留置双J管后分期输尿管软镜手术时机选择的动物实验研究

发布时间：2018-05-20 19:57

本文选题：双J管 + 分期手术　；参考：《蚌埠医学院》2014年硕士论文

【摘要】：目的：本实验通过观察雌性家猪短期输尿管内留置双J管后输尿管的病理变化及输尿管管腔扩张情况。目的探讨留置双J管后使输尿管达到扩张目的而同时病理改变最轻的最佳双J管留置时间，来指导临床治疗过程中分期行输尿管软镜手术最佳时机。方法：选择体重为25-30kg的4只雌性家猪分为4组，分别在气管插管全麻麻醉下经输尿管镜下予单侧输尿管内置入F5双J管。每组双J管留置时间分别为3天、7天、10天和14天。观察时间期满时，，切除双肾、双侧输尿管及膀胱，分别经双侧输尿管开口向其内30mmHg压力灌注碘普罗胺并行X线射片观察，对比输尿管内径变化情况。随后选取输尿管上段近肾盂处、输尿管中段及输尿管下段近膀胱处行HE染色镜检观察其病理变化。结果：4组手术置管均成功，所有置管侧输尿管均有不同程度扩张。其中3天组输尿管壁水肿明显，7天组由于双J管上端滞留于输尿管上段故输尿管上段内尿液潴留且输尿管壁水肿明显，而中下段可见轻微水肿，10天组及14天组无明显水肿，但输尿管壁触之较韧，且所有置管侧输尿管膀胱开口处均有滤泡样新生物生成。逆行造影行同组双侧输尿管对比置管侧均明显扩张，各组间对比置管侧输尿管扩张程度，3天、7天、10天及14天组无明显差别。病理学检查见3天及7天组输尿管黏膜上皮部分脱落，淋巴细胞浸润明显伴少量中性粒细胞浸润，水肿伴间质部分出血；10天及14天输尿管黏膜均无明显脱落，可见少量淋巴细胞浸润，均未见明显水肿及出血；膀胱开口处滤泡样新生物病理示淋巴细胞浸润，细胞层数增多，提示慢性炎症。结论：1.输尿管内留置双J管3天即可达到扩张输尿管目的； 2.输尿管内留置双J管10天后输尿管水肿完全消失，炎症反应轻微； 3.分期输尿管软镜手术术前留置双J管10-14天左右较为适宜。
[Abstract]:Objective: to observe the pathological changes and ureteral lumen dilatation in female pigs after indwelling double J tubes. Objective to explore the best time of double J tube indwelling after indwelling double J tube to make ureter dilate and pathological change the least so as to guide the stage of ureteral soft endoscopy in clinical treatment. Methods: four female pigs with weight of 25-30kg were divided into 4 groups. F5 double J tubes were inserted into unilateral ureter under ureteroscope under general anesthesia with tracheal intubation. The retention time of double J tube in each group was 3 days, 7 days, 10 days and 14 days, respectively. At the end of the observation period, both kidneys, ureters and bladder were resected, and 30mmHg pressure was perfused into the ureteral orifice and X ray radiographs were used to observe the changes of ureteral diameter. Then the upper ureter near the renal pelvis, the middle ureter and the lower ureter near the bladder were examined by HE staining. Results the ureter was dilated to varying degrees in all the ureter indwelling. The ureteral wall edema was obvious in the 3rd day group and the upper ureteral wall edema in the upper ureteral segment because of the retention of the upper end of double J tube in the 7-day group, but there was no obvious edema in the middle and lower ureteral segment in the 10-day and 14-day groups. However, the ureteral wall was tough to touch, and follicle-like neobiesis was found in all ureteral bladder orifices on the indwelling side of ureter. The degree of ureteral dilatation in the same group was 3 days, 7 days, 10 days and 14 days, and there was no significant difference between the two groups. Pathological examination showed that the ureteral mucosal epithelium was exfoliated at 3 and 7 days, the lymphocyte infiltration was obviously accompanied by a small amount of neutrophil infiltration, and there was no obvious exfoliation of the ureteral mucosa on the 10th and 14th day after edema and interstitial hemorrhage. A small number of lymphocytes infiltrated without obvious edema and haemorrhage and follicle-like biopathology of bladder opening showed lymphocytic infiltration and increased cell layer which suggested chronic inflammation. Conclusion 1. Ureteral dilation can be achieved in 3 days by indwelling double J tube in ureter. 2. After 10 days of indwelling double J tube in ureter, the edema of ureter disappeared completely, and the inflammatory reaction was slight. 3. It is suitable to keep double J tube for 10-14 days before soft ureteroscopy.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.4

【参考文献】