胎儿期解除单侧输尿管不完全梗阻的实验研究

Correction of unilateral partial ureterul obstruction in fetal lambs

目的探讨胎儿期解除单侧输尿管不完全梗阻的效果。方法取22只健康孕羊在妊娠第75至85天采用宫内手术的方法造成胎羊左侧输尿管不完全梗阻。然后分为二组，第一组12只继续妊娠，第二组10只三周后再次手术去除胎羊输尿管上的硅胶环和丝线以解除梗阻。对羔羊进行影像、病理学研究。结果第一组12只孕羊中有3只流产，有9只孕羊顺产羔羊；第二组10只孕羊中有2只流产，有8只孕羊顺产羔羊。第一组羔羊左肾均可见增大、积水和肾功能损害；第二组羔羊左肾大小、肾功能正常，左肾盂无扩张，但表面不平滑、肾实质较薄。组织学上，第二组羔羊左肾肾小球数目无减少，肾小管扩张也较第一组羔羊左肾轻。结论胎儿期解除单侧输尿管不完全梗阻，可以及时阻止病程进展，使梗阻解除肾在形态和功能上都可得到较好的恢复。

Objective To investigate the efficacy of antenatal correction of unilateral partial ureteral obstruction in fetal lambs. Methods Twenty two healthy pregnant ewes were underwent intrauterine operation between 75 and 85 days of gestation to induce unilateral partial urethral obstruction on fetuses. The ewes were randomly divided into 2 groups. Twelve ewes of Group 1 were allowed to continue pregnancy until delivery. On the 10 ewes of Group 2, the second intrauterine operations were performed to remove the silastic rings and the silk sutures on the ureter of fetuses three weeks after the first surgery. The kidneys of the neonatal lambs were harvested and studied histologically. Results In Group 1, three ewes aborted after surgery, nine ewes delivered normally. In Group 2, two ewes aborted after the second operation, the other 8 ewes delivered living lambs. Hydronephrosis and renal function impairment were found on the left kidneys of Groupl lambs. On the lambs of Group 2, normal sizes left kidneys without hydronephrosis were noted, but the kidneys had unsmooth surface and thin renal parenchyma. Histological examination revealed that the number of glomerulus in the left kidneys of neonatal lambs from Group 2 were still normal. Compared with Group 1, the severity of tubules dilation was alleviated in Group 2. Conclusions The surgical relief of urethral obstruction on fetuses prevents the progression of nephropathy. The renal function will be preserved or even recovered after antenatal surgery.