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Polytetrafluoroethylene을 이용한 방광재생에 관한 실험적 연구

Other Titles
 (An) experimental study on bladder regeneration using polytetrafluoroethylene 
Authors
 마상열 
Department
 Dept. of Urology (비뇨의학교실) 
Issue Date
1984
Description
의학과/박사
Abstract
[한글]

장관을 이용한 방광확대술은 위축방광등에서 용적을 증대시키려는 목적으로 자주 시행된다. 그러나 수술후 초기 합병증으로 장폐색, 복막염등이 올 수 있고 후기 합병증으로는 배뇨장애, 잔뇨, 점액분비, 결석형성 및 전해질불균형등을 초래할 수가 있다.

그래서 방광의 결손부위륵 재건하거나 위축방광의 용적을 증대시키는 경우 장관을 사용하지 않고 이식물질을 이용하는 방법이 연구되어 왔다. 지금까지 근막(DeMuth, 1953), 복막, 피부절편(Draper와 Stark, 1956)등과 인공이식물질인 polyvinyl sponge(Kudish, 1957), gelatin sponge, formalin으로 처리한 개의 방광절편(Tsuji등, 1967b)등 여러 종류의이식물질이 사용되어 혹은 성공하고 혹은 실패하였다.

Polytetrafluoroethylene(PTFE)은 최근 혈관대용물질로 개발되었으며 (Soyer등, 1972)실험적으로나(Campbell등, 1974; Young과 Yasargil, 1981; Barry등, 1981) 임상적으로(Campbell등, 1976) 말초혈관수술에서 소동맥의 대치용으로 널리 사용되고 있다. Tizian등(1980)은 쥐에서 신하부의 대동맥일부를 절제하고 원통형의 PTFE로 대치하였더니 아무 이물반응없이 주위의 정상동맥조직과 융합되어 결국 재생된 조직속에 묻히는 것을 관찰하였다.

본인은 이러한 PTFE가 방광에서도 같은 반응을 보인다면 가장 좋은 이식물질이 되리라는 가정에서 이러한 가능성을 알아보기 위하여 본 실험에 착수하였다.

실험동물로는 체중 250∼450gm을 갖는 Sprague-Dawley계통의 백서를 사용하였다. Secobarbital마취 (5mg/100gm)후 하복부정중선 절개로 방광을 노출하였다. 방광상부 전층을 원형으로 부분절제하고 이 결손부위에 PTFE를 이식하였다.

15마리는 출혈, 마취과다, 복막염등으로 사망하였으며 35마리를 희생시켜 수술후 3일,1, 2.4, 8, 12 및 16주에 관찰하여 다음과 같은 결론을 얻었다.

1. 상피세포층은 수술 3일후 원래방광의 단단부에서 이식물질의 외측을 따라 재생되기시작하였고 2주후에 전결손부위에 재생되었다.

2. 근육층은 2주후에 상피세포층과 마찬가지로 잔존방광의 단단부로부터 재생되었다. 8주후에는 정상방광 근육층의 두께의 약 절반가량으로 재생되어 전 결손부위를 덮고 있었으며 12주후에 완전한 재생을 보였다.

3. 장막층은 근육과 같은 시기에 재생되어서 12주후에 완성되었다.

4. PTFE는 육아-결체조직막과 융합되지 못하고 결국 4∼8주만에 방광내로 탈락되었다.

5. 2주군에서 처음 방광내의 결석이 관찰되었으며 (평균무게 67mg) 점차 증가되어 16주군에서는 평균 1,300mg이 되었다. 결석을 시험분석한 결과 magnesium ammonium phosphate결석이었으며, 이는 요로감염에 의해 발생하였을 것으로 사료된다.

이상의 결과를 종합하면 PTFE를 이용하여 방광결손부위를 재건한 실험은 성공하였다.

즉, 새로 형성된 방광은 완전한 상피세포층과 완전한 근육층을 이루고 있었다. 그러나 PTFE는 주위의 정상방광조직과 융합되지 못하여 결국 4∼8주만에 방광내로 탈락되었으며 또한 방광결석이 많이 형성되었으므로 앞으로 이 방향에 대한 연구가 필요할 것으로 생각되

었다.

[영문]

Intestinocystoplasty is currently performed for enlargement of the contracted bladder. However, postoperative early complications such as ileus and peritonitis may occur in some cases and, furthermore, late complications such as dysuria, residual urine, mucus secretion, calculi formation and electrolyte imbalance may be unavoidable.

It is desirable to find an ideal graft material to repair large defects in bladder or to enlarge the contracted bladder, without using the intestine. Numerous and varying materials, such as muscle fascia (DeMuth, 1953), peritoneum, skin (Draper and Stark, 1956), etc., including certain artificial materials, such as

polyvinyl sponge (Kudish, 1957), gelatin sponge, and preserved dog bladder(Tsuji et al., 1967 b), have been proposed as grafts, without success.

Polytetrafluoroethylene (PTFE) is an inert polymer of carbon and fluorine. Since its introduction as a vascular prosthesis (Soyer et al., 1972), PTFE has been widely applied both experimentally (Campbell et al., 1974 Young and Yasargil, 1981;

Barry et al., 1981) and clinically (Campbell et al., 1976) as a synthetic small artery substitute in peripheral vascular surgery. Tizian and associates (1980) attempted to substitute the infrarenal part of the abdominal aorta with tubular PTFE micrograft in rats. Initially fibrin, platelets and red blood cells covered the inside lining of the implant. The neointima was established after one month.

When completed, a well-developed multilayer neointima, with mononuclear cells connected to one another and to the interstitial tissue, was seen. Investigation of the aorta-implant junction showed the prosthesis functionally embedded in the

structure of the aorta.

If PTFE react on bladder regeneration as same as on the blood vessel, it should be the ideal graft material. So present study was undertaken in order to investigate this possibility.

Experiments were conducted in Sprague-Dawley rats, weighing 250∼450gm. After the secobarbital anesthesia (5mg/100gm) the bladder of rat was exposed through a suprapubic midline incision and freed from the overlying peritoneum. A roughly circular, full thickness segment of the upper part of bladder was excised and the defect was grafted with PTFE.

Fifteen rats were died of hemorrhage, over-anesthesia, and peritonitis. There were 35 rats which survived and sacrificed at 3 days, 1, 2, 4, 8, 12, and 16 weeks after the bladder repair.

The results are summarized as follows :

1. At 3 days after operation, epithelium started to regenerate from the preserved edges of the original bladder along the outer surface of the graft. After 2 weeks the grafted part was completely covered with regenerated epithelium.

2. Muscle regeneration also began from the cut edges at 2 weeks and progressed toward the center of the grafted portion. The new bladder at 8 weeks had a complete muscle layer up to the center of the grafted portion but the depth was half as much as the normal bladder muscle layer. At 12 weeks the state of muscle of the new bladder was almost same as that of the normal bladder.

3. The serosa was regenerated simultaneously with the muscle layer and completed after 12 weeks.

4. The PTFE failed to incorporate with the granulation-connective membrane and was discharged in 4 to 8 weeks.

5. Intravesical stone formation was first recognized at 2 weeks (average, 67 mg) and progressively increased thereafter up to 1,300mg of average weight at 16 weeks. The stone was analysed and revealed as magnesium ammonium phosphate which was thought to be responsible for the urinary tract infection.

In conclusion, the experimental studies on repairing defects of the bladder by using PTFE were successfully made. A new bladder with complete epithelialization and also with complete muscle layer developed through the regenerative power of the urinary tract. But PTFE failed to incorporate with the normal bladder tissue and was discharged after 4 to 8 weeks. And in order to ascertain the responsible factor for stone formation further studies in this direction will be needed.
Full Text
https://ymlib.yonsei.ac.kr/catalog/search/book-detail/?cid=CAT000000045527
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 3. Dissertation
Yonsei Authors
Mah, Sang Yol(마상열)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/127478
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