摘要
目的通过观察脊髓圆锥损伤膀胱功能重建术后大鼠膀胱逼尿肌及神经肌肉接头(neuromuscularjunction,NMJ)的形态学变化规律,探讨膀胱重建术抑制或改善膀胱逼尿肌退行性变的可行性。方法成年雌性SD大鼠104只,体重200～250 g,随机分为3组,正常组(n=8)、脊髓圆锥损伤对照组(对照组,n=48)及脊髓圆锥损伤膀胱功能重建组(实验组,n=48)。正常组大鼠不作任何处理;对照组大鼠采用L4、5平面锐性横断脊髓制作脊髓圆锥损伤模型;实验组在脊髓圆锥损伤模型基础上将双侧L5前、后根与S2前、后根吻合制作脊髓圆锥损伤后膀胱功能重建模型。术后观察大鼠存活情况,于术后3 d及1、2、3、4、5、6个月前连续3 d分别测定大鼠残余尿量;术后1、2、3、4、5、6个月取膀胱逼尿肌行HE染色观测肌纤维截面积变化规律,Masson三色染色计算结缔组织百分比,透射电镜观察膀胱逼尿肌和NMJ的变化。结果术后11只大鼠死亡,均对应补充。对照组术后膀胱残余尿量随时间延长逐渐增加(P<0.05);实验组术后膀胱残余尿量逐渐增加,3个月后逐渐减少,除术后3 d与5个月比较差异无统计学意义(P>0.05)外,其余各时间点间比较差异均有统计学意义(P<0.05)。两组间除术后3 d及1、2个月外,其余各时间点比较,差异均有统计学意义(P<0.05)。HE染色及Masson三色染色示,对照组术后逼尿肌肌纤维排列紊乱、萎缩随时间延长逐渐加重,肌束间大量结缔组织浸润;实验组术后4、5、6个月逼尿肌形态逐渐恢复,结缔组织数量无明显增加。各时间点对照组及实验组逼尿肌肌纤维截面积及结缔组织百分比与正常组比较,差异均有统计学意义(P<0.05)。对照组随时间延长逼尿肌肌纤维截面积逐渐减小,结缔组织百分比逐渐增加(P<0.05)。实验组中术后3个月内随时间延长逼尿肌肌纤维截面积下降,4个月后逐渐增大;结缔组织百分比随时间延长缓慢增
Objective To study the microstructural change of detrusor muscle and neuromuscular junction （NMJ） after bladder functional reconstruction for atonic bladder caused by medullary cone injury and to discuss the feasibility of bladder functional reconstruction for improving the detrusor muscle degeneration. Methods A total of 104 adult female Sprague-Dawley rats （weighing, 200-250 g） were randomized divided into 3 groups： normal group （n=8）, control group （n=48）, and experimental group （n=48）. No treatment was given in normal group; the medullary cone injury was established by sharp transection of spinal cord at L4, 5 levels in control group; and the anastomosis of bilateral L5 ventral root （VR）-S2 VR and L5 dorsal root （DR）-S2 DR was performed for bladder functional reconstruction after modeling of medullary cone injury in experimental group. After operation, the survival condition of rats was observed. At 3 days and 3 consecutive days before 1, 2, 3, 4, 5, and 6 months after operation, the residual urine volume was measured; at 1, 2, 3, 4, 5, and 6 months after operation, the detrusor muscle was harvested to measure the muscle fiber cross-sectional area by HE staining, to calculate the percentage of connective tissue by Masson trichrome staining, and to observe the ultrastructure of the detrusor muscle and the NMJ by transmission electron microscope （TEM）. Results Eleven rats were supplemented because of death after operation. In control group, a significant increase of the residual urine volume was observed with the extension of time （P 〈 0.05）; in experimental group, an increase was observed at the first 3 months after operation, and then gradually decreased, showing significant differences between the other time point （P 〈 0.05） except between at 3 days and at 5 months after operation （P 〉 0.05）; there was significant difference between control and experimental groups at other each time point （P 〈 0.05） except at 3 days, 1 month, and 2 months （P 〉 0.0
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第7期836-842,共7页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
脊髓圆锥损伤
膀胱功能重建
逼尿肌
神经肌肉接头
大鼠
Medullary cone injury Bladder functional reconstruction Detrusor muscle Neuromuscular junction Rat
