Reproductive Uterine Surgery
Reproductive Uterine Surgery
复制标题
生殖子宫手术
DOI：
10.1055/s-2007-1023839
复制
发表时间：
1984
期刊：
影响因子：
--
通讯作者：
A. Berkeley
中科院分区：
文献类型：
--
作者：
A. Berkeley
子宫和卵巢的发育是独立的胚胎学事件，因此子宫发育异常通常与卵巢发育异常无关。胚胎5周龄时，中肾旁管（苗勒管）表现为尿生殖嵴外侧部分的退化，沿着中线背侧肠系膜和主动脉后壁出现。这种结构，在没有睾酮的情况下，可能在雌激素的存在下，在头部和尾部方向都延长。头侧部分仍然与腹腔相通，成为管和伞。尾侧部向下延伸至中肾管（可能以中肾管为模板），直至到达骨盆区。然后导管转向中线，腹侧穿过中肾导管。一旦进入中线，尾部生长继续，直到成对的中肾旁管在9周龄时到达尿生殖窦后壁。坚实的尾端融合形成子宫颈和子宫体。虽然以前认为阴道的上2/3也是苗勒管的起源，但最近的证据表明，当融合的中肾旁管与尿生殖窦接触时，两个副产物--窦阴道球--迅速增殖并形成阴道板。这个板变厚并伸长，形成一个组织体，将成为阴道。在11周时，该组织的尾端出现管腔，并在20周时完全再通。在两个副中肾管中线融合后，实芯渠化，从而存在两个彼此相邻的腔。进一步分化导致分隔这两个腔的隔膜吸收，形成单一的子宫腔和宫颈管。
The development of the uterus and ovaries are separate embryologic events; therefore, abnormalities of uterine development are not usually associated with abnormal ovarian development. At 5 weeks embryologic age, the paramesonephric (müllerian) ducts appear as an involution of the lateral portion of the urogenital ridge, which arises along the posterior wall of the midline dorsal mesentery and aorta. This structure, in the absence of testosterone, and possibly in the presence of estrogen, elongates in both cranial and caudal directions. The cranial portion remains open to the abdominal cavity and becomes the tube and fimbria. The caudal portions descend laterally to the mesonephric (wolffian) ducts (possibly using them as a template) until the pelvic region is reached. The ducts then turn to the midline, crossing the mesonephric ducts ventrally. Once in the midline, the caudal growth continues until the paired paramesonephric ducts reach the posterior wall of the urogenital sinus at 9 weeks embryologic age. The solid caudal poles fuse to form what will become the cervix and body of the uterus. Although it was formerly thought that the upper two-thirds of the vagina was also of müllerian derivation, more recent evidence suggests that, when the fused paramesonephric ducts come into contact with the urogenital sinus, two outgrowths—the sinovaginal bulbs—proliferate rapidly and form the vaginal plate. This plate thickens and elongates to form a body of tissue that will become the vagina. A lumen appears in the caudal end of this tissue at 11 weeks and completely recanalizes it by 20 weeks. After midline fusion of the two paramesonephric ducts, the solid core canalizes so that there are two lumina adjacent to each other. Further differentiation leads to resorption of the septum separating these two lumina with the formation of a single uterine cavity and endocervical canal.