醋酸氯已定对原位回肠新膀胱术后早期黏液分泌功能的影响  

Effect of chlorhexidine acetate on mucus secretion in the early stage of ileal neobladder in situ

作　　者：彭康 宋震 李节 孙晓磊 王军起 陈仁富 PENG Kang;SONG Zhen;LI Jie;SUN Xiaolei;WANG Junqi;CHEN Renfu(Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China)

机构地区：[1]徐州医科大学附属医院泌尿外科,江苏徐州221002

出　　处：《中国肿瘤外科杂志》2020年第6期513-517,538,共6页Chinese Journal of Surgical Oncology

摘　　要：目的研究醋酸氯已定对原位回肠新膀胱术后早期黏液分泌功能的影响,为临床提供新的肠黏膜处理方法。方法选取徐州医科大学附属医院2017年7月至2018年12月收治的24例行原位回肠新膀胱手术患者,按照术中对新膀胱黏膜处理方式不同,分为碘伏组、无水乙醇组和醋酸氯已定组,每组8例。每组术中新膀胱肠段灌注黏膜处理剂5 min,取标本观察新膀胱黏膜组织学形态变化,测量术后第3~14天的新膀胱肠黏液质量,随访1年,记录并比较三组的并发症发生情况。结果24例手术顺利完成,无水乙醇组、醋酸氯已定组术后新膀胱早期肠黏液分泌量明显低于碘伏组,差异有统计学意义(P<0.05)。无水乙醇和醋酸氯已定两组间术后新膀胱早期肠黏液分泌量差异无统计学意义(P>0.05)。光镜下碘伏组新膀胱肠黏膜层完整,绒毛排列整齐、紧密,绒毛顶端间少许杯状细胞消失,肌层未见损伤;无水乙醇组新膀胱肠黏膜层结构不清,绒毛排列紊乱、低平,远端断裂、脱落,肌层结构紊乱,有不同程度损伤,伴有少量的红细胞和大量的炎性细胞浸润;醋酸氯已定组新膀胱肠黏膜结构完整,绒毛低平,远端断裂、脱落,肌层炎性细胞浸润,无明显损伤。结论醋酸氯已定作为一种新的肠黏膜处理剂在抑制原位回肠新膀胱术后黏液分泌上更优于无水乙醇和碘伏。Objective To study the effect of chlorhexidine acetate on mucus secretion in the early stage after orthotopic ileal neobladder surgery,and to provide a new method for clinical treatment of intestinal mucosa.Methods Twenty-four cases of new bladder surgery in situ were randomly divided into iodophor group,anhydrous ethanol group and chlorhexidine acetate group according to the different treatment of new bladder mucosa during the operation.In each group,the new bladder intestinal segment was perfused with mucosa treatment agent for five minutes,and the histological changes of the new bladder mucosa were observed.The quality of the new bladder intestinal mucus was measured from 3 to 14 days after surgery,and the complications were recorded after one year's follow-up.Results Twenty-four cases of the operation were successfully completed.The early intestinal mucus secretion of the neobladder in the absolute ethanol group and the chlorhexidine acetate group was significantly lower than that in the iodophor group,and the difference was statistically significant(P<0.05).There was no statistical difference in the amount of intestinal mucus secretion in the early stage of neobladder between the two groups after absolute ethanol and chlorine acetate(P>0.05).Under the light microscope,the mucosa layer of iodophor group was intact,the villi were arranged orderly and tightly,a few goblet cells disappeared between the top of villi,and the muscle layer was not damaged;the structure of the mucosa layer of anhydrous ethanol group was unclear,the villi were arranged disorderly and flat,the distal end was broken and fell off,the structure of the muscle layer was disordered,with varying degrees of damage,a small amount of red cells and a large number of inflammatory cells infiltration;chlorhexidine acetate group was new bladder intestine The structure of mucosa was intact,villi were low and flat,distal end was broken and exfoliated,inflammatory cells were infiltrated in muscular layer,and there was no obvious damage.In terms of compl

关 键 词：原位回肠新膀胱 肠黏液分泌 醋酸氯已定 膀胱癌 

分 类 号：R73[医药卫生—肿瘤]