带蒂腹内斜肌肌瓣逼尿肌肌成形术治疗逼尿肌无收缩实验探究.docVIP

带蒂腹内斜肌肌瓣逼尿肌肌成形术治疗逼尿肌无收缩实验探究 　【摘要】 目的 探讨腹内斜肌肌瓣（internal oblique flap，IOF）逼尿肌肌成形术治疗逼尿肌无收缩（acontractile detrusor，AD）的可行性，以期为构建新的临床治疗方法提供实验依据。方法 2006年3～5月，以6只雄性犬为实验对象。解剖游离腹内斜肌肌瓣，包绕膀胱模型，电流刺激支配腹内斜肌的腰神经腹支，记录模型内的压力。暴露膀胱，测压管插入膀胱，行膀胱基础状态尿动力学检测（A组）。在膀胱底部，去掉整个膀胱50%的逼尿肌肌层，保留膀胱黏膜完整，制作AD动物模型，行AD模型尿动力学检测（B组）。腹内斜肌肌瓣近肋弓端向内下翻转，包绕70%的膀胱，腹内斜肌肌瓣与膀胱余壁吻合。腹内斜肌肌瓣膀胱逼尿肌肌成形术后再次行尿动力学检测（C组）。电流刺激支配腹内斜肌的腰神经支行膀胱测压，观测排空情况，术后5周，行B超检查、尿动力学检测（D组），肌瓣标本行病理检查。结果 术后犬健康4例，死亡2例。IOF包绕膀胱模型分别注射生理盐水40 ml、80 ml、120 ml，刺激支配IOF之腰神经支，模型内压力分别达到（12.3±2.3）cm H2O、（26.8±10.1）cm H2O、（40.3±11.0）cm H2O，压力和模型容量正相关（Plt;0.05）。膀胱最大灌注容量（ml）：A组345.8±39.1，B组340.2±27.5，C组315.7±18.8，D组326.8±13.5。膀胱内最大压力（cm H2O）：A组25.5±21.0，B组10.2±8.0，C组14.7±4.0，D组15.3±4.1。顺应性（ml/cm H2O）：A组19.6±9.8，B组45.9±21.4，C组23.1±7.4，D组22.8±6.7。未发现逼尿肌的主动收缩，膀胱具有良好的稳定性。腹内斜肌肌瓣逼尿肌肌成形术完毕，灌注150 ml时，刺激神经，1例排出17 ml，1例排出22 ml，平均排空率13%；术后5周，刺激神经，1例排出15 ml，排空率10%。B超检查：膀胱形态规整，膀胱壁光滑，无憩室，无尿瘘，无上尿路积水。光镜和电镜病理提示转移之IOF肌束有活力，生长良好。结论 带蒂腹内斜肌肌瓣逼尿肌肌成形术可以增强或部分替代缺失的逼尿肌功能，治疗逼尿肌无收缩具备可行性。 【关键词】 逼尿肌无收缩 逼尿肌肌成形术 腹内斜肌肌瓣 实验研究 Experimental study on pedicled internal oblique muscle flap detrusor myoplasty for detrusor assistance in case of acontractile detrusor ［Abstract］ Objective Experimental studies were undertaken to investigate the practicability of transfering pedicled internal oblique muscle flap to the bladder，and to look for possible techniques enhancing evacuation of a reservoir as the bladder by the muscle flap.To elucidate the potential value of the technically feasible surgical procedure that may eventually provide a treatment alternative.Methods From March to May 2005，six male dogs were used for the studies.The internal oblique muscle was dissected and tailored to be muscle flap was and then wrapped around a bladder model varying sizes.The intraluminal pressure measurements were recorded when the innervated muscle flap was being stimulated.The bladder was explored and urodynamic studies were performed （group A）.At the dome，the bladder wall was removed，with up to 50 percent of the mu