本文選題：雙J管 + 分期手術(shù)�。� 參考：《蚌埠醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：本實(shí)驗(yàn)通過(guò)觀察雌性家豬短期輸尿管內(nèi)留置雙J管后輸尿管的病理變化及輸尿管管腔擴(kuò)張情況。目的探討留置雙J管后使輸尿管達(dá)到擴(kuò)張目的而同時(shí)病理改變最輕的最佳雙J管留置時(shí)間，來(lái)指導(dǎo)臨床治療過(guò)程中分期行輸尿管軟鏡手術(shù)最佳時(shí)機(jī)。 方法：選擇體重為25-30kg的4只雌性家豬分為4組，分別在氣管插管全麻麻醉下經(jīng)輸尿管鏡下予單側(cè)輸尿管內(nèi)置入F5雙J管。每組雙J管留置時(shí)間分別為3天、7天、10天和14天。觀察時(shí)間期滿時(shí)，，切除雙腎、雙側(cè)輸尿管及膀胱，分別經(jīng)雙側(cè)輸尿管開(kāi)口向其內(nèi)30mmHg壓力灌注碘普羅胺并行X線射片觀察，對(duì)比輸尿管內(nèi)徑變化情況。隨后選取輸尿管上段近腎盂處、輸尿管中段及輸尿管下段近膀胱處行HE染色鏡檢觀察其病理變化。 結(jié)果：4組手術(shù)置管均成功，所有置管側(cè)輸尿管均有不同程度擴(kuò)張。其中3天組輸尿管壁水腫明顯，7天組由于雙J管上端滯留于輸尿管上段故輸尿管上段內(nèi)尿液潴留且輸尿管壁水腫明顯，而中下段可見(jiàn)輕微水腫，10天組及14天組無(wú)明顯水腫，但輸尿管壁觸之較韌，且所有置管側(cè)輸尿管膀胱開(kāi)口處均有濾泡樣新生物生成。逆行造影行同組雙側(cè)輸尿管對(duì)比置管側(cè)均明顯擴(kuò)張，各組間對(duì)比置管側(cè)輸尿管擴(kuò)張程度，3天、7天、10天及14天組無(wú)明顯差別。病理學(xué)檢查見(jiàn)3天及7天組輸尿管黏膜上皮部分脫落，淋巴細(xì)胞浸潤(rùn)明顯伴少量中性粒細(xì)胞浸潤(rùn)，水腫伴間質(zhì)部分出血；10天及14天輸尿管黏膜均無(wú)明顯脫落，可見(jiàn)少量淋巴細(xì)胞浸潤(rùn)，均未見(jiàn)明顯水腫及出血；膀胱開(kāi)口處濾泡樣新生物病理示淋巴細(xì)胞浸潤(rùn)，細(xì)胞層數(shù)增多，提示慢性炎癥。 結(jié)論：1.輸尿管內(nèi)留置雙J管3天即可達(dá)到擴(kuò)張輸尿管目的； 2.輸尿管內(nèi)留置雙J管10天后輸尿管水腫完全消失，炎癥反應(yīng)輕微； 3.分期輸尿管軟鏡手術(shù)術(shù)前留置雙J管10-14天左右較為適宜。
[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.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 杜友懷;王曉鋒;滕東海;;雙J管并發(fā)癥的預(yù)防和治療[J];當(dāng)代醫(yī)學(xué);2010年25期

2 周莎;王敏;王s

本文編號(hào)：1916020