選擇性背根與腹根切除手術對大白鼠排尿活動之影響

摘要 本實驗之主要目的是探討 acetylcholine、α,β-methylene ATP、atropine和D-tubocurarine 在局部層次對膀胱活動的影響以及可能的作用機制並利用外科手術性傷害，破壞單側排尿感覺神經或運動神經，觀察膀胱之神經與收縮反應。使用的方法有二：其一是將生理食鹽水經膀胱插管直接注入活體膀胱，記錄膀胱壓、骨盆神經之傳入與傳出神經和外尿道括約肌肌電圖活動之變化；其二是將藥物滴於離體膀胱組織上，觀察膀胱體和尿道平滑肌之收縮反應。 結果顯示，在活體膀胱實驗中，破壞單側排尿感覺神經顯著增加排尿收縮之膀胱壓閾值、降低骨盆神經之傳入與傳出神經活動和增加外尿道括約肌肌電圖的活動。另外，增加排尿收縮之歷經時間和降低排尿收縮之頻率，均不具統計意義。破壞單側排尿運動神經增加排尿收縮之膀胱壓閾值和外尿道括約肌肌電圖之活動、降低骨盆神經之傳入與傳出神經活動。另外，降低排尿收縮之歷經時間和頻率，均不具統計意義。 在離體膀胱與藥物處理實驗中，破壞單側排尿感覺神經之大白鼠經α,β-methylene ATP處理後，顯著降低膀胱體平滑肌對acetylcholine的張力反應和α,β-methylene ATP對尿道平滑肌之抑制效應。因此，嘌呤類受體拮抗劑α,β-methylene ATP顯著降低膀胱體平滑肌對acetylcholine的張力反應和對尿道平滑肌之抑制效應。

Abstarct The purpose of this study is to investigate the local responses of bladder to acetylcholine, a, b-methylene ATP, atropine and D-tubocurarine. Meanwhile, the neurological responses of bladder were determined using urodynamic examination with surgically disruption of sensory or motor nerves. In urodynamic recordings,pressure threshold, extra-urethral electromyogram, pelvic afferent and efferent activity were significantly increased in sensory denervated rats. On the contrary,motor denervated rats showed decrease in all the parameters described above. In tissue bath experiments, the detrusor muscle strip of sensory denervated rats developed a lower acetylcholine induced tension than normal ones, furthermore the inhibitory efferent of a, b-methylene ATP to the urethra was decreased in dorsal root rhizotomized rats. All the results suggested that sensory input seems to be essential in initiation of voiding contraction.