胰十二指肠区火棉胶包埋薄型化断层的应用解剖学研究

发布时间：2018-01-01 19:02

本文关键词：胰十二指肠区火棉胶包埋薄型化断层的应用解剖学研究　出处：《天津医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的应用火棉胶包埋胰十二指肠区,行薄型化水平断层切片,为临床影像学检查和各科诊疗提供形态学依据。材料方法 1.取经福尔马林固定的成年尸体14具(8男,6女)。腹部做十字切口,肉眼观察腹腔器官无病变后沿胃大弯侧切开大网膜,然后将胃向上翻起,切开后腹膜充分暴露胰十二指肠区,观察并记录该区域周围结构的毗邻关系。分别经第12胸椎上缘和第3腰椎下缘横断标本,选取其间的躯干部作为制备断层标本的材料。根据研究需要将标本修成18cm×12cm×10cm大小的标本块,剔除胰十二指肠区周围的无关组织,将该区及该区腹后壁组织保留进行火棉胶包埋。采用大脑切片机做连续水平断层切片,片厚0.5mm,切片按顺序编号后照相,应用3D-DOCTOR软件进行测量并记录数据,对重要的局部区域在体式显微镜下放大8-10倍进行观察。另选取两例标本,在十二指肠大乳头区进行局部取材,然后对该区域进行火棉胶-HE染色处理。 2.选取天津医科大学第二附属医院放射科及兰州大学第一医院放射科2010年1-3月份期间的15名患者(9男,6女)腹部无明显病变及1例胆总管扩张患者的CT摄像片与解剖断层图片进行了观察和分析。结果①胰头是位于胰腺右侧的膨大部分,前后形扁,其位置的变化范围较大,主要位于第12胸椎与第2腰椎之间。胰头上方有肝总动脉及其分支走行；下方邻接十二指肠水平部；前下方与十二指肠升部连接的空肠毗邻；前面的中部邻接横结肠系膜根的右端；后面与下腔静脉、右肾静脉、左肾静脉终末部及胆总管毗邻,门静脉起点多位于胰头后上方；右上角紧邻胃幽门窦和十二指肠上部,胰头右侧连接十二指肠降部,两者之间相连紧密,难于分离。 ②火棉胶断层切片的层厚0.5mmm,大约可获得128到135个薄型连续横断切片或层面,胰十二指肠区的可见范围集中显现于110个层面。以经十二指肠乳头最大切面为标准层面,胰头平均分别出现在其上70个层面,其下40个层面。 ③火棉胶切片观察,胰头位于十二指肠降部的左前方,其最大前后径为(20.17±3.19)mm,最大左右径为(28.14±3.12)mm；钩突最大前后径(9.40±1.58)mm,最大左右径为(12.30±3.04)mm；胰管在肠系膜上静脉右缘突然转向后,走行在胰头靠后部,主胰管在胰头部管径为(1.04±0.34)mm；胆总管下段行于胰十二指肠沟中,后边可有胰腺组织覆盖；十二指肠乳头在十二指肠降部中1／3处占64.29%。在体式解剖镜下将胰胆管汇入十二指肠乳头处局部放大8倍发现,十二指肠左侧与胰头右侧毗邻处其肌层不连续,且与胰头处的胰腺小叶相连,胰管及胆总管末端括约肌清晰可见,壶腹部腔内可见锯齿状粘膜皱襞。 ④正常CT图片层厚3mm的图像相当于含有6个层面0.5mm的火棉胶切片,这就会使得每相邻两张CT图片之间的一些细小结构无法显示,CT图像可见胰头位于十二指肠降部左侧,脾静脉与肠系膜上静脉在胰头后上方汇成门静脉进入肝门,钩突位于肠系膜上静脉后方、肠系膜上动脉的右侧。胰管、胆管在不扩张的情况下显示不充分。结论①火棉胶包埋薄型化断层切片技术简单易操作、成本低廉,经济实用。包埋固定后的器官无变形,组织原位固定好。切片过程中组织器官无任何损耗,因而实验结果可靠,数据可信,为临床高分辨率影像学观察研究提供了最佳的形态学基础研究平台。 ②胰十二指肠区一层CT扫描图片的厚度相当于火棉胶切片厚度的6倍,且相邻两层CT图像之间的层距为3mm,同样相当于火棉胶切片厚度的6倍,这就使得相邻两层CT图像之间厚度相当于火棉胶切片厚度的12倍,会造成了一些细小结构的盲区,从而影响对一些小病灶的诊断。在CT图片上可以清楚的识别胰头、十二指肠、肠系膜上动静脉等相关结构,通过肠系膜上动静脉很容易找到钩突,并观察其形态变化。在胃肠充盈的条件下十二指肠乳头显示尚可,胰胆管在不扩张的情况下观察不佳。 ③在火棉胶薄型化断层切片上,十二指肠乳头形态及胰胆管汇合处表现在断面上清晰可见；肠系膜上静脉是区分胰头和胰颈的标志,肠系膜上动脉可作为判断胰头钩突是否增大的标志。该实验可为组织分辨率更高的影像学检查和临床各科诊疗提供详实的解剖学资料。
[Abstract]:The purpose of the application of celloidin embedding pancreaticoduodenal region, thin line level sections, to provide morphological basis for clinical imaging examination and diagnosis subjects.
Material method
1. from formalin fixed 14 adult cadavers (8 male, 6 female). The abdomen cross incision, visual observation of abdominal organs lesions after the stomach lateral incision omentum, then stomach up to incision retroperitoneal fully exposed pancreaticoduodenal region, observe and record the relationship structure around this region twelfth. Respectively by the upper edge of the lower edge of the third lumbar vertebra and transverse specimens, the selection of the trunk as preparation material. According to the research of fault samples need to be sample specimens into 18cm * 12cm * 10cm size, no organization around excluding the pancreaticoduodenal region, the area and the area of posterior abdominal wall the organization retain the celloidin embedding. The brain slice machine continuous horizontal slicing, slice thickness 0.5mm, slice sequentially numbered after photography, 3D-DOCTOR software was used to measure and record the data of important local area in optical microscope Magnification of 8-10 were observed. The other two cases were local materials in the major duodenal papilla, then the region was celloidin stained with -HE.
2. selected 15 patients in Second Hospital Affiliated to Tianjin Medical University radiology and radiology department of First Hospital Affiliated to Lanzhou University from 2010 1-3 month (9 male, 6 female) and 1 cases of pathological changes of bile duct dilatation in patients with CT film and sectional anatomical images were observed and analyzed. Results: no abdominal pancreatic head is located on the right side of the bulge part of pancreas, and shape flat, range position is large, mainly located in the twelfth thoracic vertebrae and second lumbar vertebrae. The pancreatic head above the hepatic artery and its branches; below the adjacent duodenum; before the bottom and ascending portion of duodenum jejunum connected adjacent; right end adjacent the central transverse mesocolon root in front of the back; and the inferior vena cava. The right renal vein, left renal vein end and bile duct in portal vein adjacent to the starting point located in the pancreatic head after above; the upper right corner adjacent to the gastric antrum and upper duodenum, pancreatic head right The side is connected to the descending duodenum, and the two are closely connected and difficult to separate.
The collodion slice thickness 0.5mmm, approximately from 128 to 135 thin continuous transverse section or level, visible range of pancreaticoduodenal region concentration appear in 110 levels. The largest section of duodenal papilla as the standard level, the head of the pancreas respectively appear in the 70 level, the 40 level.
To observe the celloidin section, the left front of the head of pancreas in the descending duodenum, the maximal diameter for (20.17 + 3.19) mm, the maximum diameter is (28.14 + 3.12) mm; the maximum anteroposterior diameter of the uncinate process (9.40 + 1.58) mm, the maximum diameter is (12.30 + 3.04) mm; pancreatic duct at the right edge of the superior mesenteric vein suddenly turn, walking in the head of pancreas on the rear of the main pancreatic duct in pancreatic head diameter (1.04 + 0.34) mm; common bile duct in pancreatic duodenal groove, back pancreatic tissue coverage; duodenal papilla in the descending duodenum in 1 / 3 accounted for 64.29%. in the body under the anatomical microscope the pancreatic duct into the duodenal papilla at local magnification of 8 times, the left and right duodenal pancreatic head near the muscle layer is not continuous, and the head of the pancreas at the pancreatic lobules with pancreatic duct and bile duct sphincter visible, ampulla spacesvisible serrate mucosal folds.
The normal image CT image 3mm thickness is equivalent to the celloidin section contains 6 levels of 0.5mm, it will make some fine structure between two adjacent CT images to display CT images, visible in the duodenal pancreatic head left, splenic vein and superior mesenteric vein. In pancreatic head after merged into the portal vein enter the portal, the uncinate process in superior mesenteric vein posterior superior mesenteric artery right. Pancreatic duct, bile duct in the expansion of the display is not sufficient.
Conclusion the celloidin thin slice technique is simple and easy to operate, low cost, economical and practical. The immobilized organs after deformation, in situ fixed tissue sections. In the process of organ without any loss, so the test result is reliable and credible data for clinical high resolution imaging observation provides a morphological basis for research the best platform for the study.
6 times the thickness of a layer of CT scans of the pancreaticoduodenal region corresponds to the collodion slice thickness, and between two adjacent layers of CT layer image distance is 3mm, the same is equivalent to 6 times the thickness of the celloidin section, which makes between the two adjacent layers of the CT image is equivalent to 12 times the thickness of celloidin section thickness the blind will cause some small structure, thus affecting the diagnosis of some small lesions. The head of the pancreas, can clearly identify in the CT picture of the duodenum, the related structures of superior mesenteric arteriovenous through superior mesenteric artery and vein, it is easy to find the uncinate process, and to observe the morphological changes in gastrointestinal filling conditions. Duodenal papilla display is acceptable, the pancreatic duct in the dilated under the condition of poor observation.
The collodion thin slice, duodenal papilla morphology and pancreatic duct confluence shows clearly visible in the cross section; superior mesenteric vein was the distinguishing of the pancreatic head and neck of pancreas, signs of superior mesenteric artery can be used to judge whether the increase of uncinate process of pancreas. The experiment can provide detailed anatomical information for tissue resolution the higher the imaging and clinical diagnosis and treatment.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322

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