前列腺增生症的逼尿肌超微结构变化

为了研究前列腺增生症（ＢＰＨ）引起的膀胱逼尿肌超微结构变化，对１３例ＢＰＨ患者、９例同龄无膀胱颈梗阻（ＢＯＯ）老年人及８例正常青年人逼尿肌进行透射电镜观察。结果发现：ＢＰＨ的逼尿肌超微结构特点为：（１）平滑肌细胞（ＳＭＣ）肥大、扭曲变形，排列不齐；（２）ＳＭＣ之间的间隙明显增宽，内有大量胶原纤维，细胞间中间连接明显减少；（３）肌质膜内小泡小凹明显减少，细胞内肌丝萎缩，排列不齐，细胞器退变。认为ＢＰＨ超微结构变化的结果引起逼尿肌功能改变，从而加速ＢＰＨ的病理生理进程。     

雄性兔膀胱出口部分梗阻所致逼尿肌功能障碍的研究

目的探讨膀胱出口部分梗阻所致逼尿肌功能改变.方法取新西兰雄性白兔14只,梗阻组和对照组各7只.梗阻组行手术人为造成膀胱出口部分梗阻,饲养5周后解剖膀胱,测定膀胱重量、容量;检测逼尿肌功能;对膀胱逼尿肌细胞超微结构进行观察.结果梗阻组膀胱重量为(12.129±1.627)g,对照组膀胱重量为(3.762±1.067)g(P＜0.05);梗阻组膀胱容量为(64.000±6.272)m1,对照组膀胱容量为(94.432±12.850)ml(P＜0.05);单位重量膀胱逼尿肌对各种刺激反应性均明显下降(P＜0.05或P＜0.01);梗阻膀胱逼尿肌细胞中粗面内质网明显扩张,线粒体水肿.结论通过手术可人为建立膀胱出口部分梗阻动物模型;膀胱出口部分梗阻将导致逼尿肌功能障碍;逼尿肌功能变化与其形态学变化相关.     

The latissimus dorsi myo-cutaneous flap for breast reconstruction

Summary The authors present a method of breast reconstruction after mastectomy making use of the versatile latissimus dorsi myo-cutaneous flap. Two different flap designs are proposed. A fish-shaped flap for reconstruction after mastectomy without irradiation damage and a tennis rackuet type flap for the replacement of irradiated skin, breast and pectoralis muscle. This axial pattern innervated composite flap enables a safe 2-stage breast reconstruction.     

背阔肌解剖分区及其肌电研究

目的 明确背阔肌的解剖分区及各区在肩关节运动中的肌电表现。方法 对10具成人尸体背岂进行血管、神经解剖并按主要血管、神经的分支、分布将背阔肌分区、。利用体表电极记录13例（25侧）健康成人背阔肌不同区在肩关节运动中的肌电表现，并将记录结果进行统计学处理、分析。结果 背阔肌的主要血管、神经来自胸痛血管、神经及其内、外侧分支，部分来自肋间血管、神经，胸背血管、神经分支及肋间血管、神经分支间有广泛的吻合，胸背血管、神经内、外侧支及其延长线将背阔肌分成三个区域。三区在肩关节6种运动中的肌电表现不同。结论 背阔肌内不同区域肌纤维在肩关节运动中的作用不同。     

逼尿肌自身肌源性变化与逼尿肌不稳定的关系

目的:探讨逼尿肌不稳定(Detrusor instability,DI)的发病机制。方法:建立Wistar大鼠膀胱流出道梗阻(Bladder outlet obstruction,BOO)动物模型,6周后行充盈性膀胱测压分出梗阻后稳定组和不稳定组,进行离体膀胱充盈性测压、逼尿肌条机械牵拉及胆碱类药物刺激试验。结果:不稳定组膀胱充盈至出现收缩时的压力明显低于稳定组及正常对照组,收缩发生时的容积明显低于稳定组;不稳定组逼尿肌条机械牵拉至其出现收缩时的最小张力明显低于稳定组及正常对照组;不同浓度氯化氨基甲酰胆碱刺激诱发的收缩频率各组间差异无统计学意义(P<0.05)。结论:逼尿肌不稳定的发生与逼尿肌自身的兴奋性增强密切相关。     

膀胱出口梗阻所致逼尿肌过度活动的神经电生理研究

目的 从膀胱传入神经以及盆底相关神经肌肉角度探讨神经因素及肌源性因素在膀胱出口梗阻所致的逼尿肌过度活动发生中的作用.方法 采用耻骨上膀胱颈梗阻的方法建立逼尿肌过度活动大鼠模型,测定不稳定收缩时盆神经传入电位信号,并同步测定阴部神经运动支电位、尿道外括约肌肌电及腹肌肌电的反射反应.并观察T8段脊髓截断、双侧盆神经截断、腹交感干截断以及双侧阴部神经截断后大鼠膀胱充盈测压不稳定收缩的变化.结果 成功制作了膀胱出口梗阻逼尿肌过度活动大鼠模型,成功率62.5%.充盈性膀胱测压神经肌电生理同步记录结果显示,允盈期逼尿肌过度活动可分为两种类型,一种为收缩幅度高于10 cmH2O(1 cmH2O=0.098 kPa)的逼尿肌过度活动(B-DO),伴有同步盆神经传入的信号明显增强,且能引发阴部神经、尿道外括约和腹肌肌电图出现显著变化;一种为收缩幅度低于10 cmH2O的逼尿肌过度活动(S-DO),没有上述盆神经传入及相关神经肌电变化.T8脊髓截断后,膀胱充盈-排尿收缩周期消失,膀胱基础压显著升高,B-DO消失,S-DO仍然存在,且收缩幅度较截断前略有上升,但差异无统计学意义.依次截断控制膀胱的盆神经、交感神经和阴部神经后,膀胱失去充盈-排尿收缩周期,基础压显著升高,不稳定收缩中B-DO消失,S-DO仍然存在.结论 膀胱出口梗阻所致的逼尿肌过度活动存在不依赖于中枢和周围神经的膀胱源性因素.     

Endoscopic harvesting of the latissimus dorsi muscle flap

The harvesting of the latissimus dorsi flap is performed usually through a large. skin incision. To avoid the associated large scar a minimally invasive technique has been developed for harvesting the latissimus dorsi muscle. To date, this procedure has been used in eight clinical cases. The advantages of the endoscopic procedure are the decrease of visible scarring and the reduction of morbidity at the donor site.     

Delayed seroma formation at the latissimus dorsi donor site

Seroma formation is known as the most common complication of reconstruction using the latissimus dorsi muscle flaps. Although the development of a seroma in the immediate or acute postoperative period is a fairly common consequence after latissimus dorsi harvest, it is unusual for a fluid collection to recur several years after the procedure. To the best of our knowledge, there has been no report regarding very late seroma formation in the English literature. Here, we present a delayed development of seroma at the latissimus dorsi donor site of a patient 4.5 years postoperatively.     

The clam enterocystoplasty in the treatment of idiopathic detrusor instability

Enterocystoplasty is being used increasingly frequently in the treatment of both idiopathic detrusor instability and neuropathic bladder dysfunction. After operation, most patients with idiopathic detrusor instability and disabling urinary incontinence refractory to previous treatments, experience improvements in continence and urgency, but residual symptoms are common. Detrusor instability can be demonstrated in over half of patients after operation, but significant decreases in the severity of instability are found after operation as assessed by the volume at first unstable contraction.Enterocystoplasty is a major operation with the potential for postoperative morbidity and mortality. In addition, the improvements in symptoms are bought at a price: increases in residual urine are common, and in the long term many patients need to perform clean intermittent self-catheterization, and some experience recurrent urinary infections. Patients about to undergo enterocystoplasty should be carefully selected and should be trained in the use of CISC. In selected patients with severe refractory idiopathic detrusor instability, the procedure can yield satisfactory results.     

Endoscopic latissimus dorsi flap harvesting

BACKGROUND: Immediate breast reconstruction using the latissimus dorsi musculocutaneous flap is a standard technique that allows for cosmetically acceptable results yet leaves a great scar on the donor site. To reduce the scars, we have been using a different surgical technique consisting of endoscopic harvesting of the latissimus dorsi pure muscular flap with a virtual cavity created by CO2 gas distention. METHODS: Between May 1, 2001, and June 30, 2005, there were 52 patients who underwent latissimus dorsi endoscopic harvesting for an immediate breast reconstruction after a skin-sparing mastectomy. RESULTS: The mean surgical endoscopic time was 64 minutes. There was one conversion to an open technique. We reported no deaths, but complications included 2 hematomas, 6 inflammatory syndromes, and 1 pulmonary embolism. CONCLUSIONS: The endoscopic harvesting of the latissimus dorsi flap when performed with this mixed technique is feasible, reproducible, and permits a significant reduction of incision size and postoperative pain, with good aesthetic results.     

逼尿肌活动过度伴收缩功能受损对膀胱排空的影响

目的探讨逼尿肌活动过度伴收缩功能受损(DHIC)对膀胱排空功能的影响。方法通过压力流率测定分别对99例DHIC和176例单纯逼尿肌收缩力减弱的患者(对照组)进行评估,对相应资料进行统计学分析。结果DHIC组患者的剩余尿量、最大尿流率(Qmax)、最大尿流率时逼尿肌压(PdetQmax)、膀胱顺应性、膀胱容量(V)分别为(106.40±149.55)ml、(5.91±3.24)ml/s、(44.52±17.78)cmH2O、(26.34±48.16)ml/cmH2O和(228.28±93.36)ml,对照组分别为(228.88±241.71)ml、(4.13±3.10)ml/s、(34.42±20.82)cmH2O、(66.96±97.53)ml/cmH2O和(328.30±123.19)ml,2组比较差异均有统计学意义(P<0.05)。有膀胱出口梗阻的DHIC(44例)与有梗阻的单纯逼尿肌收缩力减弱患者(52例)相比,剩余尿量、膀胱顺应性和V的差异有统计学意义(P<0.05)。口服黄酮哌酯或舍尼亭出现尿潴留者16例。有上尿路扩张者11例,其中DHIC者8例。结论DHIC的膀胱排空能力高于单纯逼尿肌收缩力减弱者。应谨慎应用抑制逼尿肌收缩的药物。DHIC患者膀胱顺应性较低,应警惕可能发生上尿路损害。     

A new approach to the study of latissimus dorsi muscle vasoreactivity in rats

In this paper we describe a new approach to the study of changes in latissimus dorsi (LD) muscle microcirculation in rats. The experiments were carried out under anesthesia in normal male Wistar rats (C, n = 6) and in diabetes-induced rats (D, streptozotocin, 50 mg/kg, i.v., n = 6). The left LD muscle was exposed in order to preserve the proximal tendon with its thoracodorsal nerve and artery. The animal was kept in lateral decubitus over a heating board attached to the mechanical stage of the intravital microscope. The ventral surface of the muscle was exposed over a transparent plate and fixing. The image of the LD vascularization was transferred to the camera system, which was connected to a microcomputer equipped with software (KS-300, Kontron Elektronik, Munich, Germany) for image storage. The vasoreactivity of LD was analyzed by changes in arteriole diameter after topically administered noradrenaline (0.3 microg/ml) and acetylcholine (300 microg/ml). The microscopic image provided by the described optical setup permitted clear resolution of capillary vessels and a stable preparation over a period of 3-4 h. D rats showed increased vasodilatation (29 +/- 2% vs. 18 +/- 2.6% in C) and similar vasoconstriction (25.5 +/- 3% vs. 27.5 +/- 3.3% in C) as compared to C rats. The method described in this paper is suitable for the study of changes in responsiveness of LD arterioles, vessels which represent the major site of vascular resistance and are most actively involved in the control of tissue perfusion.     

Bilateral latissimus dorsi flaps for the reconstruction of extensive scalp defects

BACKGROUND:

The reconstruction of large scalp defects is occasionally required. Several methods of scalp reconstruction have previously been described. This paper presents the authors’ experience with two patients in whom traditional methods were not sufficient and in whom bilateral latissimus dorsi free flaps were required.

OBJECTIVES:

To evaluate the effectiveness of a new technique in reconstructing extensive scalp defects.

METHODS:

Two case histories are presented. These include the rationale for the choice of reconstruction used as well as a discussion on the technical features of the surgery.

RESULTS:

Reconstruction was effective in both cases. However, one patient died in the early postoperative period from a pulmonary embolus.

CONCLUSIONS:

Bilateral latissimus flaps can be safely and effectively used in closing massive scalp defects in selected cases.     

Age-associated changes in detrusor sensory function in women with lower urinary tract symptoms

This study examined changes in bladder sensation which occur with age in women. 1381 women (age range 20–95 years, mean 54.9) with symptoms of lower urinary tract dysfunction underwent urodynamic study. The bladder capacity at which they first became aware of the desire to void was taken as a quantitative measure of bladder sensation. Maximum bladder capacity fell in the eighth and ninth decades (H=95.84, df=7,P=0.00), but by contrast bladder capacity at first desire to void rose progressively in association with age, both in the group as a whole (H=17.13, df=7,P=0.017) and in a subgroup with detrusor instability (n=952, H=15.42, df=7,P=0.032). This rise in capacity points to a decrease in bladder sensation in association with age. This is not due to neurological disease, antimuscarinic drugs or oestrogens, as the median capacity at first desire to void of these three subgroups did not differ significantly from that of the group as a whole.     

Release of severe post-burn axillary contracture with the latissimus dorsi flap

Summary One stage reconstruction of the anterior axillary fold, in a case of severe post-burn axillary contracture, with the island latissimus dorsi musculocutaneous flap is described. Postoperatively the patient had a full range of active abduction and a good cosmetic result.     

前列腺增生症患者剩余尿与膀胱出口梗阻逼尿肌收缩力的相关性研究

目的 :探讨前列腺增生症 (BPH)患者剩余尿 (RUV )与膀胱出口梗阻 (BOO)、逼尿肌收缩力相关性。方法 :对 42例 BPH患者进行尿动力学检查。结果 :RUV与 BOO呈正相关 (r =0 .716 0 ,P <0 .0 1) ,与逼尿肌等容收缩压 (Piso)呈负相关 (r =- 0 .5 718,P <0 .0 1)。术前和术后的 RU V、尿道阻力因子 (URA )的差异有显著性意义 (P<0 .0 5 ) ,而术前和术后的 Piso差异无显著性意义 (P>0 .0 5 )。结论 :BPH患者 RUV的产生及增多是由于 BOO的加重和逼尿肌功能受损的共同结果 ,在病程的不同阶段 ,BOO和逼尿肌收缩力对 RUV的产生、增多及减少具有不同的作用和意义。