膀胱出口梗阻对逼尿肌收缩力的影响及其与神经支配关系的研.doc

膀胱出口梗阻对逼尿肌收缩力的影响及其与神经支配关系的研究与神经的关系研究 封建立，孙道冬，蒙明森，颜加强，刘元丰，康元上，舒勇，高瑾，孙丹宁 重庆市中国人民解放军324医院泌尿外科，400020 [摘要] 目的：观察膀胱出口部分梗阻（PBOO）不同阶段逼尿肌收缩力及神经纤维密度的改变，探讨PBOO对逼尿肌收缩力的影响及其与神经的关系。方法：近端尿道结扎法建立大鼠PBOO模型，实验动物分为假手术6周组及8周组、梗阻6周组及8周组。通过测定膀胱排尿压及顺应性以及离体逼尿肌条收缩幅度评估逼尿肌收缩力；通过应用神经递质乙酰胆碱M受体激动剂阿托品以及阻滞剂卡巴可观察其对逼尿肌收缩的影响；采用免疫荧光组化法检测逼尿肌神经纤维表达。结果：梗阻6周组膀胱排尿压及顺应性较对照组显著升高；梗阻8周组较对照组显著降低。梗阻6周组逼尿肌条收缩幅度较对照组显著升高，加入阿托品后逼尿肌条收缩幅度有所降低，但仍较对照组高；梗阻8周组逼尿肌条收缩幅度较对照组显著降低，加入卡巴可后无明显改善。梗阻组逼尿肌中神经纤维密度随梗阻时间延长呈明显单向降低。结论：持续膀胱出口部分梗阻可以导致逼尿肌收缩力呈双向性改变，神经支配在此过程中影响有限，可能主要源于自身肌源性因素改变。 PBOO初期逼尿肌收缩力增强，神经因素部分参与其中，但自身肌源性因素可能占主导地位；后期逼尿肌收缩力减弱，去神经支配现象加重，但神经因素对逼尿肌收缩力的影响有待进一步研究。 [关键词] 膀胱出口部分梗阻；逼尿肌；神经支配 [中图法分类号] R361.2；R334.3; R363.14 The effects of partial bladder outlet obstruction on detrusor contractility and its relationship with the change of detursor innervation. Feng Jianli, Sun Daodong, Meng Mingsen, Yan Jiaqiang, Liu Yuanfeng, Kang Yuanshang, Gao Jin,Sun Danning. The Department of Urology,324 hospital of PLA, Chong Qing,400020 [Abstract] Objective: By studying the change of detrusor contractility and the [基金项目]?重庆市自然科学基金（ cstc2012jjA1566） [作者简介] 封建立，男，汉族，博士，主治医师。主要研究方向：膀胱功能障碍。联系方式：023E-mail： f-jianli@163.com. density of nerve fibres after partial bladder outlet obstruction(PBOO), to investigate the effects of PBOO on detrusor contractility and its relationship with the change of detursor innervation. Methods: Rat PBOO model was established by partial ligation of proximal urethra. All the experimental animal were divided into four groups: sham-operated 6 weeks(SO6), obstruction 6 weeks (OB6), sham-operated 8 weeks (SO8)and obstruction 8 weeks group(OB8). Muscle strips in vitro experiment and filling cystometry were used to assess detrusor contractility. And the effects of M receptor antagonist(atropine) or agonist(carbachol) on detrusor contractility were tested. The expression of nerve fibres(NF) were detected by immunofluorescence histochemistry. Results: The micturition pressure and bladder compliance of OB6 grou