膀胱粘膜下层无细胞基质作为细胞载体的可行性研究

目的 探讨膀胱粘膜下层无细胞基质作为组织工程学细胞载体的可行性。方法 采用胶原酶自膀胱组织分离出平滑肌细胞,在DMEM(含10％胎牛血清)中培养、传代。自膀胱显微解剖出膀胱粘膜下层,以0.5％SDS、双蒸水彻底洗涤后形成无细胞基质。平滑肌细胞以5.0×10~6/cm~2密度种植于膀胱无细胞基质,分别于1周、2周、3周、4周时取标本,HE染色、扫描电镜等观察细胞生长情况。结果 平滑肌细胞可在膀胱粘膜下层无细胞基质上粘附。1周时,平滑肌细胞主要位于膀胱粘膜下层无细胞基质的表面。第2、3周,细胞数量明显增多,并可见细胞向膀胱粘膜下层无细胞基质的中间部位侵入。第4周细胞数量减少。结论 膀胱粘膜下层无细胞基质可以作为细胞载体应用于组织工程学研究。该细胞-载体复合物的回植时间应在3周前。     

无细胞基质组织工程膀胱的实验研究

目的 探讨以膀胱无细胞基质为细胞载体的无细胞基质组织工程膀胱作为膀胱替代材料的可行性.方法 采用叠氮钠、DNase、PBS反复振荡洗涤膀胱组织,形成膀胱无细胞基质.自8只杂交长风白猪手术获取小块膀胱组织,分离出膀胱平滑肌细胞、移行上皮细胞培养、增殖,将增殖的两种细胞种植于膀胱尢细胞基质两面,共培养后回植,大面积替代自体猪的部分膀胱.分别观察1个月(2只)、3个月(3只)、6个月(3只)后处死,HE免疫组化观察替代部分膀胱组织结构,组织浴槽巾研究无细胞基质组织工程膀胱肌条的体外功能情况.结果 无细胞基质中已无细胞成分残留,培养的膀胱细胞可粘附于无细胞基质并生长.细胞-无细胞基质复合物替代膀胱后,3个月、6个月组均见替代处完整的移行上皮细胞覆盖于腔面,其下膀胱肌层形成,均排列良好,与正常膀胱组织无明显区别.组织浴槽研究提示无细胞基质组织工程膀胱肌条具有与正常膀胱肌条相似的体外功能.结论 无细胞基质组织工程膀胱技术有望为临床提供可行的替代材料来源.     

膀胱粘膜移植法治疗尿道下裂的新进展

自 194 7年Ｍｅｍｍａｌｌａａｒ首创游离膀胱粘膜移植法治疗尿道下裂以来 ,此方法在临床上的应用价值一直存在争议。争论的焦点是游离的膀胱粘膜本身无血运 ,易挛缩 ,术后容易出现尿道狭窄。一般认为 ,对于不能应用带蒂皮瓣或多次手术后局部取材困难的病例 ,该方法才是值得考虑的术式[1] 。据许多大宗病例的报告 ,膀胱粘膜移植法的手术方式、技巧有了许多改进 ,相应的手术效果也比较满意。因此是否需要重新认识这一方法的应用价值是值得考虑的问题 ,本文就最近有关文献做一综述 ,以便为同道提供有益的参考。一、近期大宗病例回顾对于手术效…     

膀胱粘膜移植术治疗复杂型及重型尿道下裂

目的 对膀胱粘膜移植术Ⅰ期矫治复杂型及重型尿道下裂的适应证及手术技巧进行深入讨论，以期重新认识这一手术方法的应用价值。方法 总结1999年—2001年经多次手术失败及重型尿道下裂15例，平均尿道缺损10．5cm，均采用膀胱粘膜移植术Ⅰ期尿道成形。结果 除1例术后感染外其余14例术后均获得较为满意的疗效，阴茎伸直满意，外形好，尿线粗，开口近似正常位置。手术一次成功率14／15(93．3％)。结论 对多次手术失败、阴茎瘢痕严重、局部取材困难及重型尿道下裂、尿道缺损过长的病例，采用膀胱粘膜移植术I期尿道成形术是目前成功率较高，疗效较理想的手术方法。     

膀胱粘膜尿道成形术治疗尿道下裂48例

我院自1990年1月～1997年7月采用膀眺粘膜移植尿道成形术治疗先天性尿道下裂48例，效果满意，现报道如下。临床资料一、一般资料；本组48例，均为男性，年龄2～13。，平均6a，互期手术46例，回期手术2例。其中冠状沟型1例，阴茎体形13例，阴茎阴囊型22例，会阴型12例。其中会阴     

膀胱粘膜尿道成形术治疗尿道上裂

目的：使阴茎充分伸直和延长为尿道上裂矫正术的重要目的。方法：采用了将尿道沟粘膜瓣从阴茎海绵体完全剥离，使阴茎充分伸直，再用了游离膀胱粘膜居表缺损的的尿道的术式。１例中，同时完成阴茎及尿道成形５例，先行阴茎菜主水道造口，半年后再行尿道成形６例，结果Ｌ术后阴茎延长、上曲矫正满意。无尿道狭窄，１例出现尿瘘。４例尿失禁中，治愈２例，好转１例，无效１例，获随访７例，阴茎外观均满意，排尿畅顺。结论：本术式能充     

游离膀胱粘膜或包皮内板尿道成形术治疗尿道下裂的评价

对一期膀胱粘膜尿道成形术和游离包皮内板尿道成形术治疗下裂的长期疗效进行评价。方法统计分析我院１９７７年１月－１９９７年１２月尿道下裂病例,共施行尿道成形术治疗１４岁以下小儿尿道下裂５７３例次。而运用一期膀胱粘膜尿道成形术或游离包皮内板尿道成形术治疗５６４例次,占同期尿道成形术的９８．４％。     

皮肤袖套式膀胱粘膜尿道成形术治疗尿道下裂

20 0 0年 1月至 2 0 0 1年 9月我科对12例重型尿道下裂患儿进行皮肤袖套式膀胱粘膜尿道成形术 ,取得了满意的效果 ,现报告如下。临床资料一、一般资料全组 12例患儿 ,年龄 4～ 13岁 ,其中阴囊型尿道下裂 8例 ,会阴型尿道下裂 4例。 3例为首次手术 ,7例为阴茎下曲矫正术后Ⅱ期手术 ,2例为外院尿道成形术失败后在我院再次手术的。手术中测量尿道缺损 4 .5～ 7.5ｃｍ。二、手术方法已做阴茎下曲矫正的病例 ,首先于龟头下 0 .8～ 1.0ｃｍ阴茎腹侧正中作纵形切开达阴茎海绵体白膜浅面 ,并向中线两侧解剖形成 0 .6ｃｍ宽的深槽 ,然后沿切口环形切…     

Using porcine small intestinal submucosa in intestinal regeneration

Small intestinal submucosa (SIS) is an unusual tissue that promotes constructive tissue remodeling when applied as a xenogeneic material. The aim of our experimental study was to assess its effectiveness in intestinal regeneration. Twenty white New Zealand rabbits were anesthetized and underwent celiotomy. A 6-cm antimesenteric incision was created at the jejunal segment. An elliptical SIS graft measuring 6 cm long and 2 cm wide was sutured to the jejunal defect as a patch graft. Thirteen living rabbits were divided into groups of three and the grafts were harvested at postoperative weeks 2, 4, and 6. The obtained specimens were evaluated for gross and histologic appearance. In morphometric examination, in the 2, 4, and 6 weeks groups, the diameters of grafted intestines were larger than preoperatively by 50%, 25%, and 25% respectively; also the grafts had contracted to 0%, 25%, and 50% of their original sizes respectively. At the end of 2 weeks, the grafts were intact without evidence of epithelial regeneration. By 4 weeks, intestinal tissue regeneration was started, and epithelial coverage of the grafts was detected. The grafts were covered with a complete intestinal mucosa at 6 weeks. Remarkable regeneration marked fibroplasia, angiogenesis, and mild mononuclear cell infiltration had also occurred throughout the grafts at 6 weeks. Porcine SIS appeared an effective biodegradable scaffold, facilitating regeneration of intestinal tissue. These results suggest that SIS may be useful to increase the mucosal surface of intestine and may provide a new substance for short gut syndrome in the future.     

In vivo bladder regeneration using small intestinal submucosa: experimental study

Significant side effects are correlated with bladder augmentation. Recently, small intestinal submucosa (SIS) has been proposed for clinical use. The efficacy of SIS bladder regeneration was studied in a porcine experimental model. Partial cystectomy (40–60% of bladder wall) was performed and replaced by SIS graft. Animals were planned to be killed at 2 weeks, 5 weeks and 3 months. Bladder capacity at 40 cmH₂O pressure and macroscopic graft morphology were assessed before and after SIS implant. Histological examination was carried out with computer assisted morphometric analysis for collagen/smooth muscle ratio. Student’s t test was adopted for statistical analysis. Two piglets died on the 9th and 10th post-operative day due to urinary peritonitis. The remaining piglets were killed after uneventful post-operative period at 5 weeks (two animals) and 3 months (two animals). The bladder capacity was reduced (−18%) at the 5 week follow-up and quite similar to the pre-operative volume (+2.5%) at the 3 months control. No diverticular formation, bladder calculi, mucus and urinary infection were found. The SIS graft resulted not significantly contracted. Histology at 10 days showed SIS membrane lined by transitional epithelium islands with some capillaries. At 5 weeks, transitional epithelium was fully covering the graft; new blood vessels and fibroblasts with smooth muscle cells were observed. At 3 months, the SIS was not evident. Two layers were defined: inner transitional epithelium, outer collagen with fibroblasts and muscular bundles. Computer assisted morphometric analysis showed collagen/muscle ratio 70/30% (normal bladder=56/44%, P<0.05). The SIS was effective as a scaffold for bladder wall regeneration in four out of six animals. Long-term studies are required to confirm the efficacy of the newly developed wall and for eventual clinical use.     

The impact of bladder shape on the ultrasonographic measurement of bladder volume in children

Background US is used for non-invasive assessment of bladder shape and for calculation of bladder volume.Objective To evaluate the impact of bladder shape on the accuracy of US estimation of bladder volume in children and to calculate formulas for US estimation of volume for different bladder shapes.Materials and methods US was performed in 146 children (94 girls, 52 boys, age range 9 months to 17 years, median 7.9 years) referred for urodynamic investigation. Three bladder diameters were measured, and bladder shapes were categorized as round, ellipsoid, cuboid, triangular and undefined. Urine was collected, and total bladder volume calculated. Correction coefficients (k) were calculated for the whole sample and for each bladder shape using linear regression analysis.Results Round bladder shape was present in 23%, 25% showed a cuboid shape, 21% an ellipsoid shape, 25% a triangular shape, and 6% had an undefined shape. Correction (regression) coefficient (k) for the whole sample was 0.66 (SE=0.011); for round bladder 0.561 (SE=0.013), cuboid bladder 0.923 (SE=0.012), ellipsoid bladder 0.802 (SE=0.006), triangular bladder 0.623 (SE=0.007), and for undefined shape 0.749 (SE=0.048). Mean percentage errors when using different correction coefficients were significantly lower than errors when using k=0.5 applied to our data.Conclusions Bladder shape has considerable impact on the accuracy of US estimation of bladder volume in children. Correction coefficients should be used for volume measurements of different bladder shapes.     

间歇性清洁导尿治疗神经源性膀胱的疗效和随访结果

目的 回顾性分析我院神经源性膀胱患儿经间歇性清洁导尿(CIC)治疗和长期随访的临床资料,总结这一方法 的治疗效果.方法 2001年1月至2006年5月共治疗57例.男38例,女19例,年龄3个月至17岁.反复尿路感染病例35例,尿失禁45例.上尿路扩张积水SFU分级3～4级38侧,0～2级39侧.尿动力检查逼尿肌无收缩或功能低下12例,逼尿肌过度活动10例,括约肌关闭功能不全39例.逼尿肌括约肌不协调或括约肌过度活动20例.结果 57例中36例获长期随访.完全采用CIC排尿27例,采用crede动作辅助排尿4例.两者均有5例.导尿2～3次2例,4～6次25例.6次以上5例.每次尿量80～400 ml.36例患儿中31例治疗前有反复发热性尿路感染,导尿后21例有菌尿,8例出现发热性尿路感染.治疗前尿失禁Likert评分平均为2.25,治疗后为4.04,t检验差别有统计意义.治疗前SFU分级2级以下为30侧,3级以上为42侧,治疗后2级以下40侧,3级以上32侧.卡方检验差别有统计学意义.结论CIC在神经源性膀胱的治疗中有重要意义,它对控制尿路感染.缓解尿失禁,改善上尿路扩张积水都有明显效果.     

Management of post-operative bladder spasm

OBJECTIVE: Pain management following bladder surgery in children is often complicated by bladder spasm. The overall severity of spasm can be reduced with opioids, anticholinergic medication and sedatives, although breakthrough spasms often occur. At the Royal Children's Hospital, Melbourne, intravesical bupivacaine has been used to manage postoperative bladder spasm to good effect. The administration of intravesical bupivacaine is analysed in this prospective audit of locally applied intravesical anaesthetic and compared with other methods. METHOD: From February to August 2003, histories of 58 patients who had intravesical bupivacaine were studied and compared with six other methods of management of postoperative bladder spasm. CONCLUSION: Data showed that epidural anaesthesia was the most effective treatment of pain, with a pain score reduction of 6.6, compared with a reduction of 6.1 with intravesical bupivacaine, and 4.5 using intravenous morphine. However, intravesical bupivacaine was the most effective method for the relief of bladder spasm.     

Management of neurogenic bladder dysfunction secondary to myelomeningocele

We investigated 55 children, aged from 24 months to 14 years with neurogenic bladder dysfunction secondary to myelomeningocele, by serial urodynamic. They were serially evaluation over 2–5 years. Management consisted of drug therapy together with intermittent vesical catheterization in different combinations on the basis of initial urodynamic assessment. In 5 children with a hypotonic sphincter, it was necessary to implant an artificial sphincter. With this regimen control or frank improvement of micturition was achieved in 53 patients, urodynamic function became normal or improved in 54, and recurrent urinary tract infections persisted only in 5 patients. In the light of these results, we believe that treatment of the neurogenic bladder secondary to myelomeningocele should be determined by initial urodynamic evaluation.