Rehman Jamil, Ragab Maged M, Venkatesh Ramakrishna, Sundaram Chandru P, Khan S Ali, Sukkarieh Troy, Samadi David, Chughtai Bilal, White Francis, Bostwick David, Waltzer Wayne
Department of Urology, SUNY-Stony Brook University School of Medicine, Stony Brook, New York 11794-8093, USA.
J Endourol. 2004 Dec;18(10):982-8. doi: 10.1089/end.2004.18.982.
Endopyelotomy is the preferred treatment for ureteropelvic junction (UPJ) obstruction because of its short operating time, limited morbidity, fast recovery, and reasonable efficacy. We used tissue and immunohistochemistry staining and electron microscopy to look at the muscle regeneration following an endopyelotomy incision in a porcine model.
Bilateral electrosurgical endopyelotomy was performed in six domestic pigs with placement of 7F 20-cm Percuflex double-J stents for up to 4 weeks, and urinary tracts were harvested at 3 or 5 months. Specimen evaluation included tissue staining with hematoxylin-eosin, Masson's trichrome, and Verhoeff's iodine and Van Gieson solution; histochemical staining for smooth-muscle actin, desmin and myosin staining, and electron microscopy. Each specimen was assigned a "healing" score of 0 (normal) 1 (slight changes), 2 (mild changes), or 3 (severe changes). The fibrosis score was based on six factors: muscle layer fibrosis, lamina propria fibrosis, amount of granulation tissue present, new deposits of collagen, fibrosis in the periureteral fat, and presence of myofibroblasts. The muscles were characterized with immunohistochemistry and electron microscopy.
At both 3 and 5 months, the urothelium was healed, and the lamina propria was healed with focal loss. By 3 months, smooth-muscle bundles bridged the defect, and by 5 months, the whole defect was covered. Smooth muscle cells were evident by electron microscopy by 3 months, and actin and myosin could be detected by immunohistochemistry. Desmin-positive cells accounted for 50% of the population at 3 months and 40% at 5 months. The regenerated smooth-muscle bundles were oriented in different directions and intermingled with fibrous tissue. They could be distinguished easily from normal ureter under the microscope.
Verifiable, functional smooth-muscle bundles bridge the endopyelotomy defect by 3 months, as confirmed by immunohistochemistry staining and electron microscopy.
肾盂内切开术因其手术时间短、发病率低、恢复快且疗效合理，是治疗肾盂输尿管连接部（UPJ）梗阻的首选方法。我们运用组织学、免疫组织化学染色及电子显微镜技术，观察猪模型肾盂内切开术后的肌肉再生情况。
对6只家猪进行双侧电刀肾盂内切开术，并置入7F 20厘米的Percuflex双J支架，留置长达4周，于3或5个月时采集尿路标本。标本评估包括苏木精-伊红染色、马松三色染色、韦尔霍夫碘染色及范吉森溶液染色；平滑肌肌动蛋白、结蛋白和肌球蛋白的组织化学染色，以及电子显微镜检查。每个标本依据“愈合”情况分为0分（正常）、1分（轻微改变）、2分（轻度改变）或3分（重度改变）。纤维化评分基于六个因素：肌层纤维化、固有层纤维化、肉芽组织量、新胶原沉积、输尿管周围脂肪纤维化及肌成纤维细胞的存在情况。通过免疫组织化学和电子显微镜对肌肉进行特征分析。
在3个月和5个月时，尿路上皮均已愈合，固有层愈合但有局灶性缺失。到3个月时，平滑肌束连接了缺损处，到5个月时，整个缺损被覆盖。3个月时电子显微镜下可见平滑肌细胞，免疫组织化学可检测到肌动蛋白和肌球蛋白。3个月时结蛋白阳性细胞占细胞总数的50%，5个月时占40%。再生的平滑肌束方向各异，并与纤维组织交织在一起。在显微镜下可轻易与正常输尿管区分开来。
免疫组织化学染色和电子显微镜证实，术后3个月可验证的功能性平滑肌束连接了肾盂内切开术的缺损处。
