撕脱输尿管去外膜后自体移植于带肠系膜缘浆肌层肠段重建输尿管血运的实验研究

目的 探讨撕脱输尿管去外膜后自体移植于带肠系膜缘浆肌层肠段以重建输尿管血运的可行性.方法 将33只杂交犬分A组3只、B组15只、C组15只,B、C组术后又分4周组、6周组、8周组,每组各5只.所有犬均分离出带肠系膜缘的浆肌层肠段作为移植床模型,A组、B组、C组分别采用输尿管切开置管、保留输尿管外膜和去除输尿管外膜3种方法制备输尿管模型,将各组制备的输尿管模型分别移植到浆肌层肠段内,于术后4、6、8周分别处死相应组别的犬,取出移植输尿管进行病理检查.结果 A组输尿管黏膜及肌层保持正常状态;B组移植输尿管内膜层移行上皮细胞消失,输尿管壁肌层退化、变薄或消失,外膜层可见黄色钙化斑以及大量炎性细胞侵润;C组移植输尿管内膜有移行细胞存在,细胞核生长良好,细胞层(2~3层)较正常减少,输尿管壁肌层存在,并与外周肠壁肌层融合,血运重建良好.结论 撕脱输尿管去外膜后自体移植于带肠系膜缘浆肌肠段能够使输尿管的血运快速建立,这可能是将来解决输尿管撕脱造成输尿管长段缺损的有效方法之一.

Experimental research on ureteral revascularization through autologous transplantation of avulsive ureter without adventitia into intestinal segment with seromuscular layer and mesenteric margin

Objective To investigate the feasibility of ureteral revascularization through autologous transplantation of avulsive ureter without adventitia into intestinal segment with seromuscular layer and mesenteric margin.Methods Thirty-three mongral dogs were divided into Group A(n=3),Group B(n=15) and Group C(n=15).After operation,Group B and Group C were divided into 4-week group,6-week group and 8-week group separately,with 5 dogs in each group.Intestinal segments with seromuscular layer and mesenteric margin were dissociated and were taken as transplant beds in all dogs.Ureter models were established by ureteral incision and catheterization,preservation of ureteral adventitia and removal of ureteral adventitia in Group A,Group B and Group C respectively.The ureter models of each group were transplanted into the intestinal segments with seromuscular layer separately.The dogs in corresponding groups were killed in 4,6 and 8 weeks after operation,and the ureters transplanted were removed for the pathological examination.Results Normal mucous membrane and muscular layer of ureter were observed in Group A.In Group B,the transitional epithelial cells of transplanted ureteral intimal layer disappeared,the muscular layer of ureteral wall degenerated,turned thinned or disappeared,and yellow calcified spots and much inflammatory cell infiltration were observed in the adventitial layer.In Group C,the transitional epithelial cells with well-grown nuclei still existed in the transplanted ureteral intimal layer,the cellular layers reduced but still maintained 2-3 layers,the muscular layer of ureter existed and were fused with the muscular layer of intestinal wall,and a good revascularization was achieved.Conclusion The blood supply of ureter can be quickly established by autologous transplantation of avulsive ureter without adventitia into intestinal segment with seromuscular layer and mesenteric margin,and this approach may be one of the effective solutions to long segment defect of ureter caused by ureteral avulsion.