臺灣博碩士論文加值系統

為探討使用採自自側腹壁的游離肌腹膜瓣修補犬膀胱的可行性， 共用
24隻體重 6.0-11.6kg 的雜種犬，其中 20 隻行 50% 部份膀胱切除術，
小心止血後，用 5-0Dexon 線將一約 5x5cm 的肌腹膜瓣逢合於膀胱缺損
上；另 4 隻對照組，於行 50% 部份膀胱切除術後，即將創口縫合。於實
驗組行血球計數、血液化學檢查、尿液分析和膀胱造影， 並未發現尿漏
或其他併發症。 於術前及術後 1 週、 2 週、 1 個月、 3 個月和 6 個
月測量膀胱壓力容積； 將術後容積除以術前容積即得膀胱容積恢復率。
試驗組及組於各期的結果為 54.7% 、 53.0% 、 66.4% 、 74.0% 、
89.7% 和 25.6% 、 32.1% 、 37.2% 、 57.5% 、 72.0% ；顯示實驗組
於各時期較對照組皆具統計差異 (p<0.05) 。組織病理學檢查，於術後
1 個月時可見移行上皮覆蓋移殖瓣，且膀胱內壁平滑，無任何癒合不良的
情形。 和原存膀胱交界處的肌腹膜瓣的黏膜下層，於術後 3 個月和術
後 6 個月組各 2 隻，見有化生骨形成且其上之移行上皮完整而無炎症反
應。剝離肌腹膜瓣的腹璧於術後 1 週，為其下血管周圍即的間葉結締組
織分化所產生的間皮細胞所覆蓋。由本試驗結果可知游離肌腹膜瓣可回復
原來膀胱儲存尿液的功能， 亦能使移行上皮再生， 且不影響上泌尿道的
功能，又具安全、易取得及再生良好等諸多優點， 因此，以肌腹膜瓣修
補膀胱缺損，似為一相當理想且可行之方法。

Bladder augumentation using a autogenic free myoperitoneal
graft from the lateral abdominal wall was evaluated in
canine bladders. Of 24 dogs weighing 6.0-11.6 kg, 20 were
used as experiment and 4 as control, were subjected to a
50% partial cystectomy. A free myoperitoneal graft (5x5 cm)
was sutured to the bladder remnant with 5-0 Dexon sutures
in the experimental group, whereas they were closed primarily
in the control group. Complete blood count, blood
chemistry, urinalysis and double-contrast cystography were
performed on all dogs, and no extravasation or other
complication was revealed. Cystometry with filling pressure
and bladder volumes were measured befored and after the
operation at 1 week, 2 weeks, 1 month, 3 months and 6
months. The mean recovering rate of bladder
capacities (postoperate/preoperate) for experimental and
control datas were 54.7%, 53.0%, 66.4%, 74.0%, 89.7% and 25.6%,
32.1%, 37.2%, 57.5%, 70.2%, respectively. Postmortem
hiotological evaluation showed a well germinating
uroepithelium on the inner surface with no traces of any
surface irregularities, after a month. Presence of small
metaplastic bone which caused no side effects could be seen
in the submucosa of the myoperitoneal graft adjoining the
bladder remnant in 4 experimental animals. The mesothelium can
well cover the deperitoneal surface by metaplasia of the
underlying perivascular mesechymal connective tissues. The
free myoperitoneal graft provides an intact structural
reservoir for urine and serves as a template for
uroepithelium regeneration. On the basis of this study,
free myoperitoneal grafts, because of their easy availability,
safety and recovering normal bladder capacity, provide a good
graft material for the bladder augmentation.