肾盂输尿管连接处的临床解剖学观察

Clinical anatomic observation on the ureteropelvic junction

目的为肾盂输尿管连接处(UPJ)的形态学定位提供临床应用解剖学研究资料。方法取材于32例10%福尔马林固定的成人尸体双侧泌尿系标本,进行大体测量、组织学染色、神经纤维银染和图像分析。结果 UPJ外径(3.12±0.81)mm和内径(2.26±0.15)mm分别小于肾盂中部和输尿管中部的各自相应值(P<0.05)。UPJ神经纤维分布比肾盂中部和输尿管中部稀疏,胶原纤维较丰富。UPJ肌层厚度(0.34±0.03)mm和管壁厚度(0.63±0.04)mm也分别小于肾盂中部和输尿管中部各自相应值(P<0.05)。肾倾斜角平均为61°,与肾倾斜角有关的UPJ位置平均在肾下极平面以上1.2～1.3cm处,且肾倾斜角越大,UPJ位置相对越高。结论 UPJ约位于距肾下极平面以上1.25cm处。UPJ存在生理性内、外径狭窄,神经纤维分布较稀疏,平滑肌较薄弱,且排列不规则。

Objective To supply the clinical applied anatomic data for locating the ureteropelvic junction （UPJ）. Methods The urinary system specimens of 32 fixed adult cadavers were used for general measurement and then, the middle part of renal pelvis（ RPmid）, UPJ and the middle part of ureter（ URmid ） were taken for HE and nevre fibers sliver staining and the histological features were observed. Meanwhile, the staining images of the three parts were analysed and measured by computer. Results The outer diameters of UPJ（3. 12 ＋ 0. 81 ）mm, was among the shortest one of three outer diameters. Similarly, the inner diameter of UPJ （2.26 ＋ 0. 15 ）mm, was respectively shorter than that of RPia or URmid （P 〈 0. 05） . The nerve fibers were less in UPJ and RPmia ,whereas, the collagen fibers were relatively richer in muscular fascicles of UPJ. The smooth muscles arranged irregularly in UPJ . Both the wall （0.63 ＋ 0. 04） mm and the muscular layer （0. 34 ＋0. 03） mm of UPJ were thiner respectively than those of RPmid and URmid （P 〈0. 05）. The average value of renal incline angle was 61°. Related the angle, the general position of UPJ was about 1.2-1.3 cm above the plane extended horizontally from renal inferior extremity （Pinf）. The larger the incline angle （0） was, the higher the UPJ located in. Conclusion The location of UPJ is generally about 1.25cm above Pinf. There are physiologic intracavitary narrow and constriction around the outside of UPJ, in which nerve fibers are sparsely supplyed, the muscular layer is thiner and muscular fascicles arrange irregularly.