本文選題：胸10節(jié)段脊髓損傷 + 膀胱�。� 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的： 通過建立大鼠胸10節(jié)段脊髓橫斷模型,誘導(dǎo)出神經(jīng)源性膀胱,觀察胸10節(jié)段脊髓橫斷致大鼠膀胱順應(yīng)性改變后膀胱重量、逼尿肌漏尿點壓、膀胱順應(yīng)性、膀胱壁組織結(jié)構(gòu)及ICC細(xì)胞分布、數(shù)量的變化。探討不同順應(yīng)性膀胱的病理生理改變,明確ICC細(xì)胞在神經(jīng)源性低順應(yīng)性膀胱發(fā)病中的作用,為進(jìn)一步豐富和完善神經(jīng)源性低順應(yīng)性膀胱發(fā)病機(jī)理及治療提供必要的理論和實驗基礎(chǔ),同時,為后續(xù)進(jìn)一步實驗提供前期支持。 方法： 正常成年雌性Wistar大鼠40只,體重在210-220g,隨機(jī)分為兩組：A組8只、B組32只。A組為假手術(shù)對照組,B組為胸10節(jié)段脊髓橫斷組。主要步驟為：稱重、麻醉后,鼠板俯臥位固定,定位：根據(jù)浮肋連接的第13胸椎作為骨性標(biāo)志定位至胸10節(jié)段脊髓(對應(yīng)脊柱第8胸椎),確定損傷部位后背部備皮、消毒,取背部正中切口,依次切開皮肽、皮下筋膜、向兩側(cè)鈍性分離豎脊肌,破壞椎體,直至暴露脊髓,用眼科手術(shù)刀將脊髓快速切斷(可見大鼠后肢痙攣性抽搐數(shù)次后軟癱,用顯微剪剪除一段約1mm長脊髓,保證脊髓完全橫斷)。對照組只暴露脊髓,不切斷,逐層縫合切口。各組均于手術(shù)后6周行尿動力學(xué)檢測,檢測完成后處死大鼠并留取膀胱標(biāo)本,行膀胱稱重。常規(guī)HE染色觀察膀胱壁平滑肌、纖維結(jié)締組織變化；VG染色及Vaehoeff染色,光鏡下觀察膀胱中肌層厚度、膠原纖維及彈力纖維量的變化；應(yīng)用免疫熒光技術(shù)觀察ICC細(xì)胞在膀胱壁的分布及數(shù)量,每個標(biāo)本隨機(jī)選取5個視野,得到的數(shù)碼照片用Image pro圖像處理軟件分析,計算每個視野ICC細(xì)胞數(shù)量,進(jìn)行統(tǒng)計分析。 結(jié)果： 1.成功制作了大鼠胸10節(jié)段脊髓橫斷動物模型并順利地進(jìn)行了大鼠膀胱尿流動力學(xué)測定。 2.膀胱順應(yīng)性：至行尿流動力學(xué)檢測時,32只實驗組大鼠,死亡10只,尿流動力學(xué)結(jié)果顯示,存活的22只大鼠中,神經(jīng)源性高順應(yīng)性膀胱大鼠12只,神經(jīng)源性低順應(yīng)性膀胱大鼠6只,正常順應(yīng)性膀胱大鼠4只。神經(jīng)源性高順應(yīng)組膀胱順應(yīng)性與假手術(shù)對照組相比明顯升高,有統(tǒng)計學(xué)意義(P0.05)；神經(jīng)源性低順應(yīng)組膀胱順應(yīng)性與假手術(shù)對照組相比明顯降低,有顯著差異(P0.01)。 3.形態(tài)學(xué)研究顯示： 胸10節(jié)段脊髓橫斷6周后膀胱結(jié)構(gòu)和功能發(fā)生了明顯改變,膀胱重量明顯增加,實驗組膀胱重量明顯比對照組重,有顯著差異(P0.01)；膀胱/體重比實驗組明顯高于對照組,有顯著差異(P0.01)。 光鏡觀察到胸10節(jié)段脊髓橫斷6周后逼尿肌出現(xiàn)不同程度的肌萎縮,肌束間膠原纖維浸潤顯著增多；低順應(yīng)組纖維結(jié)締組織的百分含量明顯大于對照組及高順應(yīng)組,有顯著差異(P0.01)；高順應(yīng)組纖維結(jié)締組織百分含量大于對照組,有統(tǒng)計學(xué)意義(P0.05)。熒光顯微鏡觀察顯示不同組間ICC細(xì)胞有所變化,高順應(yīng)組平均每視野下ICC數(shù)量較正常組明顯減少(P0.01),差異顯著；低順應(yīng)組平均每個視野下ICC數(shù)量較正常組明顯增加(P0.01),差異顯著。 結(jié)論： 1胸10節(jié)段脊髓損傷對膀胱功能的影響在膀胱順應(yīng)性上可表現(xiàn)為高順應(yīng)性及低順應(yīng)性兩類,具體類型應(yīng)根據(jù)尿流動力學(xué)結(jié)果劃分。 2神經(jīng)源性膀胱尿流動力學(xué)表現(xiàn)為：低順應(yīng)組膀胱最大容量降低、逼尿肌漏尿點壓力增高、膀胱順應(yīng)性降低；高順應(yīng)組膀胱最大容量增大、逼尿肌漏尿點壓力降低、膀胱順應(yīng)性升高。 3胸10節(jié)段脊髓損傷后,膀胱壁組織發(fā)生重塑,逼尿肌出現(xiàn)不同程度的肌萎縮,肌束間膠原纖維浸潤,纖維結(jié)締組織含量發(fā)生變化,影響膀胱順應(yīng)性。 4胸10節(jié)段脊髓損傷后,不同順應(yīng)性組別間ICC數(shù)量發(fā)生變化,可能與膀胱順應(yīng)性發(fā)生變化有關(guān)。
[Abstract]:Purpose :

Objective To investigate the changes of bladder weight , pressure of urinary bladder , bladder compliance , bladder wall structure and the distribution and quantity of ICC cells after spinal cord transection in thoracic 10 segments of rats . The changes of bladder weight , urinary bladder pressure , bladder compliance , bladder wall structure and ICC cell distribution and quantity were observed .

Method :

Forty - four normal adult female Wistar rats weighing 210 - 220g were randomly divided into two groups : Group A : Group A : Group A : Group A : Group A : Group A : Group A : Group A : The spinal cord of the thoracic 10 segments ( corresponding to the eighth thoracic vertebra ) . In the control group , only the spinal cord was exposed , the incision was not cut and the incision was sutured layer by layer . After 6 weeks after surgery , the rats were sacrificed and the bladder specimens were removed and the bladder was weighed . Routine HE staining was used to observe the changes of bladder wall smooth muscle and fibrous connective tissue ;
VG staining and Vaehoeff staining were used to observe the changes of muscle layer thickness , collagen fiber and elastic fiber quantity in the bladder under light microscope .
The distribution and quantity of ICC cells in the bladder wall were observed by immunofluorescence technique . Five visual fields were randomly selected for each specimen . The digital photographs obtained were analyzed by image pro image processing software , and the number of ICC cells in each field of view was calculated and analyzed statistically .

Results :

1 . The rat model of spinal cord transection was successfully established and the urodynamic measurement of bladder urodynamic in rats was performed successfully .

2 . Bladder compliance : At the time of urodynamic examination , 32 experimental rats died 10 rats . The results of urodynamic showed that in 22 rats survived , 12 were neurogenic high - compliance bladder rats , 6 in neurogenic low - compliance bladder , 4 in normal - compliant bladder .
Compared with the sham - operated control group , the bladder compliance in the low - compliance group was significantly lower than that in the sham operation group ( P0.01 ) .

3 . The morphology study shows :

The bladder structure and function changed significantly after 6 weeks of spinal cord transection in thoracic 10 segments . The bladder weight was significantly increased , and the bladder weight in the experimental group was significantly higher than that of the control group ( P0.01 ) .
Compared with the control group , the bladder / body weight ratio was significantly higher than that of the control group ( P0.01 ) .

After 6 weeks of transection of the spinal cord in the thoracolumbar spinal cord , different degrees of muscle atrophy were observed , and there was a significant increase in the infiltration of collagen fibers between the muscle bundles ;
The percentage of fibrous connective tissue in low - compliance group was significantly higher than that in control group and high - compliance group ( P0.01 ) .
The percentage of ICC in the high - compliance group was higher than that of the control group ( P0.05 ) .
The average number of ICC in the low - compliance group was significantly higher than that in the normal group ( P0.01 ) , and the difference was significant .

Conclusion :

The effect of spinal cord injury on bladder function in thoracic 10 segments can be seen as high compliance and low compliance in bladder compliance , and the specific types should be divided according to the results of urodynamic results .

The urodynamic characteristics of neurogenic bladder were as follows : the lower urinary bladder capacity of the low - compliance group , the increase of the pressure of the urethral sphincter and the decrease of the bladder compliance ;
The bladder maximum capacity of the high - compliance group was increased , the pressure of the urethral sphincter decreased , and the bladder compliance increased .

After spinal cord injury in 10 segments of the thoracic cavity , the bladder wall tissue was remodeled , the muscle atrophy , the infiltration of collagen fibers between the muscle bundles , the changes of connective tissue content in the muscle bundles and the bladder compliance were affected .

After spinal cord injury in thoracic 10 segments , the number of ICC changes in different compliance groups may be related to changes in bladder compliance .

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R651.2

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