作者：张勇 张志超 田龙 姜汉胜 林桂亭 郭应禄

　　摘  要

　　目的：为了改善经尿道球囊扩张术(TUDP)治疗前列腺增生的临床效果，对球囊的构造进行了改造，从单一球囊改为复合球囊且增大了球囊直径、增多扩张部位和延长扩张时间，以提高疗效并通过动物实验阐明其有效的机理和对其安全性进行观察。

　　方法：10只老年雄犬随机分成扩张组和对照组，每组5只，扩张组采用改造的球囊，先采用0.3Mpa压力，扩张膀胱颈、前列腺尿道和膜部尿道5分钟，然后减压至0.1Mpa，使球囊不压迫膜部尿道，维持扩张时间24小时，之后释放球囊压力，留置扩张管1周，术后1周行各项检查。对照组行假于术。两组在试验终点时行膀胱镜、膀胱压力测定、尿动力学、神经肌电点位测定和组织病理学检查。

　　结果：通过膀胱镜检查发现行TUDP后扩张组前列腺尿道直径明显增粗，扩张组无出血及尿外渗等严重并发症发生。尿动力学提示扩张前后膀胱排尿点压力无明显变化，尿道外括约肌无明显功能损伤。神经肌电点位测定，尿道外括约肌受损微小，保持了正常肌电特性和排尿功能。组织病理学研究进一步证实，扩张组前列腺包膜裂开，尿道扩张明显，扩张的前列腺内可见炎症反应、微小坏死、间质出血、平滑肌纤维变性。马森三色染色结果提示，前列腺尿道在扩张后胶原含量减少。

　　结论：动物实验证实应用复合球囊行TUDP术安全、可行，其机理可能是充分适当的扩张使尿道明显变宽，前列腺组织炎性浸润、平滑肌纤维变性及胶原含量减少使其无法回缩，而周围组织填塞入裂开的前列腺包膜使裂开的腺体无法复位。

　　关键词：经尿道前列腺球囊扩张术，良性前列腺增生症，尿道括约肌，组织学，老年雄犬

　　Mechanism  of 

　　The  Experimental  Animal 

　　Study  on  Composite 

　　Balloon  Transurethral BalloonDilatation of Prostate (TUDP) Treatment of Benign Prostatic Hyperplasia

　　ZHANG  Yong 1,ZHANG 

　　Zhi-chao1,TIAN  Long1,JIANG  Han-sheng2,LIN  Gui-ting3,GUO Ying-lu1.

　　1.Department  of  Andrology,The 

　　First  Hospital  of 

　　Peking  University,Beijing,l00034,China;

　　2. Department of Urology,Ping Du People’s Hospital, Ping Du,266700,China;

　　3. Department of Urology, University of California San Francisco, SanFrancisco, 94l43, USA。

　　ABSTRACT: Objectives To improvethe clinical effect of transurethral balloon dilation of the prostate (TUDP)， anew modified balloon was developed .Composite balloon was modified from asingle balloon, balloon diameter and the dilatation site was increased and of theexpansion of time was extended in order to improveefficacy andthrough animal experiments to clarify its effective bmechanism and its securitywas observed. Methods Ten aged male dogs were used in this experiment andrandomly divided into two groups,  including lballoon dilation group and a control group with sham surgery. We first dilatethe bladder neck, prostatic urethra and membranous urethra 5 minutes at 0.3Mpapressure, then decompression to 0.lMpa, so do not oppress membranous urethra,keep on 24 hours, followed release the balloon stress, retention dilation tubel week, and then data examination. At the end of the experitent,includingcystoscopy,voiding pressure (VP)，urodynamics graph, nerve-myoelectricity, andhistological examination were applied to evaluate the effectiveness and safety.Results After dilation, the dimeters of prostatic urethra were significantlyenlarged with cystoscopy.There is not serious complications, such as bleedingand urinary extravasation occurred. The bladder voiding pressure before andafter no significant changes through urodynamic and the urethral sphincterfunction had no significant injury.However, there were no significant changeson nerve electromyography point after the dilation, and the urethral sphinctersmooth muscle maintained normal myoelectricity and normal urination cycle.Furthermore, the histological results also indicated that the prostate capsuledehiscence and the prostatic urethras were widened obviously in the dilationgroup, though there were inflammation, minor necrosis, stroma hemorrhage, andsmooth muscle fiber degeneration in the dilated prostates. Meantime, lesscollagen in the Masson trichrome staining were noted in prostatic urethra ofthe experimental group. Conclusions Our 

　　experiments  confirmed  that TUDP surgery on the application ofcomposite balloon safe, feasible, and its mechanism may be the full and properdilation to enable significantly wider urethra, and prostate tissueinflammatory infiltration, smooth muscle fibrosis and collagen content reducedso that it can not be retracted, and the surrounding tissue packing into thedehiscent prostate capsule so that the glands can not be reset。

　　Key  Words:  transurethral 

　　balloon  dilatation  of  

　　the  prostate   (TUDP)；  

　　benign   prostatic hyperplasia(BPH)； urethral sphincter; histology; aged male dog