| BACKGROUND: After radical cystectomy, using ileum to reconstruct bladder, a large area ileum is merged into urinary tract. For the secretive and absorptive functions of the intestine mucosa still exist, these cause a series of complications, such as: acid-base imbalance, electrolyte disturbances, mucous urine, mucous plug obstructing urinary tract, stone, bone metabolic disorder, etc. Using chemical agents to kill intestinal mucosa cells to decrease the secretive and absorptive functions of intestinal mucosa, is a selectable method to prevent these complication. The agents usually used recently, include: alcohol, silver nitrate, etc. There are some common problems when use these chemical agents to kill mucosa: if the agent is too strong, or the use of the agent is unsuitable, the muscular layer of the intestinal segment will be injured, leading to the intestinal segment to develop fibrosis or contraction;if the agent is weak, the aim of decreasing the secretive and absorptive functions may be loss. Another problem is the arbitrary use of the chemical agents, there still isn't a acceptable mucosal treatment project by the most urologist. How to use these agents suitably need to be studied further. PURPOSE: 1. To study the histological and functional changes of rat small intestinal mucosa in urinaral circumstance for a long period. 2. Five different agents include: alcohol, 10g/100mlsilver nitrate, 0.5% iodophen, 10% emulsion of seminal oil of brucea javanica, etc., combined with different treatment method and time to form 16 different kinds of treatment project. To filter out the projects those are unsuitable, under the condition that not injuring the intestinal muscular layer. To observe the treatment results systematically, trying to find a best treatment project that can permanently reduce the secretive and absorptive functions of intestinal mucosa.METHODS: 1. In rat bladder substitution model, 1 month and 5 month postoperation, to observe the histological changes of the neobladder mucosa;to measure the quantity of electrolyte and water absorbed or secreted by the mucosa of the neobladder;to measure the weight of residual mucus in the neobladder. 2. Using 16 different kinds of treatment projects to treat the distal small intestinesegment, observe the histological changes after the treatment. Making "to kill mucosal cells effectively, severe pathological changes not happened" as a standard to filter out the unsuitable project, (the first filter) 3. Using the 9 kinds of project got from the first filter to treat the intestinal mucosa in rat bladder augmentation model. 5 months postoperation, to measure the bladder volume, to observe the histological changes and fibrosis degree of the intestinal segment. Making "fibrosis don't happen in the muscular layer, the intestinal segment don't contract" as a standard to filter out the unsuitable project, (the second filter) 4. Using the 3 kinds of project got from the second filter to treat the intestinal mucosa in rat bladder substitution model. From 1 month to 5 months postoperation, to measure the weight of the residual mucus in the neobladder, and the quantity of electrolyte, water volume absorbed or secreted by the intestinal mucosa of the neobladder. Making "permanently reduce the secretive and absorptive function of intestinal mucosa" as a standard to filter out the unsuitable project, (the third filter)RESULTS: 1. Compare with the normal small intestinal mucosa, 1 month postoperation, the mucosa in the neobladder shows increase in the number of goblet cells;5 month postoperation, the villus become shorter and thinner, proper layer become thicker, and decrease in the number of goblet cells. The difference between the quantity of electrolyte and water absorbed or secreted by the mucosa of the neobladder 1 month postoperation and 5 month postoperation, is not significant (P>0.05). From 1 month to 5 month postoperation, the weight of the residual mucus in the neobladder decrease month by month. 2. After mucosa treatment, the pathological changes of the intestinal segments from light to severe: the structure of villus breakdown, the structure of proper layer breakdown, mucosal layer hemorrage, etc. Projects got from the first filter include: dehydrated alcohol soaking 0.5min, dehydrated alcohol applying lmin, etc., total 9 kinds of project will be brought into the next study to observe the long period histological changes of the intestinal mucosa. 3. After treated by the projects get from the first filter, obvious fibrosis and different level of shrink happened in the most of the intestinal segment. The projects get from the second filter include: dehydrated alcohol applying 0.5min, 0.5% iodophen soaking lOmin. besides, dehydrated alcohol applying lmin, fibrosis happened obviously, but the intestinal segmentdon't contract after the treatment of this project. Total 3 kinds of project will be brought into the next study to observe the changes of the intestinal mucosa function after treatments. 4. After treated by the project of dehydrated alcohol applying lmin, the rats accepted the treatment all died for sever blood urine. 1 month postoperation, the difference between the weight of the residual mucus in the neobladder treated by dehydrated alcohol applying 0.5min (or treated by 0.5% iodophen soaking lOmin) and the residual mucus weight in the neobloadder not treated, is significant (P <0.01);from 2 months to 5 months postoperation, the difference is not significant (P >0.05). 1 months and 5 months postoperation, the quantity of electrolyte and the volume of the water secreted or absorbed by the intestinal mucosa of the neobladder, compared with the control group, the different is not significant (P >0.05).CONCLUSIONS: 1. After a long period contact with the urine, the mucosa of the small intestine show hyperplasia, the changes of the absorptive and secretive function to water or electrolyte is not significant. The quantity of the mucus secreted by neobladder mucosa will decreased slowly. 2. Using dehydrated alcohol soaking lmin, etc., to treated intestinal mucosa unsuitably in the operation, can lead to fibrosis, contraction, even errhysis in the intestine segment, which lead to death of the rats. 3. Suitable treatment using dehydrated alcohol applying 0.5min or 0.5% iodophen soaking lOmin that effectively kill the mucosa cell, don't injure the muscular layer, can only reduce the weight of the residual mucus in the neobladder in a short period during early postoperation, but can't changes the secretive and absorptive functions of the intestinal mucosa for a long period. 4. Dehydreated alcohol, the agent used widely in clinic of our country has strong tissu infiltration, can easily injure the deep muscular layer of the rat intestinal segments when the mucosa treatment is performed, if the treatment time >0.5 min, that will lead to fibrosis in the intestinal segments at last. 5. In our study, the project not be found that can reduce secretive and absorptive functions of the intestinal mucosa for a long period and not injure the muscular layer of the intestine segment. |
PDF Full Text Request