Caione P, Capozza N, Zavaglia D, Palombaro G, Boldrini R
Division of Pediatric Urology, Department of Nephrology and Urology, Bambino Gesù Children's Hospital and Research Institute, 00165, Rome, Italy.
Pediatr Surg Int. 2006 Jul;22(7):593-9. doi: 10.1007/s00383-006-1705-9. Epub 2006 Jun 14.
Significant side effects are correlated with bladder augmentation. Recently, small intestinal submucosa (SIS) has been proposed for clinical use. The efficacy of SIS bladder regeneration was studied in a porcine experimental model. Partial cystectomy (40-60% of bladder wall) was performed and replaced by SIS graft. Animals were planned to be killed at 2 weeks, 5 weeks and 3 months. Bladder capacity at 40 cmH(2)O pressure and macroscopic graft morphology were assessed before and after SIS implant. Histological examination was carried out with computer assisted morphometric analysis for collagen/smooth muscle ratio. Student's t test was adopted for statistical analysis. Two piglets died on the 9th and 10th post-operative day due to urinary peritonitis. The remaining piglets were killed after uneventful post-operative period at 5 weeks (two animals) and 3 months (two animals). The bladder capacity was reduced (-18%) at the 5 week follow-up and quite similar to the pre-operative volume (+2.5%) at the 3 months control. No diverticular formation, bladder calculi, mucus and urinary infection were found. The SIS graft resulted not significantly contracted. Histology at 10 days showed SIS membrane lined by transitional epithelium islands with some capillaries. At 5 weeks, transitional epithelium was fully covering the graft; new blood vessels and fibroblasts with smooth muscle cells were observed. At 3 months, the SIS was not evident. Two layers were defined: inner transitional epithelium, outer collagen with fibroblasts and muscular bundles. Computer assisted morphometric analysis showed collagen/muscle ratio 70/30% (normal bladder=56/44%, P<0.05). The SIS was effective as a scaffold for bladder wall regeneration in four out of six animals. Long-term studies are required to confirm the efficacy of the newly developed wall and for eventual clinical use.
严重的副作用与膀胱扩大术相关。最近，有人提出将小肠黏膜下层（SIS）用于临床。在猪实验模型中研究了SIS膀胱再生的效果。进行了部分膀胱切除术（切除膀胱壁的40 - 60%），并用SIS移植物进行替代。计划在2周、5周和3个月时处死动物。在植入SIS前后评估40 cmH₂O压力下的膀胱容量和宏观移植物形态。采用计算机辅助形态计量分析对胶原/平滑肌比例进行组织学检查。采用学生t检验进行统计分析。两只仔猪在术后第9天和第10天因尿性腹膜炎死亡。其余仔猪在术后恢复顺利后，于5周（两只动物）和3个月（两只动物）时处死。在5周随访时膀胱容量降低（-18%），在3个月对照时与术前容量相当（+2.5%）。未发现憩室形成、膀胱结石、黏液和泌尿系统感染。SIS移植物未出现明显收缩。术后10天的组织学检查显示SIS膜内衬有一些毛细血管的移行上皮岛。5周时，移行上皮完全覆盖移植物；观察到新的血管和成纤维细胞以及平滑肌细胞。3个月时，SIS不明显。可分为两层：内层为移行上皮，外层为含有成纤维细胞和肌束的胶原。计算机辅助形态计量分析显示胶原/肌肉比例为70/30%（正常膀胱为56/44%，P<0.05）。在六只动物中的四只，SIS作为膀胱壁再生的支架是有效的。需要进行长期研究以证实新开发的膀胱壁的疗效并最终用于临床。
