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

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1、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（internalobliqueflap，IOF）逼尿肌肌成形术治疗逼尿肌无收缩（acontractiledetrusor，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

2、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40ml、80ml、120ml，刺激支配IOF之腰神经支，模型内压力分别达到（±）cmH2O、（±）cmH2O、（±）cmH2O，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17/17Experiment

3、alstudyonpedicledinternalobliquemuscleflapdetrusormyoplastyfordetrusorassistanceincaseofacontractiledetrusor［Abstract］ObjectiveExperimentalstudieswereundertakentoinvestigatethepracticabilityoftransferingpedicledinternalobliquemuscleflaptothebladder，andtolookforpossibletechniquesenhan

4、cingevacuationofareservoirasthebladderbythemuscleelucidatethepotentialvalueofthetechnicallyfeasiblesurgicalprocedurethatmayeventuallyprovideatreatmentFromMarchtoMay2017，sixmaledogswereusedfortheinternalobliquemusclewasdissectedandtailoredtobemuscleflapwasandthenwrappedaroundabladderm

5、odelvaryingintraluminalpressuremeasurementswererecordedwhentheinnervatedmuscleflapwasbeingbladderwasexploredandurodynamicstudieswereperformed（groupA）.Atthedome，thebladderwallwasremoved，withupto50percentofthemucosallayerbeingleftintactandurodynamicstudieswereperformed（groupB）.Thepedic

6、ledinternaloblique17/17muscleflapwasrotationedandwrappedabout70%ofthebladder，urodynamicstudieswereperformedagain（groupC）.Theevacuationsituationweremeasuredwhentheinnervatedmuscleflapbeingfiveweeksoftheoperation，ultrasoundBexamination,histopathologicandurodynamicstudiesweredone（groupD

7、）.ResultsFourcasesrecoveredwellbuttwointraluminalpressureofthemodelwere（±）cmH2O，（±）cmH2O,（±）cmH2Orespectivelywhentheinnervatedmuscleflapwasbeingstimulated，dependingonthevaryingvolume（40ml,80ml,120mlrespectively）.ThemaximumcapacityofthebladderweregroupA（±）ml，groupB（±）ml，groupC（±）ml，gr

8、oupD（±）ml;th