Chancellor M B, Rivas D A, Bourgeois I M
Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Neurourol Urodyn. 1996;15(3):223-33. doi: 10.1002/(SICI)1520-6777(1996)15:3<223::AID-NAU7>3.0.CO;2-H.
The purpose of this study was to utilize a rat model of bladder augmentation to determine the effect on bladder rupture pressure and volume of bladders augmented using myomyotomy autoaugmentation, intestinal patch ileocystoplasty alone, and a combination of ileocystoplasty and detrusor-myoplasty techniques. Four groups of female rats were studied: 1) sham animals served as controls, 2) ileocystoplasty, 3) autoaugmentation using a myomyotomy technique, and 4) ileocystoplasty reinforced with a rectus muscle flap to envelop the augmented bladder (detrusormyoplasty). One month after surgery bladder rupture pressure and volume were determined by cystometry. Sham control rats manifested bladder rupture at a mean pressure of 154 +/- 43 mmHg and mean volume of 2.5 +/- 2.0 ml. Myomyotomy animals demonstrated a diminished mean rupture pressure and rupture volume (101 +/- 13 mmHg and 1.2 +/- 0.4 ml, respectively) compared to control (both P < 0.05). Ileocystoplasty animals demonstrated bladder rupture at a significantly higher volume of 4.0 +/- 1.9 ml than either myomyotomy or control animals (P < 0.05), although rupture pressure of 111 +/- 49 mmHg did not differ significantly from control values (P = 0.55). The combination of ileocystoplasty and detrusor-myoplasty yielded a statistically significant increase in rupture pressure (262 +/- 108 mmHg) than the other three groups (P < 0.05). Rupture volume in this group of animals did not differ significantly from animals with ileocystoplasty but without detrusormyoplasty (P = 0.46). Bladder autoaugmentation results in a significantly reduced rupture pressure and volume than noted in the native bladder. Although ileocystoplasty significantly increases bladder capacity, the risk of urinary extravasation is also increased with this technique. The combination of ileocystoplasty and detrusor-myoplasty affords not only an increase in bladder capacity, but also significantly increases rupture pressure and thereby decreases the risk of bladder rupture after bladder augmentation.
本研究的目的是利用膀胱扩大术的大鼠模型，以确定肌层切开自体扩大术、单纯肠片回肠膀胱扩大术以及回肠膀胱扩大术与逼尿肌-肌成形术技术联合应用对膀胱破裂压力和膀胱容量的影响。研究了四组雌性大鼠：1）假手术动物作为对照，2）回肠膀胱扩大术，3）采用肌层切开技术的自体扩大术，4）用腹直肌瓣加强回肠膀胱扩大术以包裹扩大的膀胱（逼尿肌-肌成形术）。术后1个月，通过膀胱测压法测定膀胱破裂压力和容量。假手术对照大鼠在平均压力154±43 mmHg和平均容量2.5±2.0 ml时出现膀胱破裂。与对照组相比，肌层切开术动物的平均破裂压力和破裂容量降低（分别为101±13 mmHg和1.2±0.4 ml）（P均<0.05）。回肠膀胱扩大术动物的膀胱破裂容量显著高于肌层切开术或对照组动物，为4.0±1.9 ml（P<0.05），尽管其破裂压力111±49 mmHg与对照值无显著差异（P = 0.55）。回肠膀胱扩大术与逼尿肌-肌成形术联合应用使破裂压力比其他三组有统计学意义的显著增加（262±108 mmHg）（P<0.05）。该组动物的破裂容量与单纯回肠膀胱扩大术但未行逼尿肌-肌成形术的动物无显著差异（P = 0.46）。膀胱自体扩大术导致破裂压力和容量比正常膀胱显著降低。尽管回肠膀胱扩大术显著增加了膀胱容量，但该技术也增加了尿液外渗的风险。回肠膀胱扩大术与逼尿肌-肌成形术联合应用不仅增加了膀胱容量，而且显著增加了破裂压力，从而降低了膀胱扩大术后膀胱破裂的风险。
