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目的:探讨通过腰骶神经吻合恢复或改善神经原性膀胱排尿功能的可行性。方法:10只家犬手术前先行尿流动力(包括膀胱容量、压力、顺应性)及肛门括约肌肌电图(EMG)测定,作为对照组数据。检测完后处死2只,取其S1、S2神经根,共8根作为对照组,行HE染色观察有髓和无髓神经纤维数量。其余8只犬为实验组,将L4与S1、L5与S2神经根分别端端吻合。术后4个月行尿流动力学测定,术后7个月再次行尿流动力学测定后处死动物,取L4、L5和S1、S2神经根吻合口段和骶神经干段行HE染色,观察有髓和无髓神经纤维数量。结果:术后4个月,实验组犬膀胱容量、顺应性和对照组比较明显增加(P<0.05);膀胱压力、肛门括约肌EMG的电压明显降低(P<0.05)。术后7个月,实验组犬膀胱压力和肛门括约肌EMG的电压和对照组比较无明显降低(P>0.05);而膀胱容量和顺应性明显增加(P<0.05)。神经根吻合口段及骶神经干段无髓神经纤维数量较对照组明显增多(P<0.05),而有髓神经纤维数量明显减少(P<0.05)。结论:用L4、L5和S1、S2神经根吻合的方法修复主要支配膀胱逼尿肌和尿道括约肌的S1、S2神经,可明显恢复或改善犬神经原性膀胱的排尿功能。
Objective: To investigate the feasibility of restoration or improvement of neurogenic bladder voiding via lumbosacral nerve anastomosis. Methods: Urine flow (bladder capacity, pressure, compliance) and anal sphincter electromyography (EMG) were measured in 10 dogs before operation as control group data. After the test, 2 rats were sacrificed, and the S1 and S2 nerve roots were taken as the control group. The number of myelinated and unmyelinated nerve fibers was observed by HE staining. The remaining eight dogs as experimental group, the L4 and S1, L5 and S2 nerve root end-to-end anastomosis. The urodynamics were measured at 4 months after operation. The animals were sacrificed again at the end of 7 months after operation. The animals were sacrificed at the end of L4, L5 and S1, S2 nerve root anastomosis and sacral nerve trunk by HE staining. The number of myelinated and unmyelinated fibers. Results: At 4 months after operation, the bladder volume and compliance in experimental group were significantly increased compared with those in control group (P <0.05). The bladder pressure and EMG voltage in anal sphincter were significantly decreased (P <0.05). At 7 months after operation, the bladder pressure and anal sphincter EMG in experimental group were significantly lower than those in control group (P> 0.05), while bladder capacity and compliance were significantly increased (P <0.05). The number of unmyelinated fibers in nerve root anastomosis and sacral nerve trunk increased significantly (P <0.05), while the number of myelinated nerve fibers decreased significantly (P <0.05). CONCLUSIONS: The S1 and S2 nerves that dominate the detrusor and urethral sphincter of the bladder are repaired by L4, L5 and S1, S2 nerve root anastomosis, which can obviously restore or improve the micturition function of the neurogenic bladder in dogs.