摘要
目的探讨新型梯度降解输尿管支架管置人动物体内的后引流作用、降解特性与原位组织相容性。方法10条比格犬随机分为2、4、6周3个时间组，分别将梯度降解输尿管支架管与聚氨酯支架管置于比格犬的左右侧输尿管内。分别于术前、支架置入后第1、2、4、6周进行尿液分析、血细胞、血液生化指标检测，同时术后即刻、2、4、6周尿路平片（KUB）／CT检查评价支架管降解、肾积水及肾功能受损情况。术后2、4、6周后通过过量麻醉分别处死犬2、2、6条，整块取出肾脏、输尿管及膀胱，进行组织学检查。结果实验、对照支架管置于犬左右侧输尿管内后，血细胞、血生化指标术后各周与术前比较未见明显变化。尿pH值明显下降，术后1～4周（6．80±0．14、6．23±0．13、5．50±0．11、5．00±0．14）与术前（7．30±0．11）比较，差异有统计学意义（P〈0．05），术后5周尿pH值开始上升；尿液中白细胞在术后即刻、术后1、4、6周分别为（264．30±63．36）、（137．67±32．49）、（43．50±19．15）、（7.67±3．78）×10^6／L，术后各组与术前[（0．83±0．98）×10^6／L]比较的P值分别为P〈0．01、P〈0．01、P〈0．01、P〈0．05。X线检查：术后2周实验组支架管已部分降解，长度缩短；术后4周cT平扫证实支架管已基本消失。术后2、4周cT增强扫描显示实验侧与对照侧的皮、髓质同时强化，肾盂同时排泌，实验侧无延迟显影。置入后大体形态观察实验侧较对照侧无明显差异；组织病理学比较：置人后2、4、6周，两组肾实质结构均正常；肾盂、输尿管及输尿管开13处膀胱壁黏膜组织学表现相似。结论梯度降解输尿管支架管在动物输尿管内约能支撑2周，然后梯度降解，降解过程中产物对肾盂、输尿管黏膜有一定刺激作用，但不影响肾功能及引流；其导致的炎性反应轻、可逆，降解完后消失，原位组织相容性良好。
Objective To investigate the effectiveness of the drainage, degradation and biocom- patibility of a novel gradient degradable ureteral stent in a beagle dog model. Methods Ten beagle dogs were randomly divided into 2 - , 4 - , and 6 - week groups. The gradient degradable ureteral stent and the ordinary ureteral stent were inserted into each side of the ureter through open operation. Urine and blood tests were performed at 1st, 2nd, 4th, and 6th week after the operation. Kidney, ureter and bladder （KUB） X- ray radiography or computed tomography （CT） was performed immediately and at 2nd, 4th, and 6th week after the operation to observe the degradation of the stent and hydronephrosis. Two, 2, and 6 dogs were sacrificed at 2nd, 4th, and 6th week after the operation for microscopic and histological evalua- tion, respectively. Results There were nosignificant differences in blood test and renal function in either group at any observation time point （ P 〉 0. 05 ）. Urinalysis showed the urine pH before （ 7. 30 ± 0. 11 ） and at 1st, and 4th week after operation （6. 80 ±0. 14, 6.23 ±0. 13,5.50 ±0. 11,5.00 ±0. 14） showed statistically significant difference （P 〈 0. 05）. The count of white blood cells was increased during 1 - 4 weeks after operation [ （264. 30 ±63.36）, （137. 67 ±32. 49）, and （43.50 ± 19. 15） × 10^6/L] and fell back at 6th week [ （7.67 ±3.78） × 10^6/L], but all higher than that of pre - operation [ （0. 83 ±0. 98） × 10^6/L] with the difference being statistically significant （P 〈0. 01, P 〈0. 01, P 〈0. 01, P 〈0. 05） ; The results of the X - ray examination showed that the stents in the experimental groups began to degrade par- tially at 2nd week. CT scanning showed the stents in the experimental groups practically vanished at 4thweek after the operation and the renal cortex and medulla in both sides were enhanced in all periods of the enhanced CT scanning. Gross specimen observation indicated that the kidney paled and plumped with ex- pansion of the renal pelvis, the renal pelvis and ureter mucosa of the experimental side were smooth with no lesions. Histological observation revealed that the renal parenchyma, proximal tubule, distal tubule and in- terstitial structure were normal at 2nd, 4th, and 6th week after implantation. The histological features of the experimental side and control side were similar. Conclusion Animal experiment indicated that the gra- dient degradable ureteral stent could provide support for about 2 weeks, then degrade in gradient. The deg- radation segments had a stimulating effect on pelvis and ureter mueosa but do not affect the renal function and drainage. The leading inflammatory reaction disappeared after the stent fully degraded, indicating good biocompatibility of the stent.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2016年第3期705-708,共4页
Chinese Journal of Experimental Surgery
基金
苏州市社会发展项目（ZXY201414）
