组、手术成功的VUR组、POM组SMF、ICC有无差异。结果共随访到218例原发VUR及POM，排除1例术后出现对侧反流，1例术侧产生梗阻并发症。共纳入研究216例，其中VUR共74例，POM共142例。术后反流19例（10例VUR术后，9例POM术后）。输尿管膀胱黏膜下隧道长度与直径比2.5～7。随访时间6～53个月。VUR、POM术后反流组分别与对应手术成功组SMF、ICC差异无统计学意义（P〉0.05）。ICC、SMF在远端输尿管的分布：对照组〉POM组〉VUR组，差异有统计学意义（P〈0.05）。结论ICC、SMF在VUR、POM中明显减少，在保证足够的输尿管膀胱黏膜下隧道长度情况下ICC可能与再植术后反流无关，ICC减少可能为VUR、POM发病原因，可作为进一步研究基础。ObjectiveTo find out the alteration of the interstitial cells of Cajal （ICC） and smooth muscle fiber （SMF） in distal ureters of primary vesicoureteral reflux （VUR） and obstructive megaureter （POM）, and whether ICC and SMF can influences on the postoperative reflux of Cohen.MethodsThe retrospective study was based on information retrieved from Beijing Children＇s Hospital from January 2001 to December 2013. All the patients were primary VUR and POM that underwent a primary operation of cross-trigonal intravesical reimplantation described by Cohen. Secondary vesicoureteral reflux and ureterovesical junction were excluded. The distal ureters of resected Wilms＇ tumor were assigned to control group （not invaded by tumor）. We chose 20 cases of Wilms＇ tumor for control group, 30 cases each for VUR and POM groups from successful operation dates, the differences of SMF and ICC were analyzed in control, VUR and POM groups by Masson and c-kit immunohistochemical staining. All the failed operation patients were divided into VUR and POM groups. Statistical tests were used to detect the differences of SMF and ICC between successful and failed operation in VUR and POM groups. ResultsThe data of 218 VUR and POM patients were available and recorded. We excluded one each in complications of contralateral reflux and vesicoureteral obstruction. Finally there were 216 cases in the research, with 74 cases in VUR and 142 cases in POM. Complications of reflux present in 19 patients （10 cases in VUR and 9 cases in POM）. Ureteral length-to-diameter ratio of the submucosal tunnel was 2.5~7.0. Follow-up time was 6~53 months. The distribution ICC and SMF in the distal ureter were significant difference： the control group〉POM group〉VUR group. ICC did not affect the prognosis of Cohen reimplantation （P〉0.05）.ConclusionsICC and SMF proportion decreas in the VUR and POM in distal ureters. There are no factors that postively affected the postoperative reflux of Cohen.The ICC might not affect the postopera

关 键 词：膀胱输尿管反流 原发性膀胱输尿管交界处梗阻 平滑肌细胞 

分 类 号：R726.9[医药卫生—儿科]