【医学英语翻译】泌尿系统解剖

医科大学教材翻译《系统解剖学》 第四章 泌尿系统 泌尿系统由肾、输尿管、膀胱及尿道四部分组成。它的主要功能是排出机体内溶于水的代谢产物。机体在新陈代谢中所产生的废物如尿素、尿酸和多余的水分等，由循环系统送至肾，在肾内形成尿液，再经排尿管道排出体外。尿的质和量经常随机体内环境的改变而发生一定的变化，对保持内环境的相对稳定和电解质的平衡起着重要的作用。如肾功能发生障碍，代谢产物蓄积于体内，改变了内环境的理化性质，则产生相应的病变，严重时可出现尿毒症，甚至危及生命。 Chapter IV Urinary System The urinary system consists of kidney, ureter, bladder and urethra. Its main function is to expel water-soluble metabolites from the body. Wastes such as urea, uric acid and excess water produced by the body in metabolism are sent to the kidney by the circulatory system, and urine is formed in the kidney, and then discharged from the body through the urination duct. The quality and quantity of urine often change with the internal environment, which plays an important role in maintaining the relative stability of internal environment and electrolyte balance. If renal function is impaired and metabolites accumulate in the body, which changes the physical and chemical properties of the internal environment, corresponding pathological changes will occur, and uremia may occur in severe cases, which may even be life-threatening. 第一节 肾 一、肾的形态 肾是成对的实质性器官，形似蚕豆，左右各一，在脊柱的两侧贴于腹后壁。新鲜肾呈红褐色，肾的大小因人而异。正常成年男性平均长约10cm，宽5cm，厚4cm，平均重量为134~148g。一般女性肾略小于男性。肾可分上、下端，内、外侧缘和前、后面。肾上端宽而薄，下端窄而厚。前面较凸，朝向前外侧；后面较平，贴靠腹后壁。外侧缘凸隆；内侧缘中部凹陷，是肾的血管、淋巴管、神经和肾盂出入的部位，称为肾门。肾门长约2~3cm，宽1.4~2.5cm。出入肾门的结构合称肾蒂。肾蒂主要结构的排列关系：由前向后依次为肾静脉、肾动脉和肾盂；从上向下依次为肾动脉、肾静脉和肾盂。因下腔静脉位于中线右侧，致使右侧肾蒂较左侧的为短，在肾手术时可造成一定的困难。肾门向肾内续于一个较大的腔，称为肾窦，由周围的肾实质围成，内含肾动脉、肾静脉的主要分支和属支、肾小盏、肾大盏、肾盂和脂肪组织等。 Section 1 Kidney First, Morphology of the kidney The kidneys are paired parenchymal organs, shaped like broad beans, one on the left and one on the right, and attached to the posterior abdominal wall on both sides of the spine. The fresh kidney is reddish brown, and the size of the kidney varies from person to person. For average adult male, it is about 10cm long, 5cm wide and 4cm thick, and the average weight is 134~148g g. Generally, women's kidneys are slightly smaller than those of men. Kidney can be divided into upper and lower ends, medial and lateral edges, and anterior and posterior surfaces. The upper end of the kidney is wide and thin, and the lower end is narrow and thick. The anterior surface is convex, facing the lateral front; The posterior surface is flat and clings to the posterior abdominal wall. The lateral margin is protruding; The middle part of the medial margin is depressed, which is the place where the blood vessels, lymphatic vessels, nerves and renal pelvis of the kidney come in and out, and is called the renal hilum. Renal hilum is about 2~3cm long and 1.4~2.5cm wide. The structure entering and leaving the renal hilum is called renal pedicle. The arrangement of the main structures of renal pedicle from front to back: renal vein, renal artery and renal pelvis; From top to bottom: renal artery, renal vein and renal pelvis. Because the inferior vena cava is located on the right side of the midline, the right renal pedicle is shorter than the left one, which may cause some difficulties in renal surgery. The hilum of the kidney continues into the kidney in a larger cavity called renal sinus, which is surrounded by the surrounding renal parenchyma, and contains the main branches and affiliated branches of renal artery and renal vein, renal calyx minor, renal calyx major, renal pelvis and adipose tissue. 二、肾的构造 在肾的额状切面上，可见肾实质分为皮质和髓质两部分。肾皮质主要位于浅层，富含血管，新鲜标本为红褐色，肉眼可见密布的细小颗粒(相当肾小体)。肾髓质位于肾实质的深部，色淡，由许多小的管道组成，它们形成15~20个锥形的肾锥体，锥体的基底朝向皮质；尖端圆钝，朝向肾窦，称为肾乳头。有时2~3个肾锥体合成一个肾乳头。乳头的顶端有许多小孔，称为乳头孔。肾形成的尿液由乳头孔流入肾小盏内。浅层的肾皮质伸入肾锥体之间的部分称为肾柱。 Second, the structure of the kidney On the frontal section of the kidney, the renal parenchyma can be divided into cortex and medulla. The renal cortex is mainly located in the superficial layer, rich in blood vessels, and the fresh specimen is reddish brown, with dense fine particles visible to the naked eye. (equivalent to renal corpuscles). The renal medulla is located in the deep part of renal parenchyma, and it is pale in color. It is composed of many small tubes, which form 15~20 cone-shaped renal pyramids, and the base of the cone faces the cortex. The tip is round and blunt, facing the renal sinus, which is called renal papilla. Sometimes 2~3 renal pyramids compose one renal papilla. There are many small holes at the top of the papilla, which are called papillary foramina. The urine formed by the kidney flows into minor renal calices from the papillary foramina. The part of the superficial renal cortex extending between renal pyramids is called renal column. 肾窦内约有7~8个呈漏斗状的肾小盏，小盏的边缘附着于肾乳头基部，包绕肾乳头，以承接排出的尿液。2~3个肾小盏合成一个肾大盏，肾大盏约2~3个，再集合成一个前后扁平、约呈漏斗状的肾盂。肾盂出肾门后，向下弯行，逐渐变细移行为输尿管。肾盂的形态有变异，以二支型最多，占74%；次为三支型，占12%；较膨大的为壶腹型，占6%；介于分支型与壶腹型之间的形状较扁窄，为中间型，占8%。 There are about 7~8 funnel-shaped renal calyces in the renal sinus, and the edge of the calyces is attached to the base of the renal papilla, which surrounds the renal papilla to accept the urine discharged. 2~3 minor renal calyces are combined into a major renal calyx, and about 2~3 major renal calyces then assembled into a flat, funnel-shaped renal pelvis. After the renal pelvis leaves the renal hilum, it bends downward and gradually tapers to the ureter. The shape of renal pelvis is varied, most of them are of bifurcation type, accounting for 74%; The second type is three branches, accounting for 12%; The bulging one is of ampulla type, accounting for 6%; The shape between the branching type and the ampulla type is flat and narrow, and it is the middle type, accounting for 8%. 三、肾的位置和被膜 (一)肾的位置 正常成年人的肾位于腹膜后间隙内，脊柱的两侧，贴靠腹后壁的上部。肾的长轴向外下倾斜，男性肾的上端距正中线的距离：左侧为4.2cm，右侧为4.0cm；下端距正中线的距离：左侧为5.5cm，右侧为5.7cm。肾的高度，左肾上端平第12胸椎上缘，下端平第3腰椎上缘；右肾上端平第12胸椎下缘；下端平第3腰椎下缘，即右肾低于左肾。第12肋斜越左肾后面的中部，右肾后面的上部。肾门约平第1腰椎平面，距正中线约5cm。在竖脊肌的外侧缘与第12肋之间的部位称为肾区(脊肋角)。在某些肾疾病患者，叩击或触压此区可引起疼痛。正常时肾的位置可随呼吸和体位而上下移动幅度约为2~3cm。肾的位置一般女性低于男性，儿童低于成人，新生儿的则更低，其至可达髂嵴附近。 Third, the location and capsules of kidney (One) the location of kidney The kidneys of normal adults are located in the retroperitoneal space, on both sides of the spine, and close to the upper part of the abdominal posterior wall. The long axis of the kidney inclines outwards and downwards, and the distance from the upper end of the male kidney to the midline is 4.2cm on the left and 4.0cm on the right; Distance from the lower end to the center line is 5.5cm on the left and 5.7cm on the right. The height of the kidney, the upper end of the left kidney is level with the upper edge of the 12th thoracic vertebra, and the lower end is level  with the upper edge of the 3rd lumbar vertebra; The upper end of the right kidney is flat with the lower edge of the 12th thoracic vertebra; The lower end is flat to the lower edge of the third lumbar vertebra, that is, the right kidney is lower than the left kidney. The 12th rib obliquely crosses the middle part of the posterior surface of the left kidney and the upper part of the right one. The hilum of the kidney is approximately level with the plane of the first lumbar vertebra, about 5cm away from the midline. The part between the lateral edge of erector spinae and the 12th rib is called the renal region (the spine rib angle). In some patients with renal diseases, tapping or touching this area can cause pain. Under normal circumstances, the position of the kidney can move up and down with breathing and posture by about 2~3cm. The position of the kidney is generally lower in women than in men, lower in children than in adults, and even lower in newborns, which reaches to the vicinity of iliac crest. 肾的毗邻：肾后面上1/3借膈与肋膈隐窝相邻，肾手术时应注意勿伤胸膜。肾后下2/3与腰大肌、腰方肌和腹横肌相邻。肾前面的邻接左、右不同：右肾邻十二指肠、肝右叶和结肠右曲；左肾邻胃、胰、空肠、脾和结肠左曲。两肾上端均紧邻肾上腺。 Adjacency of kidney: the upper 1/3 of renal posterior surface is adjacent to the costal phrenic recess through the diaphragm, so care should be taken not to hurt the pleura during kidney surgery. The posterior lower 2/3 of the kidney is adjacent to psoas major, quadratus lumborum and transverse abdominis muscles. The left and right adjacencies of renal anterior surface are different: the right kidney is adjacent to the duodenum, the right lobe of the liver and the right curvature of the colon; The left kidney is adjacent to the stomach, pancreas, jejunum, spleen and colon. The upper ends of both kidneys are close adjacent to the adrenal glands. (2) The capsules of kidney The surface of the kidney is surrounded by three layers of membranes from the interior to the exterior. 1. Fibrous capsule: a thin layer of dense and tough connective tissue membrane attached to the surface of renal parenchyma, containing a small amount of elastic fibers. Under normal circumstances, it is easy to separate from renal parenchyma, and under pathological conditions, it adheres to renal parenchyma and is not easy to peel off. This membrane should be sutured when the kidney is ruptured or partially removed. 2. Adipose capsule: It is the fat tissue around the fibrous capsule, with more fat at the edge of the kidney and continuous with the fat tissue in the renal sinus through the renal hilum. Adipose capsule plays a protective role of elastic pad on kidney. 3. Renal fascia: located at the periphery of the adipose capsule, developed from extraperitoneal tissue. The renal fascia is divided into anterior and posterior layers, which surround the kidney and adrenal gland. Above and outside the kidney, the two layers merge with each other. The two layers below the kidney are separated, and the ureter passes between them. On the inner side of the kidney, the anterior layer extends to the front of the abdominal aorta and inferior vena cava and continues with the anterior layer of the opposite renal fascia, and the posterior layer is merged with the psoas major fascia. The renal fascia sends out many small bundles of connective tissue to the deep surface, which pass through the adipose capsule and connect to the fibrous capsule, thus fixing the kidney. (二)肾的被膜 肾的表面自内向外有三层被膜包绕。 1.纤维囊：为贴附于肾实质表面的薄层致密坚韧的结缔组织膜，内含少量弹力纤维。正常情况下，易与肾实质分离，在病理情况下，则与肾实质发生粘连，不易剥离。肾破裂或肾部分切除时，需缝合此膜。 2.脂肪囊：为纤维囊外周的脂肪组织，在肾的边缘处脂肪较多，并通过肾门与肾窦内的脂肪组织相连续。脂肪囊对肾起弹性垫的保护作用。 3.肾筋膜：位于脂肪囊的外周，由腹膜外组织发育而来。肾筋膜分前、后两层，包绕肾和肾上腺。在肾的上方和外侧，两层互相融合。在肾的下方两层分离，其间有输尿管通过。在肾的内侧，前层延至腹主动脉与下腔静脉的前面与对侧肾筋膜前层相续连，后层与腰大肌筋膜融合。肾筋膜向深面发出许多结缔组织小束，穿过脂肪囊连于纤维囊，对肾起固定作用。 肾的正常位置靠多种因素来维持，肾被膜、肾血管、肾的毗邻器官、腹内压以及腹膜等对肾均起固定作用。肾的固定装置不健全时，可形成肾下垂或游走肾。 The normal position of kidney is maintained by many factors, such as renal capsule, renal blood vessels, adjacent organs of kidney, intra-abdominal pressure and peritoneum. When the fixation device of kidney is not perfect, it can form nephroptosis or wandering kidney. 四、肾段的概念和肾的异常 (一)肾段的概念 肾动脉在肾实质的分支按一定的节段分布。一个段动脉分布一定区域的肾组织。一个肾段动脉所分布的这部分肾组织称为一个肾段。每个肾分为5个肾段：上段、上前段、下前段、下段和后段。各段动脉分支之间无吻合，一个段动脉出现血流障碍时，它所供应的肾段即可出现坏死。了解肾段，对肾疾病的定位和部分切除术有实用意义。 Fourth, the concept of renal segment and renal abnormality (One) the concept of renal segment The branches of renal artery in renal parenchyma are distributed in certain segments. A segmental artery distributes renal tissue in a certain area. This part of renal tissue where a segmental renal artery is distributed is called a renal segment. Each kidney is divided into five renal segments: upper segment, upper anterior segment, lower anterior segment, lower segment and posterior segment. There is no anastomosis between the branches of each segment artery. When a segment artery has blood flow disorder, the renal segment it supplies can be necrotic. Understanding the renal segment is of practical significance for the localization and partial nephrectomy of renal diseases. (二)肾的异常 肾在发育过程中，可出现形态、位置、数目等方面的异常或畸形。常见的有:①马蹄肾:左右两肾下端互相连接形成马蹄铁形;2多囊肾:由于胚胎时肾小管与集合管不相通连，液体贮留于肾小管内，致使膨大成囊状;③双肾盂及双输尿管:如输尿管芽末端分二支，则形成双肾盂;④单肾:一侧肾缺如或发育不全称为单肾;⑤低位肾:于胚胎早期，肾原位于盆部，随着胎儿的发育逐渐上升至腰部，若发育停滞，即可成低位肾，可位于髂窝或小骨盆腔内。 (Two) Renal abnormalities During the development of kidney, there may be abnormalities or deformities in shape, position and number. Common ones are: ① horseshoe kidney: the lower ends of the left and right kidneys are connected with each other to form horseshoe shape; Polycystic kidney: because the renal tubule is not connected with the collecting duct in the embryo, the liquid is stored in the renal tubule, which causes it to expand into a cyst; (3) Double renal pelvis and double ureters: If the ureter bud ends in two branches, double renal pelvis will be formed; ④ Single kidney: the absence or hypoplasia of one kidney is called single kidney; ⑤ Low kidney: In the early embryo, the kidney is located in the pelvis, and gradually rises to the waist with the development of the fetus. If the development is stagnant, it can become a low kidney, which can be located in the iliac fossa or small pelvic cavity. 第二节 输尿管 Section Two: Ureter 输尿管为细长的肌性管道，左右各一，长度平均男性为26.5cm，女性为25.9cm，管径约为0.5~0.7cm。起自肾盂下端，终于膀胱。输尿管有较厚的平滑肌层，可作节律性的蠕动，使尿液不断地流入膀胱。如因结石阻塞而过度扩张，可产生痉挛性收缩而产生疼痛即肾绞痛。 The ureter is a slender muscular tube, one on the left and one on the right, with an average length of 26.5cm for men and 25.9cm for women, and a diameter of about 0.5~0.7cm. It originates from the lower end of the renal pelvis and ends in the bladder. The ureter has a thick smooth muscle layer, which can be used for rhythmic peristalsis, so that urine can continuously flow into the bladder. If it is excessively dilated due to stone obstruction, it can produce spasmodic contraction and pain, that is, renal colic. 输尿管的行径与分段：输尿管按行径可分为腹段、盆段和壁内段。输尿管自肾盂下端起始后，在腹后壁腹膜的深面，沿腰大肌前面下降。达小骨盆入口处，左、右输尿管分别越过左髂总动脉末端和右髂外动脉起始部的前面，此段称为腹段。 Pathway and segmentation of ureter: Ureter can be divided into abdominal segment, pelvic segment and intramural segment according to its pathway. After the ureter starts from the lower end of the renal pelvis, it descends along the front of psoas major in the interior side of the peritoneum of the abdominal posterior wall. At the entrance of the small pelvis, the left and right ureters respectively cross the end of the left common iliac artery and the front of the beginning of the right external iliac artery, and is called abdominal segment. 从髂血管入盆腔，先沿盆侧壁向下向后，越过盆壁血管神经的表面，约在坐骨棘水平转向前内侧穿入膀胱底的外上角，这一段称为盆段。在女性，输尿管经过子宫颈的外侧，阴道穹侧部的上方，距子宫颈约1.5~2cm，此处有子宫动脉横过其前上方；在男性有输精管越过输尿管下端的前方。 From iliac vessels into the pelvic cavity, it first goes down and backward along the pelvic side wall, crosses the surface of the vessels and nerves in the pelvic wall, and turn to the anterior medial side at the level of sciatic spine and then penetrates into the outer upper corner of the bladder bottom. This section is called pelvic segment. In women, the ureter passes through the lateral side of the cervix, above the lateral part of the vaginal vault, about 1.5~2cm away from the cervix, where the uterine artery crosses the anterior upper part; In men, the vas deferens crosses the front of the lower end of ureter. 输尿管自膀胱底的外上角，向内下斜穿膀胱壁，于输尿管口开口于膀胱，此部称为壁内段，长约1.5~2.0cm。当膀胱充盈时，膀胱内压增高，将壁内段压扁，管腔闭合，可防止膀胱中的尿液返流人输尿管。由于输尿管的蠕动尿液仍可不断地进入膀胱。若壁内段过短或其周围的肌组织发育不良时，也可出现尿返流现象。 The ureter passes through the bladder wall from the outer upper corner of the bladder bottom obliquely inward and downward, and opens in the bladder at the orifice of the ureter, which is called the intramural segment and is about 1.5~2.0cm long. When the bladder is full, the internal pressure of the bladder increases, flattening the inner wall and closing the lumen, which can prevent the urine in the bladder from flowing back to the ureter. Urine can still enter the bladder continuously due to the peristalsis of ureter. If the intramural segment is too short or the muscle tissue around it is underdeveloped, urine reflux can also occur. 输尿管的狭窄部：①肾盂与输尿管移行处；②与髂血管交叉处；③壁内段。这些狭窄处常是输尿管结石滞留的部位。 The strictures of ureter: ① the transition between renal pelvis and ureter; ② Intersection with iliac vessels; ③ intramural segment. These strictures are often the sites where ureteral stones remain. 第三节 膀胱 膀胱是储存尿液的囊状肌性器官，其形状、大小和位置均随尿液充盈的程度而变化。膀胱的平均容量，一般正常成年人约为300~500ml，最大容量可达800ml。新生儿的膀胱容量约为成人的1/10。老年人由于膀胱肌肉的紧张力降低，容积增大。女性膀胱容量较男性为小。 Section Three: Bladder Bladder is a cystoid muscular organ for storing urine, and its shape, size and position change with the degree of urine filling. The average volume of bladder is about 300~500ml for normal adults, and the maximum volume can reach 800ml. The bladder capacity of newborns is about 1/10 of that of adults. Old people's bladder has increased volume due to decreased muscular tension. Female bladder capacity is smaller than that of male. 一、膀胱的形态 膀胱空虚时呈三棱锥体形。顶端朝向前上，称膀胱尖。底部呈三角形，朝向后下，称膀胱底。尖与底之间的大部分称膀胱体。膀胱的下部有尿道内口，与前列腺相接触，这一变细的部分称膀胱颈。膀胱各部之间没有明显的界限。膀胱充盈时呈卵圆形。 First, the morphology of the bladder When the bladder is empty, it has a triangular pyramid shape. The tip of the bladder faces forward, which is called the tip of the bladder. The bottom is triangular, facing downward, called the bottom of bladder. The most part between the tip and the bottom is called the bladder body. The lower part of the bladder has an internal urethral orifice, which is in contact with the prostate. This thinned part is called the bladder neck. There is no obvious boundary between different parts of the bladder. The bladder is oval when filled. 切开膀胱前壁观察膀胱内面时，可见粘膜由于膀胱肌层的收缩而形成许多皱襞，当膀胱膨胀时，皱襞可全部消失。但在膀胱底的内面有一三角形区域，由于缺少粘膜下层，粘膜与肌层紧密相连，无论在膀胱膨胀或收缩时，都保持平滑状态，永不形成皱襞，此区称为膀胱三角。膀胱三角位于两输尿管口与尿道内口之间。两输尿管口之间的横行皱襞叫输尿管间襞，粘膜深面有横走的平滑肌束。膀胱镜检时，可见这一皱襞呈苍白色，是寻找输尿管口的标志。 When the front wall of the bladder is cut open to observe the inner surface of the bladder, it can be seen that many folds are formed in the mucosa due to the contraction of the bladder muscle layer, and all the folds can disappear when the bladder expands. However, there is a triangular area on the inner surface of the bottom of the bladder. Because of the lack of submucosa, the mucosa is closely connected with the muscularis, which keeps smooth when the bladder expands or contracts, and never forms folds. This area is called the bladder triangle. The triangle of bladder is located between the two ureteral orifices and the internal urethral orifice. The transverse fold between the two ureters is called the interureteric fold, and there are transverse smooth muscle bundles on the deep surface of the mucosa. Cystoscopy shows that this fold is pale, which is a sign of finding ureteral orifice. 膀胱三角的前下部，尿道内口的后方，于成年男子有因前列腺中叶而微凸的隆起，称为膀胱垂。前列腺中叶肥大时,此处明显凸起,可压迫尿道造成排尿困难。膀胱三角为肿瘤和结核的好发部位，是膀胱镜检的重点区域，有重要临床意义。 The anterior lower part of the bladder triangle, behind the urethral orifice, has a slight bulge due to the middle lobe of the prostate in adult men, which is called vesical uvula. When the middle lobe of the prostate is hypertrophy, it is obviously protruding here, which can compress the urethra and cause dysuria. The triangle of bladder is the most common site of tumor and tuberculosis, and it is the key area of cystoscopy, which has important clinical significance. 二、膀胱的位置 成人的膀胱位于小骨盆的前部，前方为耻骨联合，后方在男性为精囊腺、输精管壶腹和直肠，女性后方为子宫和阴道。膀胱颈在男性下邻前列腺，在女性下方直接邻接尿生殖膈。膀胱上面有腹膜覆盖，男性邻小肠，女性则有子宫伏于其上。 膀胱空虚时，膀胱尖不超过耻骨联合上缘。膀胱充盈时，膀胱尖即上升至耻骨联合以上，这时腹前壁折向膀胱的腹膜也随之上移，使膀胱的前下壁直接与腹前壁相贴。此时在耻骨联合上方进行膀胱穿刺或膀胱手术，可避免损伤腹膜和扰动腹膜腔。 新生儿膀胱的位置比成人的高，大部分位于腹腔内。随着年龄的增长和盆腔的发育，膀胱的位置逐渐下降，约在青春期达成人位置。老年人因盆底肌肉松弛，膀胱位置更低。 三、膀胱壁的构造 膀胱壁由肌层、粘膜下组织和粘膜构成。外面覆以薄层疏松结缔组织，浆膜层仅盖在膀胱上面和膀胱底上部中间一小部分。肌层由平滑肌纤维组成，外层和内层多为纵行，中层主要为环行，三层相互交织不易分开。整个膀胱的肌层称为膀胱逼尿肌，对排尿起重要作用。一般认为，男性平滑肌在尿道内口周围呈环形排列，形成膀胱括约肌；在女性则多斜行或纵行,不形成明显的括约肌。 第四节 尿道 男性尿道见男性生殖系统。女性尿道较男性尿道短、宽，且较直，长约 5cm，仅有排尿功能。起于膀胱的尿道内口，经阴道前方行向前下，与阴道前壁紧密相邻，穿经尿生殖膈时有横纹肌形成的尿道阴道括约肌环绕，可起随意的括约作用。末端开口于阴道前庭。尿道下端周围有尿道旁腺，导管开口于尿道外口附近。当腺体感染时可形成囊肿引起尿路阻塞。