咽食管段构筑的解剖学研究

发布时间：2018-03-27 22:08

  本文选题：吞咽　切入点：食管纵行肌　出处：《安徽医科大学》2006年硕士论文

【摘要】：目的 通过局部解剖、组织学、组织化学、断层解剖等技术分别从大体水平和细胞水平对咽食管段进行观察，为临床提供解剖学资料，探讨吞咽及环咽肌切迹的潜在机制。方法 ①采取法医学推算年龄的方法推算64例成人标本的年龄，分成青少年组(＜25岁)、中青年组(25～59岁)、老年组(＞59岁)。②对48例成人颈部咽食管段标本局部解剖观测。③对3例成人咽食管段标本火棉胶包埋制作薄层断层连续组织切片，并在显微镜下进行组织学观察。④取成人6例环咽后壁增厚标本和7例正常标本行苏木素—伊红染色(hematoxylin-eosin，HE)和特殊染色。⑤对7例胎儿咽食管段标本行HE染色。⑥对3例25周胎儿咽及食管段标本行HE染色和一抗为α-平滑肌肌动蛋白(α-Smooth Muscle Actin，α-SMA)或快肌骨骼肌重链(fast myosin heavy chain，MHC-Ⅰ)或慢肌骨骼肌重链(slow myosin heavy chain，MHC-Ⅱ)抗体的免疫组化SABC染色。结果 ①食管纵行肌有三个附着点，不仅止于环状软骨板后正中嵴，食管侧壁的大部分纵行肌纤维向上穿过环咽侧三角，与腭咽肌直接相续，小部分纵行肌纤维止于环状软骨弓侧缘。②环状软骨下缘水平内腔宽度比邻近上方内腔明显缩窄，该缩窄的咽腔侧缘与甲状软骨板后缘之间形成一个尖朝上的三角形区域，我们称之为环咽侧三角。该三角内部主要由疏松结缔组织、血管和神经所占据。三角的底为4.22±2.67mm，高为12.68±2.50mm，，面积为45.1±27.0mm，顶角的角度为26.5±118°。③局解的48例96侧成人标本中，29％喉返神经(recurrent laryngeal nerve，RLN)主干穿过环咽肌肌束至致密结缔组织膜下缘，71％RLN主干走行在环咽肌深面。69％RLN从主干分出一细小的分支，分支处距离甲状软骨下角尖端约15.2±5.5mm，主干多于环状软骨侧方下缘距离甲状软骨下角尖端约5.9±1.8mm处穿过结缔组织膜，分支入喉点距甲状软骨下角尖端约4.8±2.1mm；31％RLN未见分支。环咽侧三角下缘RLN与甲状腺下动脉(inferior thyroid artery，ITA)分支的关系为：66％(63／96)RLN位于ITA前方，27％(32／96)位于ITA后方。④咽食管内腔根据形态可分为平滑型和紧缩型两种，环咽侧三角上缘水平管腔宽度为27.83±3.74mm，甲状软
[Abstract]:Objective to observe the pharyngoesophageal segment from the gross level and cell level by means of local anatomy, histology, histochemistry, sectional anatomy and so on, so as to provide anatomical data for clinical practice. Methods 1 the age of 64 adult specimens was calculated by forensic method. They were divided into juvenile group (< 25 years old), middle and young group (25 ~ 59 years old) and elderly group (> 59 years old / 2). Local anatomy of 48 adult pharynx and esophagus specimens were observed. Histological observation was performed under microscope .4 Hematoxylin hematoxylin-eosin hehe (HE) staining was performed in 6 adult specimens with thickening of the posterior wall of annular pharynx and 7 normal controls, and HE staining was performed on 7 cases of pharynx esophagus with HE staining in 6 cases and 3 cases in 25 cases. The specimens of pericardial pharynx and esophagus were stained by HE staining and immunohistochemical SABC staining of antibodies against 伪 -Smooth Muscle actin (伪 -SMAA) or fast myosin heavy chainine MHC- 鈪

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