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[所谓先天性肾积水的发病机制]

[Etiopathogenesis of so-called congenital hydronephrosis].

作者信息

Puigvert A, Ruano D

出版信息

J Urol Nephrol (Paris). 1979 Jan-Feb;85(1-2):1-12.

PMID:439196
Abstract

Taking up again inquiries already known in the past, documents of pathological anatomy of his own person experience, and facts of embryology, the authors explain the etiology of the obstructive malformation of pyelo-ureteral function the etiology brings out two phenomena: --The insufficient hollowing of the cephalic end of the ureteral bud, which is initially grooved, when it detaches itself from the Wolffian canal, can transform itself into a full cellular cord which secondarily forms a groove after 23 mm stage.--The insufficient vascularization of the ureter just below the pelvis because of an abnormal anatomical disposition which causes displacement of the longitudinal uretero-pelvic arteries to a point clearly below the ureteropelvic junction. There an ischemia impedes the muscular development of the ureter just below the pelvic of which the wall becomes more sclerotic and fibrous than muscular. Thus a defect in the grooving of the ureteral bud and an arterial blood deficit results in a congenital ureteral stenosis. Pathological anatomical documents illustrate this theory from which flow two imperative technics; the necessity to eliminate the initial obstructive ureteral segment; care to protect the pelvic vessels which will have to vascularize the ureter which will be anastomosed to the cut edge of the pelvis.

摘要

作者重新探讨了过去已知的研究、自身病理解剖学文献以及胚胎学事实,解释了肾盂输尿管功能梗阻性畸形的病因。该病因呈现出两种现象:一是输尿管芽头端中空不足,输尿管芽最初有沟,当它从沃尔夫管分离时,可转变为完整的细胞索,在23毫米阶段后又形成沟;二是由于异常的解剖结构导致输尿管盆腔段下方血管化不足,纵向输尿管盆腔动脉移位至输尿管盆腔连接处下方明显位置,导致缺血,进而阻碍输尿管盆腔段下方的肌肉发育,使其壁变得比肌肉更硬化和纤维化。因此,输尿管芽沟的缺陷和动脉血液供应不足导致先天性输尿管狭窄。病理解剖学文献阐释了这一理论,由此引出两项必要技术:一是必须切除最初梗阻的输尿管段;二是要小心保护盆腔血管,这些血管将为与肾盂切缘吻合的输尿管提供血液供应。

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