摘要
目的 初步探讨术后肠道储尿囊粘膜远期形态学的变化与临床并发症的关系。 方法 肠道储尿囊代膀胱术后随访 2 5例患者 ,其中结肠储尿囊 15例 ,回肠储尿囊 10例。取得活检组织后行光镜和电镜检查。 结果 结肠储尿囊术后远期病例肠粘膜腺体深度为 (0 17± 0 0 4)mm ,明显浅于对照组腺体深度 [(0 42± 0 0 4)mm],微绒毛高度为 (0 35± 0 0 5 ) μm ,明显短于对照组微绒毛高度(0 6 9± 0 0 8) μm ,出现粘膜明显萎缩 ;回肠储尿囊术后肠粘膜绒毛高度 ,近期组为 (0 6 1± 0 2 2 )mm ,远期组为 (0 37± 0 16 )mm ,与对照组 (0 41± 0 14)mm比较 ,远期、近期都有明显的粘膜萎缩。在远期病例 ,2种储尿囊粘膜上皮细胞的紧密连接都保持良好。没有发现明显恶变的形态学征象。发生了代谢性酸中毒或储尿囊结石的病例在粘膜形态结构上无特殊改变。 结论 术后肠道储尿囊粘膜出现了结构上的萎缩 ,是“适应性”的变化 。
Objective To investigate the relationship between long term morphological changes in the mucosa of the intestinal urinary reservoir (IUR) and postoperative complications. Methods A total of 25 patients undergoing the replacement of bladder with IUR were followed up. Of these 25 patients, 15 had colonic pouch and 10 ileal pouch. Tissues of IUR were biopsied examined with microscope and transmission electron microscope. Results In patients with colonic pouch, the glandular depth was (0 17±0 04)mm and microvillous height (0 35±0 05)μm, which were significantly lower than those (0 42±0 04)μm and (0 69±0 08)mm in the control group. In those with ileal pouch, the microvillous height was (0 70±0 14)mm, (0 54±0 10)mm and (1 99±0 14)mm in the short term group, long term group and control group, respectively. As compared with the control group, mucous atrophy in these patients was more severe. Tight junctions of the epithelium in both kinds of pouches were well preserved even in the long term cases. No remarkable malignant changes were found in the IUR mucosa in all the patients. Meanwhile, no special morphological changes were seen in the patients with metabolic acidosis or pouch calculus. Conclusions IUR mucosa has some morphological 'adaptive' changes after the operation. Intestinal segments are ideal bladder substitutions.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2001年第8期616-618,T003,共4页
Chinese Journal of Surgery
基金
广东省重点攻关基金资助项目 (962 2 0 5 0 0 1)
