脊髓发育不良性膀胱逼尿肌形态学改变及临床意义

目的　探讨脊髓发育不良性膀胱的病理变化与尿流动力学分型之间的关系以及临床意义。方法　采用免疫组化和Masson三色法观察 38例脊髓发育不良性膀胱 (MB)及 11例正常膀胱组织标本中平滑肌与结缔组织之间的结构变化。结果　①MB组和正常组对α 平滑肌肌动蛋白均表达 ,而对α 横纹肌肌动蛋白均不表达 ;②MB组的结缔组织含量逼尿肌反射低下组 (0 .2 2 3± 0 .0 97) ,逼尿肌反射亢进组 (0 .5 4± 0 .11)均明显高于正常组 (0 .13± 0 .0 8) (P <0 .0 1) ,而逼尿肌反射亢进组与反射低下 /无反射组之间差异亦有显著性意义 (P <0 .0 5 ) ;③逼尿肌反射亢进组中有 17例(6 8.0 % )可见平滑肌细胞核排列紊乱 ,而反射低下 /无反射组肌束明显细小。结论　MB的病理改变与尿流动力学结果密切相关 ,临床上应采用相应的手术方法进行处理

Morphological changes of detrusor in myelodysplastic bladder and its clinical significance

Objective To study the relationship between pathological changes and urodynamic classification in myelodysplastic bladder (MB). Methods Thirty eight MB and 11 normal bladder specimens were studied. MB specimens included detrusor hyperreflexia in 25 cases and detrusor hyporeflexia/areflexia in 13 cases. Immunohistochemical and Masson trichrome stain were used to determine the detrusor muscle and connective tissue volume.Results (1) All of the MB and normal control detrusor expressed only smooth muscle actin. (2) There was significant increase in the connective tissue in MB compared to the control ( P < 0.01 ). The bladder of detrusor hyperreflexia also had a significant increase in the connective tissue when compared to detrusor hyporeflexia/areflexia ( P < 0.05 ). (3) Seventeen specimens ( 68.0% ) with detrusor hyperreflexia had disorganized muscle nuclear orientation. In contrast, a significantly diminished muscle bundle size was seen in detrusor hyporeflexia/areflexia.Conclusions There are a closed relationship between pathological changes and urodynamic results in MB. It is necessary to treat different types of MB with a variety of methods.