人脱细胞羊膜移植物用于兔膀胱切除修复的研究

Reconstruction of rabbit urinary baldder with human acellular amniotic membrane grafts

目的:探讨人脱细胞羊膜(HAM)移植物用于兔膀胱重建的效果。方法:用物理和酶消化方法制备人脱细胞羊膜,将12只兔行半个膀胱切除后用人脱细胞羊膜移植物进行修补,另外6只兔行半个膀胱切除后单纯缝合作为对照。分别于术后2、4、8周测定膀胱容量并取膀胱进行组织学观察。结果:应用人脱细胞羊膜行兔膀胱重建术后,实验组与对照组2、4、8周膀胱最大容量(Volmax)比较差异有显著性(P<0.05)。与术前相比,实验组和对照组膀胱容量均缩小,差异有显著性(P<0.05和P<0.01)。组织学观察,2周时人脱细胞羊膜即已吸收降解,膀胱移行细胞和平滑肌细胞开始形成,炎性反应明显;4、8周后膀胱的三层结构明显,炎性反应轻微,接近正常兔膀胱。而对照组仅2周时有轻微炎性反应,4、8周炎性反应消失。膀胱三层结构均正常。实验组大多数重建膀胱均有结石形成(8/11),对照组仅1例结石形成(1/6)。结论:人脱细胞羊膜作为膀胱移植物进行膀胱修补吸收降解迅速,移行细胞和膀胱平滑肌细胞可在移植物支架上再生,可以用做组织工程膀胱的支架材料进一步研究。

Objective To explore the effectiveness of bladder reconstruction in New Zealand white rabbits with human acellular amniotic membrane （HAM） grafts. Methods HAM grafts were prepared by physical approach and enzymatic digestion. Bladder repair with HAM grafts was performed in 12 of 18 rabbits receiving hemicystectomy, so was simple bladder suture as control in the remaining 6. Postoperative bladder volume was measured and histological examination was performed on weeks 2,4, and 8. Results The maximum bladder volume on weeks 2, 4, and 8 differed significantly between the experimental group and the control group （P 〈 0.05 ） ; the bladder volume in the two groups was significantly reduced as compared with the baseline （P 〈 0.05 and P 〈 0.01）. On week 2, HAM was absorbed and degraded, transitional cells and smooth muscle cells started to form, and inflammatory reaction was evident; on weeks 4 and 8, a near-normal bladder was formed with three marked layers and slight inflammatory reaction. In the control group, inflammatory reaction was mild on week 2 and the reaction disappeared on weeks 4 and 8, and the three layers of the bladder were normal. Stones were formed in most of the bladders （8/12） in the experimental group but in one （1/6） in the control group. Conclutions HAM as grafts for bladder repair can be rapidly absorbed and degraded. Transitional cells and smooth muscle cells regenerate in the graft. So HAM should be studied further as scaffold materials to bladder tissue engineering.