Furness P D, Kolligian M E, Lang S J, Kaplan W E, Kropp B P, Cheng E Y
Division of Pediatric Urology, Children's Memorial Hospital-Northwestern University Medical School, Chicago, Illinois, USA.
J Urol. 2000 Nov;164(5):1680-5.
We evaluated the possible use of small intestinal submucosa in endoscopic urological surgery by assessing the smooth muscle regenerative capabilities and physical response of various forms of injectable small intestinal submucosa in the canine model.
In blinded fashion we injected small intestinal submucosa in 12 dogs submucosally under direct vision using a 20 gauge endoscopic needle. The 4 small intestinal submucosa formulations varied in harvesting method and sterilization technique. Animals were divided into groups of 3 and sacrificed 2 weeks, 6 weeks, 3 months and 6 months after surgery. Each injection site was analyzed grossly and histologically. Smooth muscle regeneration was identified by alpha-smooth muscle actin immunohistochemical staining.
We identified 2 injectable small intestinal submucosa formulations that induced progressive smooth muscle regeneration at the site of submucosal injection compared with controls. De novo smooth muscle cells appeared in single cell aggregates as early as 6 weeks and in globular aggregates at 3 months. By 6 months early muscle bundle formation was noted. These 2 injectable small intestinal submucosa formulations also had the best submucosal volume preservation of about 25% of injected material during the study period.
Injectable small intestinal submucosa promotes progressive submucosal smooth muscle regeneration in the canine bladder. The combined regenerative and bulking abilities of injectable small intestinal submucosa make this compound unique and novel. The clinical usefulness of injectable small intestinal submucosa for endoscopic correction of reflux and incontinence deserves further investigation.
通过评估各种形式的可注射小肠黏膜下层在犬模型中的平滑肌再生能力和物理反应，我们评估了其在内镜泌尿外科手术中的可能用途。
我们以盲法使用20号内镜针在直视下将小肠黏膜下层黏膜下注射到12只犬体内。4种小肠黏膜下层制剂在采集方法和灭菌技术上有所不同。动物被分成每组3只，并在手术后2周、6周、3个月和6个月处死。对每个注射部位进行大体和组织学分析。通过α-平滑肌肌动蛋白免疫组织化学染色鉴定平滑肌再生。
我们确定了2种可注射小肠黏膜下层制剂，与对照组相比，它们在黏膜下注射部位诱导了渐进性平滑肌再生。新生平滑肌细胞最早在6周时以单细胞聚集体形式出现，3个月时以球状聚集体形式出现。到6个月时，注意到早期肌束形成。在研究期间，这2种可注射小肠黏膜下层制剂还具有最佳的黏膜下体积保留率，约为注射材料的25%。
可注射小肠黏膜下层促进犬膀胱黏膜下平滑肌的渐进性再生。可注射小肠黏膜下层的再生和填充能力相结合，使其具有独特性和新颖性。可注射小肠黏膜下层在内镜下矫正反流和尿失禁的临床实用性值得进一步研究。
