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Is vesicoamniotic shunt for complete urinary tract obstruction is partially effective?

膀胱羊膜腔分流术治疗完全性尿路梗阻是否部分有效？

基本信息

批准号：
16591790
负责人：
KITAGAWA Hiroaki
金额：
$ 2.11万
依托单位：
St.Marianna University School of Medicine
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2004
资助国家：
日本
起止时间：
2004 至 2005
项目状态：
已结题

项目摘要

Purpose : The long-term outcome for children after antenatal intervention for obstructive uropathy is disappointing. We reported that renal dysplastic changes are well-established 3 weeks after obstruction in a fetal lamb model. We used this model to explore renal development and bladder function after fetal intervention.Methods : We created an obstructive uropathy in fetal lambs at 60 days gestation by legating the urethra and urachus. A vesicostomy (female) or urethrostomy (male) were performed 21 days later. The fetuses were sacrificed at term (145 days) and bladder volume and were measured. The urinary tract was processed for histological examination.Results : Forty fetuses created an obstructive uropathy. Eleven miscarried or were stillborn. Twenty-nine survived and twenty-four had a successful shunt with a small bladder (8±5ml) compared to controls (71±19ml), p<0.05. Shunted bladders had poor compliance. Histologically, they had thickened sub mucosal connective tissue with hypertrophied muscle. Histology of the renal tissue demonstrated relatively well-preserved renal architecture with reduced nephrons mass (oligonephronia) in nine lambs and multicystic dysplastic change (MCDK) in three. Thirteen (54%) had normal nephrogenesis or slightly dilated pelvis as a Hydronephrosis.Conclusions : In our model, shunt operations after obstructive uropathy fail to preserve bladder function. Shunting ameliorated the development of cystic dysphasia but half of the lambs had oligonephronia or MCDK. These might develop renal failure later in life but 54% had normal nephrogenesis after shunting.

目的：儿童因梗阻性尿路病进行产前干预后的长期结果令人失望。我们报告说，在胎儿羔羊模型中梗阻后 3 周，肾脏发育不良的变化就已确定。我们使用该模型来探索胎儿干预后的肾脏发育和膀胱功能。方法：我们通过拉动尿道和尿尿管，在妊娠 60 天的胎儿羔羊中创建了阻塞性尿路病。 21 天后进行膀胱造口术（女性）或尿道造口术（男性）。足月（145天）处死胎儿并测量膀胱体积。对泌尿道进行组织学检查。结果：四十个胎儿出现梗阻性尿路病。十一名流产或死产。与对照组 (71±19ml) 相比，29 例存活，24 例成功分流，膀胱较小 (8±5ml)，p<0.05。分流膀胱的顺应性较差。组织学上，它们的粘膜下结缔组织增厚，肌肉肥大。肾组织的组织学显示，9 只羔羊的肾脏结构保存相对完好，肾单位质量减少（少肾），3 只羔羊出现多囊性发育不良性改变（MCDK）。十三名 (54%) 的肾发生正常或骨盆轻度扩张，表现为肾积水。结论：在我们的模型中，梗阻性尿路病后的分流手术无法保留膀胱功能。分流改善了囊性语言障碍的发展，但一半的羔羊患有少肾病或 MCDK。这些患者在以后的生活中可能会出现肾功能衰竭，但 54% 的患者在分流后肾发生正常。

项目成果

期刊论文数量（60）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Effects of fetal obstructive uropathy on renal development : Mechanism of MCDK.

胎儿梗阻性尿路病对肾脏发育的影响：MCDK 的机制。

DOI：
发表时间：
2004
期刊：
Journal of Tokushima Perinatal medicine 14
影响因子：
0
作者：
Tamaki Watanabe;Motoko Kawashima;Masataka Kawai Masakazu Yamada;Yukihiko Mashima;Kitagawa H
通讯作者：
Kitagawa H

The early effect of urinary tract obstruction on glomerulogenesis

尿路梗阻对肾小球生成的早期影响