組織學與胚胎學：第20章 泌尿系統(tǒng)(Urinary System)

Wednesday,April19,2023SHUJia120-274頁泌尿系統(tǒng)(UrinarySystem)組成：腎輸尿管膀胱尿道功能：生成和排尿調節(jié)體內水和電解質分泌活性物質Wednesday,April19,2023SHUJia2腎動、靜脈腎輸尿管膀胱尿道Wednesday,April19,2023SHUJia3腎纖維膜,皮質,髓質(錐體),髓放線,皮質迷路,腎小葉,腎柱,腎葉腎單位(Nephron):腎小體(血管球+腎小囊)+腎小管泌尿小管(UriniferousTubule):腎小管+集合小管Wednesday,April19,2023SHUJia4腎Wednesday,April19,2023SHUJia5Wednesday,April19,2023SHUJia6腎葉Wednesday,April19,2023SHUJia7腎的組織結構

被膜:致密結締組織實質:泌尿小管和間質

血管球迷路腎小體腎小囊曲部腎單位近端小管直部髓放線腎小管細段髓袢或遠端小管直部髓質曲部迷路集合小管泌尿小管位于位于位于Wednesday,April19,2023SHUJia8Wednesday,April19,2023SHUJia9腎切片Wednesday,April19,2023SHUJia10腎皮質Wednesday,April19,2023SHUJia11Wednesday,April19,2023SHUJia12Wednesday,April19,2023SHUJia13Wednesday,April19,2023SHUJia14腎髓質Wednesday,April19,2023SHUJia15腎單位腎小體+腎小管腎結構和功能單位Wednesday,April19,2023SHUJia16腎單位Wednesday,April19,2023SHUJia17血管球(Glomerulus)

腎小囊(RenalCapsule)腎小體(RenalCorpuscle)血管極、尿極Wednesday,April19,2023SHUJia18腎小體Wednesday,April19,2023SHUJia19血管球Wednesday,April19,2023SHUJia20腎單位Wednesday,April19,2023SHUJia21腎小體Wednesday,April19,2023SHUJia22入、出球微動脈有孔毛細血管，隔膜、基膜厚血管(球內)系膜血管球Wednesday,April19,2023SHUJia23Wednesday,April19,2023SHUJia24血管系膜

基質+細胞基質：富含Ⅳ型膠原纖維和蛋白多糖；支持毛細血管袢Wednesday,April19,2023SHUJia25系膜細胞(MesangialCell)形態(tài):多突起，核小染色深，溶酶體和吞噬體，微絲微管，粗面內質網Wednesday,April19,2023SHUJia26功能:合成基質，參與基膜更新與修復吞噬基膜內免疫復合物支持毛細血管，調節(jié)血流量分泌血小板激活因子等Wednesday,April19,2023SHUJia27血管系膜Wednesday,April19,2023SHUJia28血管系膜Wednesday,April19,2023SHUJia29近端腎小管起始部膨大凹陷外層扁平，與近曲小管上皮相續(xù)內層足細胞(Podocyte)突起之間為裂孔，覆有裂孔膜腎小囊(RenalCapsule)Wednesday,April19,2023SHUJia30足細胞Wednesday,April19,2023SHUJia31足細胞Wednesday,April19,2023SHUJia32Wednesday,April19,2023SHUJia33Wednesday,April19,2023SHUJia34血管球基膜形成與更新攝取濾液成分支撐毛細血管收縮足細胞功能Wednesday,April19,2023SHUJia35有孔內皮、基膜和足細胞裂孔膜唾液酸糖蛋白分子篩選擇性濾過濾過膜(FiltrationMembrane)Wednesday,April19,2023SHUJia36Wednesday,April19,2023SHUJia37Wednesday,April19,2023SHUJia38濾過膜Wednesday,April19,2023SHUJia39毛細血管基膜、系膜與足細胞Wednesday,April19,2023SHUJia40濾過膜Wednesday,April19,2023SHUJia41濾過膜Wednesday,April19,2023SHUJia42Wednesday,April19,2023SHUJia43Wednesday,April19,2023SHUJia44腎小管近端小管＋細段＋遠端小管近/遠端小管：曲部+直部Wednesday,April19,2023SHUJia45最長、粗單層錐體形，嗜酸性，細胞間分界不清，側突，核近基底，游離面刷狀緣，基部縱紋，Na＋、K＋-ATP酶，吞飲小泡重吸收和分泌(H＋、氨、肌酐和馬尿酸)近端小管(ProximalTubule)Wednesday,April19,2023SHUJia46近曲小管上皮Wednesday,April19,2023SHUJia47Wednesday,April19,2023SHUJia48近曲小管PAS染色Wednesday,April19,2023SHUJia49近曲小管Wednesday,April19,2023SHUJia50Wednesday,April19,2023SHUJia51近曲小管Wednesday,April19,2023SHUJia52近端小管重吸收示意圖Wednesday,April19,2023SHUJia53單層扁平上皮，弱嗜酸性水和離子易通過細段(ThinSegment)Wednesday,April19,2023SHUJia54Wednesday,April19,2023SHUJia55單層立方上皮，染色淺核近腔面,基部縱紋明顯，Na＋、K＋-ATP酶,直部有T-H(酸性糖)蛋白,水不能通過受醛固酮和抗利尿激素的調節(jié)遠端小管(DistalTubule)Wednesday,April19,2023SHUJia56Wednesday,April19,2023SHUJia57Wednesday,April19,2023SHUJia58近曲小管遠曲小管Wednesday,April19,2023SHUJia59Wednesday,April19,2023SHUJia60近曲小管遠曲小管管腔小、不規(guī)則大、規(guī)則管壁厚、細胞大薄、細胞小胞質染色嗜酸性強嗜酸性弱細胞界線不清楚較清楚刷狀緣有無基底縱紋不明顯明顯腎小管特點Wednesday,April19,2023SHUJia61腎小管和集合小管結構特點比較

近曲小管遠曲小管 細段 集合小管

部位 皮質 皮質放、錐迷、放、錐管徑

較粗 較細 細 粗 管腔

較小不規(guī)則較大 小 大 細胞大小 較大 較小 小 形狀

立方或錐體形立方形 扁平立方至柱狀著色

深 淺 淺 色淡而明亮

分界

不清（側突）清楚 清楚 核

核圓近基底部核圓居中突向管腔核圓居中深染

Wednesday,April19,2023SHUJia62腎單位袢(NephronLoop)又稱髓袢，由近端小管直部、細段和遠端小管直部構成“U”形結構Wednesday,April19,2023SHUJia63原尿（125ml/min）濾過原理血管球血壓濾過孔徑內皮和足細胞表面唾液酸糖蛋白基膜分子篩和硫酸肝素Wednesday,April19,2023SHUJia64兩種腎單位淺表腎單位(CorticalNephron)髓旁腎單位(JuxtamedullaryNephron)Wednesday,April19,2023SHUJia65兩種腎單位Wednesday,April19,2023SHUJia66淺表腎單位發(fā)生晚數量85%，體積小細段和髓袢短單個血供少尿液形成Wednesday,April19,2023SHUJia67髓旁腎單位特點相反與腎間質滲透壓梯度形成和尿濃縮有關Wednesday,April19,2023SHUJia68集合小管(CollectingTubule)弓形直(皮、髓質)乳頭管管徑由細變粗，上皮由立方柱狀高柱狀Wednesday,April19,2023SHUJia69集合小管細胞分界清楚，胞質透亮，核居中集合管細胞：Na＋和水通道蛋白閏細胞：H＋-ATP酶和Cl-/HCO3-交換載體Wednesday,April19,2023SHUJia70重吸收及分泌受醛固酮和抗利尿激素調節(jié)功能Wednesday,April19,2023SHUJia71髓質Wednesday,April19,2023SHUJia72腎髓質Wednesday,April19,2023SHUJia73髓質Wednesday,April19,2023SHUJia74集合小管Wednesday,April19,2023SHUJia75腎小管各段模式圖Wednesday,April19,2023SHUJia76腎小球旁器（球旁復合體）

(JuxtaglomerularComplex)球旁細胞＋致密斑＋球外系膜細胞Wednesday,April19,2023SHUJia77Wednesday,April19,2023SHUJia78Wednesday,April19,2023SHUJia79入球微動脈管壁內平滑肌細胞演變立方形，弱嗜堿性，PAS陽性分泌顆粒腎素和紅細胞生成素促血管收縮，醛固酮分泌、紅細胞增殖球旁細胞(JuxtaglomerularCell)Wednesday,April19,2023SHUJia80小鼠腎 猩紅-乙基紫染色Wednesday,April19,2023SHUJia81大鼠腎Wednesday,April19,2023SHUJia82遠端小管上皮演變高柱狀，核近頂部，細胞間隙感受腎濾液內Na+濃度，傳遞信息→球旁細胞→腎素致密斑(MaculaDensa)Wednesday,April19,2023SHUJia83人腎Wednesday,April19,2023SHUJia84Wednesday,April19,2023SHUJia85小，有突起，染色淺，縫隙連接信息傳遞球外系膜細胞Wednesday,April19,2023SHUJia86球旁復合體功能：分泌腎素，調節(jié)血壓和水鹽平衡；Wednesday,April19,2023SHUJia87腎素血管緊張素轉換酶醛固酮血管緊張素原血管緊張素Ⅰ血管緊張素Ⅱ遠曲小管集合小管乳頭管Wednesday,April19,2023SHUJia88腎間質皮質少，髓質多，腎乳頭最多載脂間質細胞：有突起，胞質內含脂滴，合成分泌髓脂Ⅰ→肝內轉化為髓脂Ⅱ→血管舒張，前列腺素等，形成間質血管內皮細胞分泌紅細胞生成素Wednesday,April19,2023SHUJia89腎的血液循環(huán)腎A→葉間A→弓形A→小葉間A被膜cap

入球微A入球微A

髓旁血管球淺表血管球

直小A出球微A

直小V球后cap網腎V←葉間V←弓形V←小葉間V星形VWednesday,April19,2023SHUJia90腎血液循環(huán)特點腎動脈粗短,血流量占心輸出量1/4，90％→皮質入球微動脈比出球微動脈粗,球內血壓高兩套毛細血管,過濾及重吸收直小血管與髓袢伴行,有利于原尿重吸收濃縮Wednesday,April19,2023SHUJia91Wednesday,April19,2023SHUJia92血管球球后cap網直小V直小A小葉間A小葉間V弓形A、VWednesday,April19,2023SHUJia93兔Wednesday,April19,2023SHUJia94Wednesday,April19,2023SHUJia95180L1.50L尿的形成Wednesday,April19,2023SHUJia96尿的吸收與濃縮Wednesday,April19,2023SHUJia97腎的其他功能內分泌合成和降解前列腺素:載脂細胞、系膜細胞、集合小管上皮細胞。擴血管激肽釋放酶-激肽系統(tǒng):前者由腎小管上皮產生；后者由集合小管上皮產生。擴血管利尿促紅細胞生成素:球旁細胞，內皮細胞維生素D3的羥化Wednesday,April19,2023SHUJia98腎的淋巴管：腎內淋巴叢和被膜淋巴叢腎的神經：交感和副交感神經Wednesday,April19,2023SHUJia99排尿管道腎盂和腎盞:上皮,平滑肌輸尿管：黏膜縱形皺襞,上2/3平滑肌內縱外環(huán),外膜疏松膀胱:黏膜皺襞,上皮腔面細胞大,胞膜游離面厚,縱環(huán)縱三層平滑肌,外膜疏松尿道黏膜(變移上皮)、肌層和外膜Wednesday,April19,2023SHUJia100Wednesday,April19,2023SHUJia101輸尿管肌層Wednesday,April19,2023SHUJia102人輸尿管Wednesday,April19,2023SHUJia103人Wednesday,April19,2023SHUJia104Wednesday,April19,2023SHUJia105Wednesday,April19,2023SHUJia106Wednesday,April19,2023SHUJia107Wednesday,April19,2023SHUJia108松弛時Wednesday,April19,2023SHUJia109Wednesday,April19,2023SHUJia110質膜內褶與小泡Wednesday,April19,2023SHUJia1111.

腎和輸尿管的發(fā)生1.1原基：

間介中胚層頸段

→生腎節(jié)→前腎尾段

→

生腎索→中腎、后腎一、泌尿系統(tǒng)的發(fā)生Wednesday,April19,2023SHUJia1121.2前腎生腎節(jié)

→

前腎小管

，前腎管→退化1.3中腎1)生腎索→中腎嵴→中腎

Wednesday,April19,2023SHUJia1132)中腎小管

→

大部分消失中腎管

→

通入泄殖腔

Wednesday,April19,2023SHUJia1141.4后腎原基：中腎管末端→