儿童逼尿肌反射亢进的逼尿肌超微结构观察

Observation of ultrastructure of detrusor musculature in children with detrusor hyperreflexia

目的:对逼尿肌反射亢进患儿的逼尿肌进行超微结构观察,探讨可能存在的结构改变特征和临床意义。方法:13例逼尿肌反射亢进患儿标本,括约肌活动协调型5例,不协调型8例;另设3例正常儿童膀胱组织作为对照。采用透射电镜观察。结果:逼尿肌反射亢进的逼尿肌超微结构特点为:(1)肌细胞扭曲变形,排列紊乱;(2)平滑肌线粒体内质网等细胞器出现肿胀变性,肌丝排列紊乱;(3)肌细胞间隙增宽,胶原纤维增多;(4)中间连接减少。括约肌活动不协调组另有以下特点:(1)细胞受损程度加重;(2)细胞间胶原纤维含量增加;(3)在部分患儿中出现异常细胞连接。结论:逼尿肌反射亢进患儿的逼尿肌超微结构有明显改变。这些改变都可以造成逼尿肌收缩能力受损,顺应性下降。不协调组的结构改变明显较协调组严重,异常细胞连接的出现,加速了逼尿肌反射亢进的病理生理过程。

Objective: To assess the possible characteristics and clinical significance in children with detru-sor hyperreflexia by observing ultrastrucrural changes. Methods: The specimens of 13 children with bladder hy-perreflexia were studied. Among them, the sphincters of 5 children were normal and 8 were detrusor-sphincter dyssynergia, and the specimens of 3 healthy children were used as controls. They were observed by means of transmission electron microscope. Results: The characteristics of the detrusor musculature in detrusor hyperreflexia were as follows: (1) smooth muscle cells distorted and contoured; (2) swelling and degeneration of cellular organelles; (3) wide separations between muscle cells with abundant collagen fibers and (4) reduction of intermediate cell junction. In children whose sphincter dyssynergia had the following characteristics: (1) the degeneration of cells enhanced; (2) collagen fibers between the cells increased and (3) some children had abnormal cell junction. Conclusion: There are significant changes in the ultras true ture of detrusor musculature in children with detrusor hyperreflexia. These structural changes can impair the contractibility of the detrusor musculature and decrease their compliance. Abnormal structure change is more serious than of normal one. The abnormal cell junction can accelerate the process of pathophysiology in children.