男生殖系统先天畸形课件.ppt

第二节 一 发肓概论： 是全身各系统最常见畸形，中胚层发生。 1、肾起源于（原肾、中肾）后肾，输尿管芽起 自中肾管，长入生肾组织后形成后肾。 生肾组织发肓成为—肾单位。 输尿管芽等发肓成为—集合小管以下管道。 2、膀胱尿道： 源自泄殖腔，中央的尿道直肠隔分泄殖腔为二。后为直肠，前半部上段发肓为膀胱前列腺或女性尿道。 下段发肓成女性外阴，男性尿道膜部。 3、睾丸： 来自生殖嵴，7个月进入阴囊，残留中肾管成为输精管、精囊、附睾。 基因改变，激素水平、病毒、毒素等等。 本身受体。 一、肾、输尿管先天性畸形Congenital abnormalities 囊性肾病变 是人体最常见疾病，又分为遗传和非遗传性。Simple cyst of kidney is the most common one. Simple cyst of kidney The most common one in cystic renal disease. Non-hereditary. Most of them diagnosed by Abdominal ultrasound. At the beginning, they are asymptomatic. Clinical presentations Lion pain and microscopic hematuria are due to big size, bleeding in cyst, secondary infection or compression to adjacent parenchyma of kidney. Abdominal ultrasound The first choice for detecting a cyst. A mass with no echo, having a smooth wall, thin and clear border. A cyst with higher enhanced echo harbors blood fluid. Infectious cyst shows us a noisy echo and thick wall. Irregular and nodular wall tell us a possibility of malignant change. CT scanner and MRI More accurate than B ultrasound. A round mass with a thin, smooth, regular wall. House-field units -10 to 20. Can not be enhanced by contrast medium. Differentiation from the contents and benign or malignant. Management Following-up when diameter 4 cm. Treated when diameter 4-10cm; secondary infection; blood contents; obvious loss of parenchyma; possibility of malignant change. A high recurrence after aspiration. Upper pole cyst aspiration with a higher complications. Laparoscopy is popular, and micro-invasive. Operation for Indications to malignant changes 1、孤立肾 solitary： 1) 原因： 一侧生肾组织和/或输尿 管芽未发肓。 2 临床Findings： 体检时意外发现。 X线：KUB+IVU 肾影大，对侧无肾 影。 Cystoscopy:只有一侧输尿管口。 3）应知道： 在治疗有病肾脏前，要知道对侧肾脏情况。 唯一肾的丢失，则只有透析dialysis或肾移植renal transplantation。 2、肾发肓不全(dysplasia)： 1）发肓不全或生长障碍。 2）肾体积很小，尿分泌少，临床上 多以腰痛、高血压就诊。 X线：患肾狭小，显影模糊，健肾 大、形态好。 3）有症状者确定后