游离腹膜管重建黏膜剥脱输尿管的实验研究

An experimental study of tubularized peritoneal free grafts as ureteral mucosa substitutes

目的探讨腹膜重建黏膜剥脱输尿管的可行性，探索治疗输尿管黏膜袖状剥脱的新方法。方法成年杂种犬12条，随机分为重建组和对照组，每组6条。首先制作输尿管黏膜剥脱模型，黏膜剥脱3—5cm。重建组采用游离腹膜管植入黏膜缺损段，并留置输尿管支架管；对照组仅留置支架管。术后10周行IVU和组织病理学检查。结果术后10周重建组IUV示术侧肾脏形态大小正常，无肾积水，输尿管均可全程显影，腹膜替代部分输尿管无明显狭窄；对照组IVU示术侧肾脏均不显影或仅显示增大模糊轮廓，输尿管均未显影。对照组犬输尿管腔均严重狭窄或闭锁。重建组犬腹膜组织被完整成熟的移行上皮替代，输尿管无明显狭窄，上皮下可见丰富的新生血管。结论输尿管黏膜剥脱〉3cm时，仅留置支架管将导致输尿管狭窄或闭锁；利用游离腹膜管替代输尿管黏膜是一种有效的治疗方法。

Objective To investigate the feasibility of reconstruction of ureter with tubularized peritoneal free grafts for the treatment of avulsion of ureteral mueosa using animal models. Methods Twelve adult dogs were randomly divided into the reconstruction group （ n = 6） and the control group （ n = 6）, Firstly,the model of avulsion of ureteral mucosa about 3 - 5 cm long was made. In reconstruction group, tubularized peritoneal free grafts and ureteral stents were placed in the injured ureters ;and in control group, no operation was performed but to place the stents into the ureter. The curative effect was observed by IVU and histological examination 10 weeks after operation. Results In reconstruction group,IVU showed normal size and morphology of the kidneys. There was no hydronephrosis,and no obvious stricture of the part of ureter in which peritoneal free grafts were used as mucosa substitutes. In control group,IVU showed no image or only obscure enlarged outlines of the kidneys, and no image of the ureters. Atresia or severe stricture of the ureters was observed in all dogs in control group;while in reconstruction group, the peritoneal membrane was replaced by integrate transitional epithelium, and no obvious stricture was observed. Subepithelial abundant neovascularization was also seen. Conclusions For avnlsion of ureteral mucosa exceeding 3 cm,placing stents only will lead to ureteral stricture or atresia, reconstruction using tubularized peritoneal free grafts as mucosa substitutes is an effective method.