带蒂大网膜对严重损伤输尿管的修复作用

Repair effect of pedicled omentum in serious ureteral injury

目的探讨带蒂大网膜对严重输尿管损伤的修复作用及其机制。方法随机将20条犬均分为实验组及对照组，建立严重输尿管损伤动物模型，实验组采用带蒂大网膜包裹损伤输尿管，对照组未采用大网膜包裹。术后观察尿瘘及输尿管坏死情况，术后12周再手术观察输尿管损伤愈合及吻合口血管再生情况，免疫组织化学染色检测血管内皮生长因子（VEGF）及其受体KDR的表达。结果实验组均无尿瘘，对照组2例因尿瘘反复腹腔感染而死亡。术后12周实验组输尿管吻合口处黏膜及平滑肌层再生，血管再生现象明显，VEGF及KDR表达升高。对照组吻合口处愈合不良或瘢痕愈合，血管再生不明显，VEGF及KDR阴性或弱表达。结论带蒂大网膜有促进严重输尿管损伤修复的作用，可能通过VEGF及KDR的表达升高促进血管再生而实现。

Objective To investigate the repair effect of pedieled omentum on serious ureteral injury. Methods Twenty dogs were randomly divied into two groups. The animal model of serious ureteral injury was established. The pedieled omentum was used to wrap up the serious ureteral injury in experimental group,but not in control group. Urinary fistula and ureteral necrosis were observed. At 12th week, the animal models were operated again to investigate whether the serious ureteral injury was healed. Blood vessel regeneration, vascular endothelial growth factor （VEGF） and its receptor KDR were also detected in stoma and surrounding tissues histopathologieally. Results No urinary fistula was observed in experimental group, but 2 eases in control group were dead because of repeated infection after urinary fistula. The mucous membrane and smooth muscle of stoma were regenerated, and the blood vessels were regenerated significantly in experimental group. The YEGF and KDR were also over-expressed. But in control group, the stoma was healed badly, and the blood vessels were not regenerated. The VEGF and KDR were not expressed or expressed weakly. Conclusion Pedieled omentum can promote the repair of serious ureteral injury by the over expression of VEGF and KDR to prompt the vascular regeneration.