食管上括约肌的显微解剖与临床应用解剖研究

发布时间：2018-03-05 20:04

本文选题：食管上括约肌　切入点：火棉胶　出处：《安徽医科大学》2005年硕士论文　论文类型：学位论文

【摘要】：目的通过大体解剖,薄层断层解剖、组织学观察、影像学和内窥镜观察等方法对食管上括约肌进行研究,为临床提供解剖学资料,并结合临床和解剖数据解释吞咽困难的潜在机制。方法 ①对63例成人颈部咽食管区标本进行大体解剖观测;②采取法医学推算年龄的方法推算63例成人标本的年龄,并分成青少年组(25岁)、中青年组(25～59岁)、老年组(59岁);③取环咽后壁增厚和未增厚标本各一例行HE染色,并进行组织学观察;④对9例不同年龄组的食管上括约肌区连续组织切片,每5张切片为一组,选第4张裱片,第5张V-G染色,并在显微镜下进行组织学观察;⑤对门诊146例吞咽困难患者进行食道钡餐检查,判断是否有环咽肌切迹;⑥对3例环咽肌切迹阳性患者进行食管镜检查,判断切迹的性质。结果 ①食管上括约肌后壁的筋膜根据厚度与组织结合紧密程度可分为三层。②在食管上括约肌区包括甲咽肌、环咽肌和近端食管环形肌三部分。甲咽肌在甲状软骨板后缘的宽度为30.60±4.36mm,咽后壁中线的厚度为2.66±0.67mm;环咽肌在后壁近似菱形,上下角都有弧形和三角形两种形态,环咽肌在后壁中线的厚度为1.51±0.35mm,菱形区的高度为19.23±2.01mm;近端食管环行肌在后壁中线的厚度为1.18±0.27mm。③食管上括约肌段内腔根据形态可以分平滑型和紧缩型两种类型,于环状软骨上缘水平管腔内的宽度为14.97±3.62mm、环状软骨下缘水平管腔内的宽度为11.74±2.21mm、第一气管软骨环下缘管腔内的宽度为13.70±3.19mm,不同年龄组比较有显著性差异。④食管上括约肌薄层断层切片能原位、精确地显示甲咽肌、环咽肌、近端食管连续形态变化。在低倍镜下能清楚显示肌纤维的形态及走行,甲咽肌肌纤维根据起点可以分为三类,第一类起于与环甲肌相连的结缔组织,第二类起于甲状软骨侧缘,第三类起于后壁粘膜层;环咽肌根据起止点和肌纤维的走行可分为斜行部和水平部两部分;食管环行肌起止点都位于食管前壁中份的结缔组织,纵行肌止于环状软骨板下缘及后表面中缝。⑤V-G染色切片能清楚区分肌纤维和结缔组织,并能显示肌层结缔组织的形态,食管上括约肌肌层的结缔组织在横断面呈网状,甲咽肌网眼大较
[Abstract]:Objective to study the upper esophageal sphincter by means of gross anatomy, thin sectional anatomy, histological observation, imaging and endoscope observation, so as to provide anatomical data for clinical practice. Combined with clinical and anatomical data, the underlying mechanism of dysphagia was explained. Methods 1 the age of 63 adult specimens of pharynx and esophagus were calculated by forensic method. They were divided into juvenile group (25 years old), middle and young group (25 ~ 59 years old), aged group (59 years old) and aged group (59 years old). One specimen of thickening and no thickening of the posterior wall of annular pharynx was stained by HE staining respectively. Histological observation was performed on 9 consecutive tissue sections of the upper esophageal sphincter area in 9 cases of different age groups. Every 5 slices were divided into one group, the fourth was mounted, the fifth was V-G staining, and the histological observation was carried out under the microscope, 146 patients with dysphagia were examined by barium meal of esophagus. To determine if there is a circular pharynx muscle notch, 3 patients with positive ring pharynx muscle notch were examined by esophagoscopy. Results 1 the fascia of the posterior wall of the upper esophageal sphincter can be divided into three layers according to the thickness and the tightness of the tissue. The width of thyropharyngeal muscle in the posterior edge of the thyroid cartilage plate was 30.60 卤4.36 mm, and the thickness of the middle line of the posterior pharyngeal wall was 2.66 卤0.67 mm. The thickness of the rhomboid region and the thickness of the central line of the posterior wall were 1.51 卤0.35mm and 19.23 卤2.01mmrespectively, and the thickness of the proximal esophageal circular muscle was 1.18 卤0.27mm.3 in the upper esophageal sphincter segment, which could be divided into smooth type and constrictive type according to the shape of the sphincter segment, and the thickness of the proximal esophageal circular muscle was 1.18 卤0.27mm in the middle line of the posterior wall. The width of the horizontal lumen in the superior edge of annular cartilage was 14.97 卤3.62 mm, the width in the horizontal lumen of the inferior edge of the annular cartilage was 11.74 卤2.21 mm, and the width of the first tracheal cartilage ring was 13.70 卤3.19 mm. There was significant difference in the upper esophageal sphincter in different age groups. Thin slice sections can be in situ, The continuous morphological changes of the thyropharyngeal muscle, the annular pharynx muscle and the proximal esophagus can be accurately displayed. The shape and movement of the muscle fiber can be clearly displayed under low power microscope. According to the starting point, the muscle fiber of the thyroid pharynx muscle can be divided into three categories. The first type originates from connective tissue connected with the cricothyroid muscle, the second from the lateral margin of thyroid cartilage, the third from the mucous layer of the posterior wall, and the circular pharyngeal muscle can be divided into oblique and horizontal parts according to the starting and ending point and the movement of muscle fiber. The starting and ending points of the circular muscles of the esophagus were located in the connective tissues in the anterior wall of the esophagus. The longitudinal muscles were located at the lower margin of the annular cartilage plate and the suture of the posterior surface. 5V-G staining sections could clearly distinguish the muscle fibers from the connective tissues, and show the shape of the connective tissues in the muscle layer. The connective tissue of the upper esophageal sphincter muscle layer is reticular on the cross section, and the reticulum of the thyroid pharyngeal muscle is larger than that of the thyroid sphincter muscle.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R322

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