胚胎及胎儿肾、肾上腺、肝脏发育模式探讨

Approach of developmental mode of embryo and fetal kidney,adrenal and liver in the near period

目的探讨胚胎及胎儿发育不同时期肾、肾上腺及肝脏的发育模式,为临床评估胎儿泌尿系统、肝脏的发育状况及预测某些发育异常提供参考。方法收集吉林大学第一医院妇产科、中日联谊医院妇产科以及长春市部分市区级妇幼保健机构2003年1月至2007年12月由于计划生育原因或者意外终止妊娠的各孕周的胚胎和胎儿共167例。对其中135例孕12+6～36周胎儿的肾脏、肾上腺及肝脏的三维径线和质量进行了测量和统计。通过组织胚胎学方法观察余32例孕4+2～12+6周的胚胎及胎儿肾脏组织的发生过程。结果3个月胎龄胎儿的肾脏平均质量为0.1g,到孕9个月时达到7.8g。肾脏体积的发育与质量增加几乎是相称的。3～9个月胎龄胎儿左、右肾上腺各径线的长度和质量基本上呈匀速发育。在体积上,胎儿早期肾上腺大于肾脏,至孕4～5个月时二者体积相当,此后肾脏体积逐渐大于肾上腺。3个月胎龄时的肝脏仅有1.6g,到9个月时增加了53倍,达85.7g。组织胚胎学研究表明,妊娠40d时在胚胎的腰骶部基质组织中出现生后肾原基,50d时,发育成后肾。到妊娠90d时,已形成形态清晰、完整的肾小球。结论在整个胚胎及胎儿期,肾的发生与塑型一直在持续着;胎儿早期肾上腺体积大于肾脏;孕5～9个月是胎肝发育较快的时期。

Objective To investigate the developmental mode of embryo and fetal kidney, adrenal and liver during the different developmental stages. Providing the reference to appraisal developmental state of fetal urinary system and liver, and predicting dysplasia. Methods To collect 167 embryo and fetus in different gestational weeks, 135 fetuses during 12 - 36 gestational weeks were measured and analyzed,including three diamensions diameters and weight of kidney, adrenal and liver. 32 embryo and fetus during 4 ^＋2 - 12^＋6 gestational weeks were observed the growth of kidney by histological method. Results The weight of fetal kidney in 3 gestational months was 0.1 g,in 9 gestational months was 7. 8g. Increase of renal volume and weight was harmonious. From 3 -9 gestational months ,the development of left and right adrenal of 3D diameters length and weight were equal. In earlier embryonic stage, the volume of adrenal was more than kidney, in 4 - 5 months, they became equivalency gradually,and then the volume of kidney was more than adrenal. The weight of fetal liver in 3 gestational months wa 1.6g,in 9 gestational months was 85.7g, it raised 53 times. In 40 gestational days metanephrogenic blastema appeared in embryon lumbosacral ground substance by histological method. In 50 gestational days developed to metanephros and 90 days renal glomerulus with clear appearance and complete structure can be observed. Conclusion During the whole embryo and fetal period, development and molding of kidney is persistent. In earlier fetal stage, the volume of adrenal was more than kidney. 5 - 9 gestational monthes is the faster growth phase of fetal liver.