先天性腹壁缺损36例尸体解剖和组织学观察

目的：探讨腹壁缺损的病理形态学变化,方法：对36例腹壁缺损进行尸体解剖,按照Hartwig方法分型,并对24例不同组织和胎盘进行组织学观察。结果：36例腹壁缺损多伴有其它畸形,包括肢体,颜面,神经管,泌尿生殖及消化和心血管系统,腹壁缺损皮肤－膜移行区为复层扁平上皮逐渐向意志层上皮过渡,间质由丰富胶原纤维变为疏松的结缔组织,证实了羊膜外胚层过渡带的存在。5例肾脏和1例脑组织中发策钙化病灶,胎盘表现绒毛发育不同步,绒毛间质水肿或纤维化,有血管增生,血栓形成等变化。部分病例提示有绒毛炎,13例孕母曾有TORCH感染,11例胎儿脏器TORCH PCR－DNA扩增检测阳性,结论：在胚胎腹壁形成期,如果受到某些致畸因素的干扰,除发生腹壁缺损外,还将出现多种复杂畸形,腹壁缺损的致畸因素不能除外TORCH如巨细胞病毒等感染的可能。

Gross and histologic changes of abdominal wall defect:a report of 36 autopsy cases

Purpose To find the morphological changes of abdominal wall defect (AWD). Methods The autopsies were performed and classified with Hartwig's method in 36 cases of AWD. Main organs and placentas of 24 cases were observed by the microscopy. Results Majority of 36 cases of AWD were associated with other malformations. A transition from the stratified squamous epithelium into the simple epithelium was found in the skin membranous zone of AWD. Interstitial collagenous fiber was changed into loose connective tissue. The amnio ectodermal transition zone was present. There were calcification foci in the kidney of 5 cases and the brain tissue of one case. The development of placenta was not consistent. The villous stroma was edematous or fibrotic. There were proliferations of the blood vessels with thrombosis. Some placentas were suggested with villitis. Thirteen pregnant wormen used to infect with TORCH. TORCH DNA were discorered in the organs of 11 cases AWD. Conclusions If disturbance of any teratogenic agent happens during the formation of the abdominal wall, different congenital malformation will occur besides AWD. The teratogenic factors of AWD can not be ruled out the microorganic infection such as cytomegalovirus.