Gill H S, Wein A J, Ruggieri M R, Whitmore K E, Levin R M
Division of Urology, University of Pennsylvania School of Medicine, Philadelphia.
J Urol. 1989 Sep;142(3):860-4. doi: 10.1016/s0022-5347(17)38931-0.
Although the use of ileocystoplasty has increased significantly in recent years, very little is known concerning the smooth muscle properties of the implanted bowel segment. In a previous study, preliminary evidence was presented which indicated that the pharmacological response of the cytoplastic ileal segment to autonomic agonists changed toward that of the bladder. The present study extends and expands these preliminary observations on the physiology and pharmacology of augmentation cystoplasty. Augmentation cystoplasty with detubularized ileum was carried out in 16 rabbits. In vivo and in vitro physiological and pharmacological studies were carried out one and three months after surgery. The results can be summarized as follows: 1) in-vivo CMG at one month was similar to that of the preoperative bladder, but at three months there was a 24% increase in capacity, with the presence of multiple phasic contractions beginning at a volume of approximately 65% of capacity. 2) The frequency and magnitude of spontaneous activity in the cystoplastic ileum did not significantly alter from that of the normal ileum. 3) Cystoplastic ileum responded to muscarinic stimulation differently from the normal ileum. The bladder responded with an increase in the tension whereas the ileum responded with an increase in the frequency and amplitude of phasic contractions. The cystoplastic ileum responded with a pronounced sustained contraction with phasic contractions superimposed. The tonic contraction at three months was of a significantly greater magnitude than that at one month. 4) The qualitative and quantitative response to field stimulation of the cystoplastic ileum was altered from that of the ileum towards that of the bladder. 5) The normal bladder contains greater amount of creatine phosphate and lesser amounts of creatine than the normal ileum. Cystoplasty, after three months induced a change in the ileal segment towards the bladder (increased creatine phosphate and decreased creatine). 6) The normal ileum was found to have greater number of muscarinic receptors than the normal bladder whereas the cystoplastic ileum at three months was intermediate.
尽管近年来回肠膀胱扩大术的应用显著增加，但对于植入肠段的平滑肌特性却知之甚少。在先前的一项研究中，有初步证据表明，去管状化回肠段对自主神经激动剂的药理反应向膀胱的反应转变。本研究扩展并深化了这些关于膀胱扩大术生理和药理学的初步观察。对16只兔子进行了去管状化回肠的膀胱扩大术。在术后1个月和3个月进行了体内和体外生理及药理学研究。结果可总结如下：1）术后1个月时的体内膀胱测压图与术前膀胱相似，但在3个月时容量增加了24%，在容量约为其65%时开始出现多次相性收缩。2）膀胱扩大术后回肠的自发活动频率和幅度与正常回肠相比无明显改变。3）膀胱扩大术后回肠对毒蕈碱刺激的反应与正常回肠不同。膀胱的反应是张力增加，而回肠的反应是相性收缩的频率和幅度增加。膀胱扩大术后回肠出现明显的持续性收缩并叠加相性收缩。3个月时的强直性收缩幅度明显大于1个月时。4）膀胱扩大术后回肠对场刺激的定性和定量反应从回肠的反应向膀胱的反应转变。5）正常膀胱中的磷酸肌酸含量高于正常回肠，而肌酸含量低于正常回肠。膀胱扩大术3个月后，回肠段向膀胱方向发生了变化（磷酸肌酸增加，肌酸减少）。6）发现正常回肠的毒蕈碱受体数量多于正常膀胱，而3个月时的膀胱扩大术后回肠则介于两者之间。
