Kluth D, Kaestner M, Lambrecht W
Abteilung für Kinderchirurgie, Chirurgische Universitätsklinik Hamburg.
Zentralbl Chir. 1995;120(2):148-55.
Disorders of intestinal rotation present with a wide spectrum of abnormalities. This variety is attributed to the puzzling embryology of the midgut. Clinicians, as well as embryologists, believe that normally a process of rotation of the midgut takes place which can be hampered at any stage resulting in the different types of "malrotations". However, a "malrotated" gut has never been observed in normal embryos. Therefore all theories on the normal and abnormal development of the gut are still highly hypothetical. In an attempt to elucidate more clearly which events occur during the development of the gut, we studied its embryology in 58 normal rat embryos between the 13th and 20th day of gestation using scanning electron microscopy. In 13 day old rat embryos, the midgut already forms a loop. It can be subdivided into three parts: the central part (with its connections to rectum and stomach), the straight part (with the colorectum on the left and the "small bowel" on the right) and the tip of the loop (inside the umbilical cord). Obviously, these three parts show no signs of developmental synchronization. Each part develops according to its own developmental blue print: the duodenal and umbilical parts of the midgut show much developmental activity, while gross changes of the straight part of the midgut are missing. This finding is surprising because a process of rotation, if occurring, should result in notable morphological changes especially in this region. Further more, the coecum never achieved a position in the upper left abdomen, as it is often outlined by schematic drawings.(ABSTRACT TRUNCATED AT 250 WORDS)
肠道旋转异常表现出广泛的异常情况。这种多样性归因于中肠令人费解的胚胎发育过程。临床医生以及胚胎学家都认为,正常情况下中肠会发生旋转过程,而这一过程在任何阶段都可能受到阻碍,从而导致不同类型的“旋转不良”。然而,在正常胚胎中从未观察到“旋转不良”的肠道。因此,所有关于肠道正常和异常发育的理论仍然高度具有假设性。为了更清楚地阐明肠道发育过程中发生了哪些事件,我们使用扫描电子显微镜研究了58只妊娠第13天至20天的正常大鼠胚胎的胚胎学。在13天大的大鼠胚胎中,中肠已经形成一个环。它可以分为三个部分:中央部分(与直肠和胃相连)、直管部分(左侧为结肠直肠,右侧为“小肠”)和环的尖端(在脐带内)。显然,这三个部分没有显示出发育同步的迹象。每个部分都按照自己的发育蓝图发育:中肠的十二指肠和脐带部分显示出大量的发育活动,而中肠直管部分则没有明显变化。这一发现令人惊讶,因为如果发生旋转过程,应该会导致显著的形态变化,尤其是在这个区域。此外,盲肠从未到达左上腹的位置,而示意图中经常描绘它在这个位置。(摘要截取自250字)