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目的长段输尿管狭窄或缺损的修复是泌尿外科棘手问题,将犬自体膀胱黏膜移植于浆肌层肠段重建输尿管,探讨其作为尿路替代材料重建输尿管的可行性。方法成年比格犬12条,体重6.5～9.3kg,雌雄不限,根据重建输尿管部位不同将其随机分成A、B、C组(n=4)。A组:自体膀胱黏膜移植于浆肌层肠段后包缝于人工输尿管支架制备人工输尿管,重建8cm长下段输尿管,将人工输尿管近端与上段输尿管断端吻合,远端与膀胱吻合。B组:同A组方法重建8cm长上段输尿管,将人工输尿管近端与肾盂吻合,远端与下段输尿管断端吻合。C组:同A组方法重建全段16cm长输尿管,将人工输尿管近端与肾盂吻合,远端与膀胱吻合。术前各组犬取血行肾功及电解质检测;术后观察犬的一般情况及支架管和造瘘管的引流、手术切口的愈合、并发症的发生等情况。术后第6周行生化指标复查及静脉尿路造影(intravenous urography,IVU)检查后,对人工输尿管行大体及组织学观察。结果B组1条犬术后2d因输尿管支架脱出,术后发生尿瘘及伤口感染,排除实验;其余犬术后均无并发症发生。术后第6周各组犬肾功和电解质检测与术前比较,差异均无统计学意义(P>0.05)。IVU显示:A组1条犬术侧肾脏积水、上段输尿管扩张,B组1条犬人工输尿管与下段输尿管吻合口狭窄、同侧肾脏积水;其余各组犬术侧肾脏功能良好,人工输尿管有蠕动功能。组织病理学观察示术后第6周3组人工输尿管组织结构与正常输尿管相似,其中A、C组各1条犬出现人工输尿管炎症。结论自体膀胱黏膜移植于浆肌层肠段重建犬输尿管,可形成组织结构与正常输尿管相似的人工输尿管,且功能良好。
Objective The long segment of ureteral stricture or defect repair is a difficult problem of urology, the canine autologous bladder mucosa transplanted in the intestinal muscle rectum reconstruction of the ureter to explore its feasibility as a urinary tract replacement material reconstruction ureter. Methods 12 adult Beagle dogs weighing 6.5 to 9.3 kg were randomly divided into groups A, B and C according to the different ureteral sites (n = 4). Group A: The autologous bladder mucosa was transplanted in the intestine of the muscular layer, then the artificial urethra was sutured in the artificial ureteral stent. The lower ureter of 8 cm long was reconstructed. The proximal ureter and proximal ureter were anastomosed, and the distal end anastomosed with the bladder. Group B: With the method of Group A reconstruction of the upper ureter 8cm long, the proximal artificial ureter and renal pelvis anastomosis, distal and lower ureter anastomosis. Group C: A group with the same method to reconstruct the entire section of 16cm long ureter, artificial ureter near the anastomosis and renal anastomosis, distal and anastomosis. Preoperative blood samples were taken for renal function and electrolyte testing; postoperative observation of the general situation of dogs and stent tube and fistula drainage, surgical incision healing, complications and so on. At the 6th week after operation, biochemical indexes and intravenous urography (IVU) were used to examine the gross and histological findings of the ureter. Results One dog in group B was removed 2 days after operation due to ureteral stenting, urinary fistula and wound infection occurred after operation, and the experiment was excluded. No complications occurred in the remaining dogs. There was no significant difference in renal function and electrolyte between the 6th week and the preoperative in each group (P> 0.05). IVU showed: A group of 1 canine kidney hydronephrosis, the upper ureteral dilatation, B group 1 dog artificial urethra and lower ureter anastomosis stenosis, ipsilateral renal hydronephrosis; other groups canine side of the kidney function well, artificial ureter Have a motility function. Histopathological examination showed that the structure of artificial urethra in 3 groups at 6 weeks after operation was similar to that of normal ureter, and 1 dog in group A and C had inflammation of artificial ureter. Conclusion Autologous bladder mucosa is transplanted in the intestine of the muscular layer to reconstruct the canine ureter, which can form the artificial urethra with the same histological structure as the normal ureter with good function.