Cetinel Bülent, Demirkesen Oktay, Cetinel Sule, Gül Umit, Kiliç Nurten, Solok Vural
Department of Urology, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey.
Urol Int. 2003;71(3):246-50. doi: 10.1159/000072673.
The aim of the present study was to evaluate the results of the use of a new technique, i.e. transversely tubularized bowel segment (TTBS) for segmental ureteral replacement in pigs. Eight pigs had segmental left ureteral replacement with the TTBS technique, via midline incision in 5 and flank incision in 3. The right ureters were left untouched and used as controls. The pigs were evaluated by excretory urography approximately 3 months after surgery and then sacrificed thereafter, harvesting the kidneys, ureters, and the bladders en bloc for macroscopic and histologic examination. Three pigs died in the early postoperative period. The remaining 5 pigs were followed for 82-112 days. Postoperative intravenous urograms revealed moderate ureterohydronephrosis in 2, mild ureteral dilation in 1, and normal upper tracts in 2. The 2 pigs with moderate ureterohydronephrosis had had midline incisions, and examination after having sacrificed these pigs revealed many intestinal adhesions to the anastomotic region. Easy catheterization of each left ureter through ileal ureteral segment and histologic examination thereafter demonstrated that all ileal ureteral segments including anastomotic sites were patent. Adjacent to the junctional area, metaplastic transitional epithelium covered atrophic villi and in some regions crypts as well. Ureteral replacement by the TTBS technique seems to be a safe and effective surgical treatment option in segmental ureteral defects in short term. However, long-term follow-up studies are needed.
本研究的目的是评估一种新技术，即横向管状化肠段（TTBS）用于猪输尿管节段替代的效果。8头猪采用TTBS技术进行左侧输尿管节段替代，其中5头经中线切口，3头经侧腹切口。右侧输尿管未处理，用作对照。术后约3个月通过排泄性尿路造影对猪进行评估，之后将猪处死，整块摘取肾脏、输尿管和膀胱进行大体和组织学检查。3头猪在术后早期死亡。其余5头猪随访82 - 112天。术后静脉尿路造影显示，2头猪有中度输尿管肾盂积水，1头猪有轻度输尿管扩张，2头猪上尿路正常。2头有中度输尿管肾盂积水的猪采用中线切口，处死这些猪后检查发现吻合区域有许多肠粘连。通过回肠输尿管段对每条左侧输尿管进行轻松插管，随后的组织学检查表明，包括吻合部位在内的所有回肠输尿管段均通畅。在连接区域附近，化生的移行上皮覆盖萎缩的绒毛，在某些区域也覆盖隐窝。TTBS技术进行输尿管替代在短期内似乎是治疗输尿管节段缺损的一种安全有效的手术选择。然而，需要进行长期随访研究。
