犬回肠裁剪去粘膜替代输尿管的实验研究  

The study of the ileum tailoring and intestinal mucosal stripping to substitute the ureter of dog

作　　者：付荣波 沈雷 吴宇波 谢辉辉 赵泽驹 Fu Rongbo;Shen Lei;Wu Yubo;Xie Huihui;Zhao Zeju(Department of Urology Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou 563099,China;Department of Surgical Lab,Zunyi Medical University,Zunyi Guizhou 563099,China)

机构地区：[1]遵义医科大学附属医院泌尿外科,贵州遵义563099 [2]遵义医科大学外科手术学实验室,贵州遵义563099

出　　处：《遵义医科大学学报》2020年第3期321-325,共5页Journal of Zunyi Medical University

基　　金：遵义市科技支撑计划项目(NO:遵市科合HZ字[2019]76)。

摘　　要：目的探讨回肠裁剪去粘膜替代全段输尿管的可行性。方法选择1~2岁比格犬10只,雌雄各半,麻醉后切除左肾、输尿管和右侧输尿管,取远段带蒂回肠约15 cm,纵向切除对系膜侧1/2肠片,系膜侧肠片剔除粘膜,内置F5双J管缝成管状,近端与右侧肾盂、远端与膀胱吻合;原回肠端端吻合。术后4周拔除双J管,术后8、12周采血检测肾功能、电解质后行静脉肾盂造影(IVU),并分批处死后取替代输尿管作HE染色检查。结果犬IVU示肾脏、输尿管和膀胱显影较好,未见造影剂外溢,手术前后电解质与肾功能比较差异无统计学意义(Р>0.05);解剖观察替代输尿管外形完整、管腔光滑、无狭窄;镜下见管壁腔面无粘膜结构,肌层及浆膜完整。术后8、12周重建输尿管行HE染色,镜下观察见粘膜下层及肌层均无纤维、增生表现,少许炎性细胞浸润;未见粘膜层结构。结论裁剪去粘膜回肠替代输尿管具有可行性,有较大潜在研究价值。Objective To investigate the possibility of full-length ureter defect reconstruction using a segment of half clipping and mucosa stripping pedicled ileum.Methods Ten beagle dogs(age 1~2 yr;five males and five females)were used to model a full-length ureter defect.A segment of pedicled ileum was selected,and half of the intestinal segment was resected longitudinally,with the mesenteric side preserved.The mucosa of it was stripped.Then,sutured the ileum to shape a tube to connect the renal pelvis and bladder,and a 5 F ureter stent was inserted into it which will be removed four weeks after surgery.Intravenous urography(IVU)was used to observe the reconstructed ureters at eight and twelve weeks after the operation.Blood samples were collected before the operation procedure and during each radiological examination to detect electrolyte and renal function.Then five dogs were randomly euthanized at eight and twelve weeks after the each IVU.After the macroscopic observation,HE staining was utilized to observe the reconstructed ureter’s microscopic changes.Results All the dogs were in good condition after surgery.The blood electrolyte and renal function of each period were statistically insignificant(P>0.05).IVU demonstrated no ureteral obstruction and extravasation of contrast agent.The macroscopic observation indicated that the lumen of the reconstructed ureter was intact and no stricture formation.HE staining showed that no mucosal structure was seen on the luminal surface.The ureter was reconstructed 8 and 12 weeks after operation,Under HE microscope,no fiber and hyperplasia were observed in the submucosa and muscularis,with a little inflammatory cell infiltration.No mucosal layer structure is seen.Conclusion The ileum tailoring and intestinal mucosal stripping in substitution of ureter is feasible and has great potential research value.

关 键 词：回肠替代输尿管 尿路重建 输尿管替代 输尿管损伤 

分 类 号：R693.5[医药卫生—泌尿科学]