异体小肠粘膜下组织替代膀胱壁的研究

Experimental assessment of bladder wall substitution with xenogenic small intestinal submucosa

目的 探讨大面积异体小肠粘膜下组织 (SIS)作为膀胱壁替代物的价值。方法 将2 0头成年猪随机分为 2组 :A组 12头行大面积SIS(10cm× 10cm )替代膀胱壁术 ;B组 8头行大面积SIS替代膀胱壁和一侧输尿管种植术。动态观察SIS再生膀胱壁的移行上皮、平滑肌的再生情况和顺应性 ;输尿管种植后的愈合和吻合口情况。结果 再生膀胱壁具有与正常膀胱壁相似的外观、厚度和顺应性 ,组织学检查显示移行上皮和平滑肌的良好再生 ,所有种植输尿管的出口均被再生的膀胱壁所封闭 ,各组的平均最大膀胱容积术前 (2 88.3± 3 1.4)ml、术后 (2 83 .8± 3 7.1)ml;最大膀胱压力术前 (3 6.1± 9.3 )cmH2 O(1cmH2 O =0 .0 98kPa)、术后 (3 7.3± 9.5 )cmH2 O ,差异无显著性 (P >0 .0 5 )。结论 异体小肠粘膜下组织是一种较理想的膀胱部分替代和扩大材料。

Objective To evaluate large piece of small intestinal submucosa (SIS) as a substitute of bladder wall.Methods Twenty adult mini pigs was divided into two groups randomly:Group A including 12 pigs received operation of bladder wall substitution with large area of SIS; Group B including 8 pigs received operation of bladder wall substitution with large area of SIS and implantation of ureter into SIS.The transitional epithelium,smooth muscle and urodynamic character of regenerated bladder wall were investigated dynamically.The healing of reimplanted ureter and anastomatic stoma were also observed.Results The regenerative bladder wall had similar appearance,thickness and compliance to normal bladder wall and all orifices of reimplanted ureters were totally blocked by regenerative bladder wall in all pigs in group B.Histologic examination indicated excellent regeneration of urothelium and smooth muscle.The preoperative and postoperative average maximum bladder volume was (288.3±31.4) ml and (283.8±37.1) ml respectively,and the preoperative and postoperative average maximum bladder pressure was (36.1±9.3) cm H 2O and (37.3±9.5) cm H 2O.There was no significant difference ( P >0.05).Conclusion Xenogenic SIS is an ideal material for bladder augmentation and replacement.