摘要
目的通过动物实验阐明复合球囊前列腺扩张术(TUDP)治疗前列腺增生的有效机制并观察其安全性。方法10只老年雄犬随机分为扩张组和对照组,扩张组采用改造后的球囊扩张膜部尿道、前列腺尿道和膀胱颈5 min,然后减压至0.1 mPa,使球囊不压迫膜部尿道,维持扩张时间30 min,释放球囊压力,留置扩张管1周,术后1周行各项检查。对照组行假手术。两组在试验终点时行膀胱镜、膀胱压力测定、尿动力学、神经肌电点位测定和组织病理学检查。结果行TUDP后扩张组前列腺尿道直径明显增粗,无出血及尿外渗等严重并发症发生。尿动力学提示扩张前后膀胱排尿点压力无明显变化,尿道外括约肌无明显功能损伤。尿道外括约肌受损微小,保持了正常肌电特性和排尿功能。组织病理学证实扩张组前列腺包膜裂开,尿道扩张明显,扩张的前列腺内可见炎症反应、微小坏死、间质出血、平滑肌纤维变性。马森三色染色结果提示,前列腺尿道在扩张后胶原含量减少。结论动物实验证实应用复合球囊行TUDP术安全、可行,其机理可能是充分而适当的扩张使尿道明显变宽,前列腺组织炎性浸润、平滑肌纤维变性及胶原含量减少使其无法回缩,而周围组织填塞入裂开的前列腺包膜使裂开的腺体无法复位。
Objective To improve the clinical effect of transurethral balloon dilation of the prostate （TUDP）, a single balloon was modified to a composite one. Thus the balloon diameter and the dilatation site were increased, and the expansion time was extended. Animal experiments were conducted to clarify its effective mechanism and to observe its security. Methods Ten aged male dogs were used in this experiment and randomly divided into two groups, including a balloon dilation group and a control group with sham surgery. The authors first dilated the membranous urethra, prostatic urethra and bladder neck for 5 minutes at 0.3 mPa pressure, then decompressed to 0.1 mPa in order not to oppress membranous urethra. After 30 minutes, the authors released the balloon stress, retained the dilation tube for 1 week, and then examined the data. At the end of the experiment, the authors performed cystoscopy, voiding pressure （VP）, urodynamic graph, nerve-myoelectricity, and histological examination to evaluate the effectiveness and safety. Results After dilation, the diameters of prostatic urethra were significantly enlarged. There was not serious complications, such as bleeding and urinary extravasation. The bladder voiding pressure before and after the dilation had no significant changes and the urethral sphincter function had no significant injury. The urethral sphincter smooth muscle maintained normal myoelectricity and normal urination cycle. The histological results indicated that the prostate capsule dehiscence and the prostatic urethras were widened obviously in the dilation group, though there were inflammation, minor necrosis, stroma hemorrhage, and smooth muscle fiber degeneration in the dilated prostates. Meantime, less collagen in the Masson trichrome staining were noted in prostatic urethra of the experimental group. Conclusion This experiments confirmed that TUDP surgery with composite balloon is safe and feasible. Its mechanism may be that the full and proper dilation makes wetha significantly wider, and prostate tissue inflammatory infiltration, smooth muscle fibrosis and reduced collagen content make the uretha unable retract,while the surrounding tissue pack into the dehiscent prostate capsule so that the glands can not be reset.
出处
《现代泌尿外科杂志》
CAS
2009年第3期218-221,共4页
Journal of Modern Urology
关键词
经尿道前列腺球囊扩张术
良性前列腺增生症
尿道括约肌
组织学
老年雄犬
transurethral balloon dilatation of the prostate
benign prostatic hyperplasia
urethral sphincter
histology
aged male dog
