Andreoni Cassio R, Lin Hsueh-Kung, Olweny Ephrem, Landman Jaime, Lee David, Bostwick David, Clayman Ralph V
Division of Urology, Federal University, Sao Paulo, Brazil.
J Urol. 2004 Feb;171(2 Pt 1):859-69. doi: 10.1097/01.ju.0000108383.18165.f5.
Endopyelotomy (EP) has yet to equal the success achieved with open dismembered pyeloplasty. To understand better the ureteral response to EP we performed a timed histopathological evaluation of the porcine ureter after Acucise (Applied Medical, Rancho Santa Margarita, California) EP.
In 28 domestic pigs bilateral Acucise EPs were performed and bilateral 7Fr stents were placed. The kidneys, ureters and bladder were harvested after EP at 0, 1, 2, 3, 6, 12 and 18 hours, 1, 3 and 5 days, and 1, 2, 4 and 8 weeks. The stents were removed after 4 weeks. The healing area of the ureter was sectioned. Half was fixed in formalin 10%, stained and evaluated by light microscopy. The other half was frozen and reverse transcriptase-polymerase chain reaction was performed to measure steady state levels of epidermal growth factor, transforming growth factor (TGF)-alpha, TGF-beta 1, TGF-beta 2, TGF-beta 3, keratinocyte growth factor, vascular endothelial growth factor, insulin-like growth factor, platelet derived growth factor, collagen type 1, integrin and fibronectin transcript expression. Immunohistochemistry for actin, desmin and myosin expression was completed. The same studies were applied to the mid portion of the unoperated ureter.
Initial sealing of the ureterotomy defect was by blood clot and periureteral fat. Complete healing of the mucosa was observed at 2 weeks in animals without an associated urinoma. However, in no case did the muscle layer bridge the whole circumference of the ureter despite followup out to 8 weeks. In the operated ureter elevated expression of keratinocyte growth factor, vascular endothelial growth factor, TGF-alpha, TGF-beta 1, TGF-beta 3 and integrin was detected 2 hours after the operation and sustained for 7 to 14 days after the procedure. Immunohistochemistry revealed that most presumed myocytes seen in the defect were actually myofibroblasts. Persistent urinoma formation beyond the first few days appeared to slow the healing process.
Urothelium regenerated rapidly over an iatrogenic ureteral defect despite the absence of a lamina propria. Muscle cell coverage failed to occur completely at 8 weeks. In the initial 8 weeks of the healing process myofibroblasts appear to be prevalent. A persistent urinoma negatively impacts the healing process.
肾盂内切开术（EP）的成功率尚未达到开放性离断性肾盂成形术的水平。为了更好地了解输尿管对EP的反应，我们对应用Acucise（应用医疗公司，加利福尼亚州兰乔圣玛格丽塔）进行EP术后的猪输尿管进行了定时组织病理学评估。
对28头家猪进行双侧Acucise EP，并放置双侧7Fr支架。在EP术后0、1、2、3、6、12和18小时、1、3和5天以及1、2、4和8周时，摘取肾脏、输尿管和膀胱。4周后取出支架。将输尿管的愈合区域进行切片。一半固定在10%福尔马林中，染色后通过光学显微镜评估。另一半冷冻后进行逆转录聚合酶链反应，以测量表皮生长因子、转化生长因子（TGF）-α、TGF-β1、TGF-β2、TGF-β3、角质形成细胞生长因子、血管内皮生长因子、胰岛素样生长因子、血小板衍生生长因子、Ⅰ型胶原、整合素和纤连蛋白转录本的稳态水平。完成肌动蛋白、结蛋白和肌球蛋白表达的免疫组织化学检测。对未手术的输尿管中段进行同样的研究。
输尿管切开缺损最初由血凝块和输尿管周围脂肪封闭。在没有合并尿瘤的动物中，2周时观察到黏膜完全愈合。然而，尽管随访至8周，但在任何情况下肌肉层都未完全环绕输尿管。在手术侧输尿管中，术后2小时检测到角质形成细胞生长因子、血管内皮生长因子、TGF-α、TGF-β1、TGF-β3和整合素表达升高，并在术后持续7至14天。免疫组织化学显示，在缺损处看到的大多数假定的肌细胞实际上是肌成纤维细胞。最初几天之后持续形成尿瘤似乎减缓了愈合过程。
尽管没有固有层，但尿路上皮在医源性输尿管缺损上迅速再生。8周时肌肉细胞覆盖未完全形成。在愈合过程的最初8周，肌成纤维细胞似乎占主导。持续性尿瘤对愈合过程有负面影响。
