Yohannes Paulos, Rotariu Paul, Liatsikos Evangelos, Malik Aftab, Alexianu Mihai, Pinkasov David, Morgenstern Nora, Lee Benjamin R, Smith Arthur D
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
J Endourol. 2002 Oct;16(8):549-56. doi: 10.1089/089277902320913224.
To investigate the role of acellular collagen matrix (Surgisis during endopyelotomy.
Nine female pigs (25-35 kg) were enrolled in our protocol. The pigs were categorized as follows. Group I (N = 3) had endopyelotomy + insertion of SIS, Group II (N = 3) creation of UPJ stricture + endopyelotomy + insertion of SIS, and Group III (N = 3) Davis intubated ureterotomy using SIS. The contralateral side served as a control for each group (one pig in each group). In three pigs (two in Group III and one in Group II), Surgisis was treated with India ink prior to insertion at the endopyelotomy site. An endopyelotomy stent (14/8 F x 24 cm) was used to stent the ureteropelvic junction (UPJ) for 4 weeks. Four weeks after the stent was removed, laparoscopic nephroureterectomy was performed, and the animals were euthanized. Histopathologic analysis of the Surgisis-regenerated segment of the UPJ was performed using hematoxylin and eosin, reticular (collagen), smooth muscle actin, and S-100 (nerve) stains.
All animals tolerated the procedure. The mean operative time was 162 minutes. One pig (Group II) developed pyonephrosis; one pig (Group III) developed significant ascites and was sacrificed 2 week before the end of the experiment. Histopathologic analysis showed complete epithelializaton at 8 weeks. Reticular stain demonstrated abundant collagen matrix in the submucosa. Smooth muscle staining revealed myofibroblastic proliferation within the SIS-regenerated tissue adjacent to disorganized smooth muscle cells. India ink-stained SIS-regenerated tissue did not show smooth muscle cells. The S-100 stain did not demonstrate neurons at 8 weeks; however, in three pigs, peristaltic activity was noted across the UPJ.
The use of acellular collagen matrix in the endoscopic management of UPJ obstruction is a promising technique. The abundance of myofibroblasts and absence of abundant smooth muscle regeneration indicates a need to investigate the role of growth factors in SIS regeneration of host tissue.
探讨脱细胞胶原基质（Surgisis）在肾盂内切开术中的作用。
9只雌性猪（25 - 35千克）纳入本研究方案。猪被分为以下几组。第一组（N = 3）进行肾盂内切开术 + 植入SIS；第二组（N = 3）制造肾盂输尿管连接部（UPJ）狭窄 + 肾盂内切开术 + 植入SIS；第三组（N = 3）使用SIS进行戴维斯插管输尿管切开术。每组对侧作为对照（每组1只猪）。在3只猪（第三组2只，第二组1只）中，Surgisis在植入肾盂内切开术部位前用印度墨水处理。使用肾盂内切开术支架（14/8 F×24厘米）对输尿管肾盂连接部（UPJ）进行支架置入4周。支架取出4周后，进行腹腔镜肾输尿管切除术，并处死动物。使用苏木精和伊红、网状（胶原）、平滑肌肌动蛋白和S - 100（神经）染色对UPJ的Surgisis再生段进行组织病理学分析。
所有动物均耐受该手术。平均手术时间为162分钟。1只猪（第二组）发生肾积脓；1只猪（第三组）出现大量腹水，在实验结束前2周处死。组织病理学分析显示8周时完全上皮化。网状染色显示黏膜下层有丰富的胶原基质。平滑肌染色显示在与紊乱的平滑肌细胞相邻的SIS再生组织内有成肌纤维细胞增殖。印度墨水染色的SIS再生组织未显示平滑肌细胞。S - 100染色在8周时未显示神经元；然而，在3只猪中，观察到UPJ有蠕动活动。
在UPJ梗阻的内镜治疗中使用脱细胞胶原基质是一种有前景的技术。成肌纤维细胞丰富而平滑肌再生不丰富表明需要研究生长因子在宿主组织SIS再生中的作用。
