内脏神经-体神经端侧吻合与端端吻合修复膀胱功能的比较

The efficacy of end - to - side nerve anastomosis of autonomic nerve to somatic nerve vs. end - to - end nerve anastomosis on restoration of bladder function

目的比较内脏神经．体神经端侧吻合与端端吻合修复膀胱功能的效果及端侧吻合与端端吻合对供体神经及其功能影响。方法将30只成年雄性SD大鼠（230～250g）随机分成3组：正常对照组（n=10）、端侧吻合组（n=10）和端端吻合组（n=10）。正常对照组：仅行L3-L6椎板切除术；端侧吻合组：左侧腰6前根（L6VR）与腰4前根（IAVR）行端侧吻合；端端吻合组：L6VR与L4VR行端端吻合。术后16周行膀胱测压、腰4神经支配肌肉胫骨前肌肌电图检测，肌肉湿重测量及苏木素．伊红（HE）染色观察肌肉形态。腰6神经前根甲苯胺蓝染色计数神经纤维。结果正常对照组、端侧吻合组、端端吻合组最大膀胱压力分别为（61．7±2．7）、（28．3±3．2）、（44．5±4．3）cmH2O（1cmH2O=0．098kPa）。仅端端吻合组下肢肌电图提示肌肉失神经改变。3组大鼠左侧L6VR神经有髓神经纤维数量分别为（1375＋183）、（669±164）、（892±175）个，三者比较差异有统计学意义（P〈0．05），肌肉湿重分别为（0．688±0．061）、（0．694±0．059）、（0．394±0．119）g，端端吻合组与其他两组比较肌肉湿重差异有统计学意义（P〈0．05）。结论内脏神经和体神经通过端侧吻合与端端吻合后均能成功修复膀胱功能，端侧吻合较端端吻合对供体神经及其功能影响小。

Objective To compare the efficacy of end - to - side nerve anastomosis of autonomic nerve to somatic nerve vs. end - to - end nerve anastomosis on restoration of bladder function and its influ- ence on the donor nerve and its functions. Methods Thirty young adult male Sprague - Dawley rats [ mean weight （230 ± 28） g ] were randomly divided into 3 groups ： control group （ n = 10）, end - to - side anas- tomosis group （n = 10）, and end- to- end anastomosis group （n = 10）. In control group only a L3 -L6 laminectomy was performed, in end - to - side anastomosis group the distal end of left L6 ventral root （L6VR） was sutured in an end- to- side fashion to left L4 ventral root （L4VR）, and in end -to -end anastomosis group, the distal end of L6VR was sutured in an end - to - end fashion to proximal IAVR. Six- teen weeks after operation cystometry was performed, left tibialis anterior muscle electromyogram （EMG） was recorded, left 1.6VR nerve segments were resected and stained with toluidine blue for nerve fiber count, L4 nerve innervated tibialis anterior muscle wet weight were measured and hematoxylin and eosin （HE） staining was used to observe muscle morphology. Results In control group, end - to - side anasto- mosis group and end- to -end anastomosis group, the recorded intravesical pressure was （61.7 ± 2. 7 ）, （ 28.3 ± 3.2 ）, （44. 5 ± 4. 3 ） cmH20 （ 1 cmH20 = 0. 098 kPa） respectively. Only in end - to - end anas- tomosis group the lower extremity muscle EMG displayed muscle denervation changes. The average number of myelinated axons of the left L6VR in control group, end - to - side anastomosis group and end - to - end anastomosis group was 1 375 ± 183,669 ± 164 and 892 ± 175 respectively. The muscle wet weights in con- trol group, end - to - side anastomosis group and end - to - end anastomosis group were （0. 688 ± 0. 061 ）, （0. 694 ±0. 059） and （0. 394 ± 0. 119） g, respectively. There was significant difference in muscle wet weights between end - to - end anastomosis group and the other two groups （P 〈 0. 05 ）. Conclusion Both end - to - side and end - to - end anastomosis can realize micturition function. End - to - side anastomosis shows less effect on donor nerve and its functions than end - to - end anastomosis.