腰骶神经吻合对自主性神经原性膀胱排尿功能影响的实验研究

Effect of lumbarsacral nerve root inosculation on the function of autonomous neurogenic bladder：an experimental study

中文关键词:  骶髓  损伤  神经原性膀胱  尿流动力学  犬

英文关键词:Sacral medulla  Injure  Autonomous neurogenic bladder  Urinary dynamics  Dog

中文摘要:

  【摘要】 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。

英文摘要:

  【Abstract】 Objective：To investigate the feasibility of lumbarsacral nerve inosculation on improvement of autonomous neurogenic bladder.Method：The urinary dynamics，including bladder volume，stress，strain and electromyography（EMG） of sphincter were undertaken in 10 domestic dogs as control prior to surgery.After that，2 dogs were sacrificed and their S1，S2 nerve root were harvested and their inner myelin and demyelin neurofibers were quantified by HE stain as control，the another 8 animals were processed into test group by inosculation of L4，L5 lumbar nerve roots and S1，S2 sacral nerve roots，the urinary dynamics were performed at 4 and 7 month after operation respectively，after that，the animals were sacrificed，the myelin and demyelin neurofibers at anastomotic site were quantified thereafter.Result：4 mouths after operation，animals in the test group showed distinct increasing of bladder volume and strain compared with the control（P<0.05），while the pressure of bladder and the EMG voltage of sphincter decreased distinctively（P<0.05）.7 mouths after operation，the pressure in bladder and the EMG voltage of sphincter showed no distinct decrease（P>0.05），while the bladder volume and strain increased remarkably（P<0.05），the demyelin neurofibers increased significantly（P<0.05），however the myelin neurofibrers decreases distinctively（P<0.05）.Conclusion：Inosculation of L4，L5 nerve roots and S1，S2 nerve roots can repair the urethra sphincter and bladder detrusor governed by S1，S2 nerve root，which can improve the autonomous neurogenic bladder due to injury to sacral cord and cone.