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目的从形态学角度探讨慢性输尿管梗阻解除后肾功能不能完全恢复的机制。方法采用新西兰大白兔36只,随机分为正常对照组3只、梗阻对照组3只及实验组30只。后两者均建立单侧输尿管梗阻的兔模型,梗阻对照组2周后处死,实验组2周后行输尿管皮肤造口术,分别于术后12 h2、4 h3、d7、d1、4 d处死。对同侧的肾乳头及皮质进行扫描电镜观察。结果梗阻解除早期可见近端肾小管上皮细胞气球样变性及刷状缘大量缺失,远端肾小管及集合管亦表现为上皮细胞严重的气球样变性,见不到正常的肾小管结构。2周后多数肾小管上皮细胞恢复正常,然而一些肾小管仍进一步衰变。可见,输尿管梗阻解除后肾小管的恢复存在明显的不均一性。结论部分肾小管进一步衰变可能是慢性输尿管阻解除后肾功能不能完全恢复的主要病理学基础。
Objective To investigate the mechanism of renal function recovery after chronic ureteral obstruction is relieved from the perspective of morphology. Methods Thirty-six New Zealand white rabbits were randomly divided into three groups: normal control group, obstruction control group and experimental group. The latter two rabbits were established unilateral ureteral obstruction model, obstructive control group were sacrificed after 2 weeks, the experimental group 2 weeks after ureteral skin ostomy, were killed 12 h, 4 h3, d7, d1, 4 d after operation. The ipsilateral kidney papilla and cortex were observed by scanning electron microscopy. Results Early removal of obstruction revealed proximal balloon proximal tubular epithelial cell balloon deformity and a large number of missing brush border, distal tubules and collecting tube also showed severe epithelial cell balloon degeneration, can not see the normal tubular structure. Most of the renal tubular epithelial cells returned to normal after 2 weeks, however, some of the tubules still further decayed. Can be seen, ureteral obstruction to relieve tubule recovery after significant heterogeneity. Conclusion The further decay of renal tubules may be the main pathological basis for the complete recovery of renal function after chronic ureteral obstruction.