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目的研究撕脱输尿管有、无外膜包埋于肠系膜缘浆肌肠段能否重建血运的差异性。方法将33条杂交犬分A、B、C三组,分别是空白对照组5条,保留撕脱输尿管外膜组5条和去除撕脱输尿管外膜组15条(再分术后4周组、6周组、8周组各5条),分别制作保留离体输尿管外膜的模型和去除离体输尿管外膜的模型,再包埋于肠系膜缘浆肌层下,术后4、6、8周分别处死犬,取出移植输尿管进行病理检查。结果空白组输尿管黏膜肌层无变化,保留撕脱输尿管外膜输尿镜下原移植输尿管内膜层消失,见不到移行上皮细胞,输尿管肌层退化,变薄或消失,原外膜层出变成黄色钙化斑,内有大量炎性细胞侵润。去除撕脱输尿管外膜组镜下移植输尿管内膜存在,移行细胞核良好,细胞层较正常减少,但仍有2~3层。输尿管肌层存在,变薄与外周肠壁肌层融合血运重建存活。结论输尿管外膜是影响撕脱输尿管重建血运的重要因素,采取去除外膜后移植于肠系膜缘浆肌层肠段的方法,能够使其恢复血运而成活,证实该方法有可能是解决输尿管撕脱造成输尿管长段缺损的有效途径之一。
Objective To study whether the avulsion of the ureter can be reconstructed with or without embedding of the outer membrane in the intestinal segment of mesenteric margin. Methods 33 hybrid dogs were divided into three groups: A, B and C, which were blank control group 5, preserved avulsion ureter outer membrane group 5 and removed avulsion ureter outer membrane group 15 (4 weeks after re-operation group , 6 weeks group, 8 weeks group of 5), were made to keep the model of exine ureteral adventitia and remove the exine ureter model, and then buried in the mesenteric margin of the plasma layer, after 4,6, The dogs were sacrificed at 8 weeks and the ureters removed for pathological examination. Results In the blank group, there was no change in the muscular layer of the ureteral mucosa, the ureteral endothelium disappeared in the original transplanted ureteroscopic ureteroscope, and no transitional epithelial cells and ureteral myometrium degenerated, thinned or disappeared. Into the yellow calcified plaque, there are a large number of inflammatory cell infiltration. Removal of avulsed ureteral adventitia transplanted ureter endometrial exists, the transitional cell nucleus is good, the cell layer than the normal reduction, but there are still 2 to 3 layers. The presence of ureteral muscle, thinning and peripheral wall muscularis fusion revascularization and survival. Conclusions Ureteral adventitia is an important factor that affects the avulsion of ureteral reconstruction. By removing the adventitia and transplanting it into the intestinal segment of mesentery marginal muscle, it can restore blood circulation and survive, confirming that this method may be to solve the ureteral One of the effective ways to tear the long ureteral defect.