Merguerian P A, Reddy P P, Barrieras D J, Wilson G J, Woodhouse K, Bagli D J, McLorie G A, Khoury A E
Division of Urology, Department of Cellular and Molecular Pathology and Department of Chemical Engineering, The Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada.
BJU Int. 2000 May;85(7):894-8. doi: 10.1046/j.1464-410x.2000.00513.x.
To evaluate the use of a large-segment (> 24 cm2) bladder substitution with porcine bladder acellular matrix allograft (BAMA) in a large animal model. Materials and methods Bladders were harvested from pigs at the time of necropsy and subjected to detergent and enzymatic extractions to render them acellular. The BAMA produced had the surgical handling and suture-retaining properties of normal bladder tissue. Six pigs had BAMA segments implanted under general anaesthesia, through a low midline abdominal incision and after partial cystectomy. The defect was repaired with a BAMA patch (mean size 43.88 cm2, range 12-72), with no urinary diversion. Two animals each were then killed at 9, 16 and 30 days and the bladders explanted. The native bladder and BAMA patch were analysed morphometrically to evaluate cellular re-population and matrix re-organization.
All animals survived surgery; there were no urinary leaks and no stones detected in any of the bladders. At 9 days there was a diffuse infiltration with acute inflammatory cells, but no areas of necrosis. There were isolated areas of smooth muscle cell (SMC) infiltration of the BAMA. At 16 days the luminal surface was lined with a single layer of urothelium, there was stromal infiltration with disorganized SMC and angiogenesis, with mature vessels in the BAMA patch. At 30 days the urothelium was multilayered with organizing groups of SMCs and angiogenesis. The highest cell density was at the periphery of the repopulated BAMA patch, decreasing towards the centre.
The implantation of large patches of BAMA is technically feasible and may prove to be a viable surgical alternative to bladder augmentation with intestinal segments. The advantages of BAMA include the potential for complete and functional regeneration of a bladder substitute. This model provides a tool with which to obtain a better understanding of the cellular and molecular aspects of matrix re-population.
在大型动物模型中评估使用猪膀胱脱细胞基质同种异体移植物（BAMA）进行大面积（>24 cm²）膀胱替代的效果。材料与方法在尸检时从猪身上获取膀胱，进行去污剂和酶处理使其脱细胞。制备的BAMA具有正常膀胱组织的手术操作和缝线保留特性。6头猪在全身麻醉下，经腹部正中低位切口并在部分膀胱切除术后植入BAMA段。用BAMA补片（平均大小43.88 cm²，范围12 - 72）修复缺损，不进行尿流改道。然后分别在9天、16天和30天处死2只动物并取出膀胱。对天然膀胱和BAMA补片进行形态计量分析，以评估细胞重新植入和基质重组情况。
所有动物手术存活；所有膀胱均未发现尿漏和结石。9天时，有急性炎症细胞弥漫浸润，但无坏死区域。BAMA有孤立的平滑肌细胞（SMC）浸润区域。16天时，腔面衬有单层尿路上皮，有基质浸润，SMC排列紊乱且有血管生成，BAMA补片中有成熟血管。30天时，尿路上皮为多层，有组织化的SMC组和血管生成。细胞密度最高处位于重新植入的BAMA补片周边，向中心逐渐降低。
植入大面积BAMA在技术上是可行的，可能被证明是一种可行的手术替代方案，可替代用肠段进行膀胱扩大术。BAMA的优点包括膀胱替代物完全功能性再生的潜力。该模型提供了一个工具，有助于更好地理解基质重新植入的细胞和分子方面。
