Eliçevik M, Celayir S, Dervisoglu S, Büyükünal S N
Department of Pediatric Surgery, Cerrahpasa Medical Faculty, University of Istanbul, Turkey.
Br J Urol. 1998 Jan;81(1):49-54. doi: 10.1046/j.1464-410x.1998.00459.x.
To compare the urodynamic, radiological and histopathological findings of a bladder autoaugmentation method combined with different seromuscular enterocystoplasty (mucosectomized) techniques and the rectus abdominis muscle-flap (RAMF) technique, and thus devise a method that may eliminate the potential risks of bladder autoaugmentation.
The study comprised 20 male New Zealand White rabbits in four groups. In group 1 (control), an autoaugmentation model was created by incising the detrusor muscle of the bladder, forming a large wide-mouthed bladder diverticulum. In group 2, a full-thickness RAMF with an intact vascular supply was used to cover the augmented bladder wall. In groups 3 and 4, besides the autoaugmentation procedure, a 5 cm ileal segment with an intact vascular supply was prepared and the muscosal layer of the segment removed. In group 3, the mucosectomized surface of the ileal graft was used to cover the autoaugmented bladder (seromuscular ileocystoplasty, SMEC) and in group 4, the serosal surface of the pedunculated ileal graft was used in reverse to cover the autoaugmented bladder wall (reversed SMEC, RSMEC). All groups were followed using intravenous pyelography (IVP), voiding cysto-urethrography (VCUG), urodynamic investigations and histopathological analysis for 2 months post-operatively.
In all groups except 2 (RAMF), a diffuse bulging of the bladder wall was detected on IVP and VCUG. In groups 1, 3 and 4, there was a significant increase in mean bladder capacity and the compliance also increased. However, in group 2 there was a significant reduction in bladder capacity and compliance, and the histopathological analysis showed severe fibrosis. The fibrotic changes were moderate in groups 1 and 4 and mild in group 3.
The urodynamic studies, IVP, VCUG and histopathology suggested that the SMEC technique decreased the potential risks of bladder autoaugmentation, had minimal side-effects and was the most appropriate coat over the uroepithelium after bladder autoaugmentation.
比较膀胱自体扩大术联合不同的浆肌层肠膀胱扩大术（黏膜切除）技术和腹直肌肌瓣（RAMF）技术的尿动力学、放射学及组织病理学结果，从而设计出一种可消除膀胱自体扩大术潜在风险的方法。
本研究包括20只雄性新西兰白兔，分为四组。第1组（对照组）通过切开膀胱逼尿肌建立自体扩大模型，形成一个大的宽口膀胱憩室。第2组使用具有完整血供的全层腹直肌肌瓣覆盖扩大的膀胱壁。第3组和第4组除了进行自体扩大手术外，还制备了一段5 cm且血供完整的回肠段，并去除该段的黏膜层。第3组使用回肠移植物的黏膜切除表面覆盖自体扩大的膀胱（浆肌层回肠膀胱扩大术，SMEC），第4组使用带蒂回肠移植物的浆膜表面反向覆盖自体扩大的膀胱壁（反向SMEC，RSMEC）。术后2个月，对所有组进行静脉肾盂造影（IVP）、排尿性膀胱尿道造影（VCUG）、尿动力学检查及组织病理学分析。
除第2组（RAMF）外，所有组在IVP和VCUG上均检测到膀胱壁弥漫性膨出。第1组、第3组和第4组平均膀胱容量显著增加，顺应性也增加。然而，第2组膀胱容量和顺应性显著降低，组织病理学分析显示严重纤维化。第1组和第4组纤维化改变为中度，第3组为轻度。
尿动力学研究、IVP、VCUG及组织病理学表明，SMEC技术降低了膀胱自体扩大术的潜在风险，副作用最小，是膀胱自体扩大术后覆盖尿路上皮的最合适方法。
