不同组织替代输尿管黏膜重建输尿管的组织病理学观察

The pathological observation of the ureter reconstruction with different tissues

目的观察腹膜和膀胱黏膜重建犬黏膜剥脱输尿管的组织病理学变化。方法成年杂种犬18条,随机分3组,制作输尿管黏膜剥脱模型后,重建组黏膜缺损处分别予膀胱黏膜或腹膜植入,对照组仅留置输尿管支架管,术后10周将犬处死,取重建段输尿管作病理学检查。结果对照组损伤段输尿管腔明显狭窄或闭锁,未见黏膜生长。膀胱黏膜替代组黏膜生长良好,其中1条犬重建段输尿管上段轻度扩张,重建段狭窄不明显。腹膜替代组腹膜组织消失,重建段见新生移行上皮,输尿管腔均无狭窄。结论腹膜或膀胱黏膜可作为输尿管黏膜剥脱后重建的理想修复材料。

Objective To investigate the histopathological changes of mucosa avulsed ureters reconstructed with tubularized peritoneal free grafts and bladder mucosa grafts. Methods 18 adult dogs were randomly divided into 3 groups. After the ureteral mucosa was avulsed to about 3-5 cm, the tubularized peritoneal free grafts or peritoneal free grafts and ureteral stents were placed in the injured ureters in the treated groups, while a simple stent was placed in the ureters in the control group. The ureters were examined by histological analysis 10 weeks after operation. Results In the control group, atresia or severe stenosis of injured ureters occurred, and no regenerated mucosa was observed. In the group reconstructed with peritoneum, no obvious stenosis was observed, and histological examination showed the constitutions of the reconstructed parts were similar to the normal appearance. Slight distension occurred in 1 dog in the group reconstructed with bladder mucosa, but no obvious stenosis was observed, and the lumens of all the dogs in this group were uniformly lined with 5-8 lays transitional epithelium. Neovascularization was evident beneath the mucosa and some chronic inflammatory cells and fibroblasts were present in the subepithelial layer. Conclusion The tubularized peritoneal free grafts and the bladder mucosal grafts are optimal substitutes to the avulsed mucosa of the ureter.