摘要
目的观察膀胱缺血情况下膀胱出口部分梗阻兔膀胱组织形态及酶学变化情况，探讨膀胱缺血对膀胱出口部分梗阻后膀胱病变的影响。方法64只成年新西兰兔电脑随机分为4组，每组16只。采用半缝扎腹主动脉制造膀胱缺血动物模型，采用部分结扎膀胱出口制造膀胱出12]部分梗阻动物模型。每组中随机选择4只行膀胱缺血手术（缺血组），4只行膀胱出口部分梗阻手术（梗阻组），4只行膀胱缺血及膀胱出口部分梗阻手术（联合组），4只为假手术对照组。于术后第1、2、4、8周各取1组测量膀胱湿重，然后膀胱全层石蜡切片MASSON染色观察黏膜层、黏膜下层、肌层及浆膜层厚度并分析膀胱间质平滑肌与胶原成分含量变化，S-100染色分析组织内神经元变化情况。检测膀胱肌层组织中肌浆网钙ATP酶与柠檬酸盐合酶活性。结果梗阻组与联合组兔膀胱重量自术后1周开始增加，分别为（5．10±0．29）、（4．80±0．37）g，均高于对照组[（1．93±0．17）g，均P〈0．05]；在术后第4周达到最大值分别为（18．48±2．03）与（12．35±0．39）g，同期梗阻组膀胱重量大于联合组（P〈0．05）。梗阻组在处置前4周主要表现为肌层组织代偿性增厚，4周后出现纤维组织及胶原成分增加，而联合组处置后即出现肌层和纤维组织及胶原成分增加，2周后主要为纤维组织及胶原成分增加。S-100染色分析显示，与对照组相比，所有处理组兔膀胱组织内均出现了不同程度的神经缺失，以联合组尤为明显。梗阻组兔膀胱平滑肌肌浆网钙ATP酶与柠檬酸盐合酶活性在术后第4周达最大值，术后第8周降至低于术后第1周水平；联合组术后第1周两种酶活性开始持续下降；同期对照组两种酶活性均高于梗阻组和联合组（均P〈0．05）。结论膀胱缺血可降低膀胱对梗阻的耐受力，加重膀胱功能的损害。
Objective To compare the structures and functions of rabbit bladder after partial bladder outlet obstruction versus without ischemia so as to explore the effects of ischemia on bladder pathogenesis in rabbits with partial bladder outlet obstruction. Methods A total of 64 mature male rabbits were divided into 4 groups （n ： 16 each）. Four of each group underwent operation to establish an ischemic animal model （ischemia group ）, another 4 underwent operation to establish a partial bladder outlet obstruction animal model （ obstruct group）, the other 4 underwent operation to establish an ischemic and partial bladder outlet obstruction animal model （ combination group） and the remaining 4 underwent a sham operation as control. The rabbits in 4 groups were evaluated at Week 1, 2, 4 and 8 post-operation respectively. The weight of bladder, the thickness of mucosal, submucosa, muscular layer and placenta percreta and the activities of sarco/endoplasmic reticulum Ca2~ ATPase citrate synthase of cystic smooth muscle were detected respectively. MASSON staining was used to observe the smooth muscle and collagen in stroma of bladder and S-100 staining for observing the neurons in bladder. Results In obstruct and combination groups, the weights of bladder at week 1 were （ 5.10 ±0. 29 ） g and （ 4. 80± 0. 37 ） g respectively. They were both significantly higher than control group [ （ 1.93 ±0. 17 ） g, all P 〈 0. 05 ]. The weights of bladder in obstruct and combination groups peaked at Week 4 and they were （ 18.48 ± 2. 03） g and （12. 35±0. 39） g respectively. The weight of bladder in obstruct group was significantly heavier than combination group in the same terms. And they were both significantly heavier than control and ischemia groups（all P 〈 0. 05 ）. Muscular tissue vicariously thickened during the first 4 weeks, and collagen and stroma increased at Week 4 in obstruct group. Muscular tissue, collagen and stroma all increased initially. But at Week 2 only collagen and stroma increased in combination group. Compare with control group, the other groups all have deletion of neurons, especially in combination group. The activities of sarco/ endoplasmic reticulum Ca2＋ ATPase and citrate synthase of cystic smooth muscle of obstruct group peaked at Week 4. In combination group , the activities of sarco/endoplasmic reticulum Ca2＋ ATPase and citrate synthase of cystic smooth muscle were decreased over 2 - 8 weeks. In the same terms, the activities of sarco/ endoplasmic reticulum Ca2＋ ATPase and citrate synthase of cystic smooth muscle in control group were significantly higher than those in obstruct and combination groups （ all P 〈 0. 05 ）. Conclusion Ischemia can reduce the tolerance of bladder and aggravate the impairment of bladder to partial outlet obstruction.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第42期3007-3011,共5页
National Medical Journal of China
基金
广东省自然科学基金（8251001002000001）
关键词
膀胱颈梗阻
缺血
动物实验
Urinary bladder neck obstruction
Ischemia
Animal experimentation
