Cheng E, Rento R, Grayhack J T, Oyasu R, McVary K T
Department of Urology, Northwestern University Medical School, Chicago, Illinois 60611-3008.
J Urol. 1994 Dec;152(6 Pt 2):2252-7. doi: 10.1016/s0022-5347(17)31652-x.
Reversed seromuscular flaps of ileum and standard bowel replacement procedures were performed in 16 dogs to evaluate their potential to decrease the likelihood of recognized complications in cases of standard bowel replacement. Of 12 dogs augmentation cystoplasty was done in 6 and ureteral replacement was done in 6. In each group 4 procedures were performed using reversed seromuscular flap, while the remaining 2 were done in the conventional manner (controls). All flap animals had partial to full re-epithelialization with transitional cells but they also had gross and microscopic evidence of flap contraction at the end of 6 months. In the flap augmentation group intravesical pressure measured preoperatively at bladder volumes of 30 cc and 60 cc averaged 25.8 and 45.8 mm. Hg compared to sacrifice pressures of 56.7 and 80.8 mm. Hg. Monthly serum blood urea nitrogen measurements were lower in reversed seromuscular flap animals compared to controls. An additional 4 dogs were studied to help elucidate the etiology of graft contraction, of which 2 underwent reversed seromuscular flap enterocystoplasty with no mucosal stripping while 2 had a procedure exposing intact intestinal serosa to the lumen of the bladder and urine. All of these animals demonstrated good re-epithelialization of the serosal surface with transitional cells as well as little or no evidence of flap fibrosis or contraction. Our results demonstrate that the use of reversed seromuscular flaps in the urinary tract in dogs results in good re-epithelialization of the serosal surface with transitional cells but also flap contraction. This fibrosis and scarring process is largely due to the trauma of mucosal stripping and not urine contact.
对16只狗进行了回肠逆血清肌瓣和标准肠置换手术，以评估其在标准肠置换病例中降低公认并发症发生率的潜力。12只狗中，6只进行了扩大膀胱成形术，6只进行了输尿管置换术。每组中，4例手术采用回肠逆血清肌瓣，其余2例采用传统方式（对照组）。所有使用瓣片的动物的浆膜表面均有部分至完全的移行细胞重新上皮化，但在6个月末也有肉眼和显微镜下瓣片收缩的证据。在瓣片扩大组中，术前膀胱容量为30毫升和60毫升时测量的膀胱内压平均分别为25.8毫米汞柱和45.8毫米汞柱，而处死时的压力分别为56.7毫米汞柱和80.8毫米汞柱。与对照组相比，回肠逆血清肌瓣动物的每月血清尿素氮测量值较低。另外对4只狗进行了研究，以帮助阐明移植物收缩的病因，其中2只进行了不剥离黏膜的回肠逆血清肌瓣肠膀胱扩大成形术，2只进行了将完整肠浆膜暴露于膀胱腔和尿液的手术。所有这些动物的浆膜表面均有良好的移行细胞重新上皮化，且几乎没有或没有瓣片纤维化或收缩的证据。我们的结果表明，在狗的泌尿道中使用回肠逆血清肌瓣可使浆膜表面有良好的移行细胞重新上皮化，但也会出现瓣片收缩。这种纤维化和瘢痕形成过程主要是由于黏膜剥离的创伤，而非尿液接触。
