微创医学

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。

ObjectiveTo study the differences of the reconstruction of ureter through autologous transplantation in intestinal segment of mesangial marginal muscle of avulsion of ureter without or with adventitial layer. Methods33 hybrid dogs were divided into three groups(group A, B and C): A.respectively 3 dogs for reference, B. 15 dogs with avulsion of ureter with adventitial layer, C. 15 dogs with avulsion of ureter without adventitial layer (further divide in to 4-weeks group, 6-weeks group and 8-weeks group,five dogs in each group), next, autologous transplanted relevant ureter models into their intestinal segment of mesangial marginal muscle, embedded in the inferior mesenteric border.The dogs were sacrificed at 4, 6 and 8 weeks after operation, and the ureters were removed for histopathological examination. ResultsA. The 3 blank control groups for reference has no change in muscularis mucosae; B. the intimal layer of the 15 with avulsion of ureter with adventitial layer disappeared, without any transitional epithelial cell, when its muscularis mucosae of ureter degenerated, thinned or disappeared, together with yellow calcified spots and inflammatory cell infiltration arsing on the adventitial layer; C. the intimal layer 15 with avulsion of ureter without adventitial layer still existed, with good transitional epithelial cell, when the cell layer reduced but still maintained 2-3 layers and its muscularis mucosae of ureter thinned and survived, which indicating the feasibility of the reconstruction of ureter. ConclusionAdventitia ureter has shielding effect, the rich capillary network can nourish the ureter, isolated outer membrane is also affecting the avulsion of ureteral smooth muscle, mucosa and graft bed ,it is also important factor of revascularization.The method of autologous transplantation in intestinal segment of mesangial marginal muscle of avulsion of ureter without adventitial layer can restore the blood supply and assure survival, confirming that the method may be a solution to solve the problem of long segment defect of ureter caused by avulsion of ureter.