带蒂腹内斜肌肌瓣逼尿肌肌成形术治疗逼尿肌无收缩的实验研究_论文.docxVIP

带蒂腹内斜肌肌瓣逼尿肌肌成形术治疗逼尿肌无收缩的实验研究 【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 2017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（±）cm H2O、（±）cm H2O、（±）cm H2O，压力和模型容量正相关（P 【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 elucidate the potential value of the technically feasible surgical procedure that may eventually provide a treatment From March to May 2017，six male dogs were used for the internal oblique muscle was dissected and tailored to be muscle flap was and then wrapped around a bladder model varying intraluminal pressure measurements were recorded when the innervated muscle flap was being 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 mucosal layer being left intact and urodynamic studies were performed （group B）.The pedicled internal oblique muscle flap was rotationed and wrapped about 70% of the bladder，urodynamic studies were performed again（group C）.The evacuation situation were measured when the innervated muscle flap being five weeks of the operation，ultrasound B examination,histopathologic and urodynamic studies were done（group D）.Results Four cases recovered well but two intraluminal pressure of the