体视显微镜下检查人体心脏房室传导轴

发布时间：2018-01-18 05:32

本文关键词：体视显微镜下检查人体心脏房室传导轴　出处：《浙江大学》2016年硕士论文　论文类型：学位论文

【摘要】：先前的研究者们对心传导系统(cardiac conduction system, CCS)做了大量研究,但因人类CCS的体积小,而且包裹的结缔组织鞘不丰富,在肉眼下不易辨认,对人类CCS的大体解剖研究并不多,对CCS的研究多用实验动物的心脏进行比较研究。研究猝死的法医病理学界在鉴定猝死案例的死因时,总有一些尸体(约15%)找不到死因。现普遍认为CCS的病变在猝死案例中有相当的重要性,一些尸体解剖找不到死因者,检查他们的CCS后,有些案例可能有重要发现。但是目前对人类CCS的法医学研究主要通过对窦房结(sinuatrial node, SAN)、房室结(atrioventricular node, AVN)这几个主要部位的局部取材之后做连续组织切片,跳跃抽取切片检查。由于对CCS取材部位过于局限,不能系统的连续观察它的组织形态结构,更无法得到它的大体形态学资料,导致还有一些尸体找不到死因,比如His束或左、右束支出现断裂、纤维化,脂肪变性或浸润等局部病变情况就很难被发现。更重要的是目前的方法需要做大量的连续切片,以及有的甚至因取材部位不够准确,没取到CCS组织,即使做了切片,也找不到什么,在成功率上存在一些不足,在法医鉴定部门得不到普遍推广。至今,国内外均无完善的人类CCS全方位立体层面的系统性病理学检查方法。此外,AVN的形态和功能还有待进一步的明确；有关CCS结间束(窦房结与房室结之间的传导束)的特化传导组织的有无,还存在一些争议；动物组织切片上发现的房室环(atrioventricular ring, AVR)的形态特征有待在人类心脏上得到验证和研究,它的功能有待进一步明确。显然,房室传导轴(atrioventricular conduction axis, ACA)的形态学检查在解剖学和法医病理学上对CCS的识别鉴定、检查、诊断有着重要的作用。我们设计了一套ACA的检查新方法体系：试着定位ACA组织的解剖入路,在体视显微镜下解剖分离出ACA组织,并进行观察、记录、取证被充分暴露后的ACA组织形态特征,然后取出被分离出来的ACA组织做平行于心内膜面的组织切片,行不同染色后对它的形态特征进行光学显微镜下观察。收集了浙江大学病理学与法医病理学研究所司法鉴定中心的5例(男性3例,女性2例,年龄跨度17岁至71岁),浙江医学高等专科学校基础医学部形态中心的3例(男性2例,女性1例,年龄跨度28岁至70岁)人体心脏(福尔马林固定保存)进行实验,验证我们设计的新方法的可行性。另外,对ACA的解剖结构进行详细的探索性观察和研究。结果发现：新方法对ACA组织定位准确,采用新方法能全部成功地解剖分离和检查ACA组织,并能获得传统的检查方法无法获得的ACA立体层面的大体病理学数据,1-2个组织块(10张切片／组织块)即可获得到足够的组织学信息,明显减少了组织学检查的工作量；8例AVN头部与扩展区之间基本没有成形的绝缘膜(包裹心肌组织的膜状结缔组织),AVN头部不易被解剖分离；8例AVN为扁平的椭圆结构,与其他学者观点不一致；疑似的房室环特化组织和结间束(AVN端)在人心常规组织切片上得到体现。为心脏病理学及法医学检查CCS提供帮助；房室结区的形态和功能有待深入研究。
[Abstract]:Previous research on heart conduction system (cardiac conduction system, CCS) to do a lot of research, but because of human CCS has the advantages of small volume, and wrapped the connective tissue sheath is not rich, is not easy to identify in the eyes of human anatomy, CCS research is not much, a comparative study of the research of CCS with the experimental animal's heart. The academic research of forensic pathology of sudden death cases in sudden death identified the cause of death, there are always some bodies (about 15%) to find the cause of death. It is generally believed that CCS lesions are of considerable importance in the case of sudden death, some autopsy can not find the cause of death, check their CCS. In some cases there may be an important discovery. But at present the human CCS forensic research mainly through the sinoatrial node (Sinuatrial node, SAN), atrioventricular node (atrioventricular node AVN) the main parts of these local materials after continuous tissue sections, jump Jump from a biopsy. Due to limited material positions on CCS continuous observation of histological structure of its system cannot, will not be able to get the general morphological data of its cause, and some bodies can not find the cause of death, such as the His bundle or left and right bundle branch breakage, fibrosis, fatty degeneration or infiltration of local lesions the situation is very difficult to be found. More important is the need to do a lot of method of serial sections, and some even because of different parts is not accurate enough, did not get to the CCS, even if the slice can not find what, there are some problems in the success rate, is not widespread in the forensic department now, the pathological examination system at home and abroad were not perfect human CCS omnibearing level method. In addition, the morphology and function of AVN remains to be further clear; the CCS internodal tract (between Dou Fangjie and atrioventricular node Conduction bundle) specialized conduction tissue or not, there are still some controversy; atrioventricular ring found in animal tissue sections of the (atrioventricular ring AVR) morphological features need to be verified and studied in the human heart, its function remains to be further clarified. Obviously, the atrioventricular conduction axis (atrioventricular conduction axis, ACA) morphology check in anatomy and forensic pathology of CCS identification, examination plays an important role in diagnosis. We design a new method to check a set of ACA system: try to locate the ACA tissue anatomical approach in stereo microscope dissected to isolate the ACA organization, and observation, recording, ACA forensics be fully exposed after the morphological characteristics, and then remove the separated ACA tissue parallel to the endocardial surface tissue sections for different staining on morphological characteristics of its optical microscope Chahar. Collection of Zhejiang University Institute of pathology and forensic center of forensic pathology in 5 cases (3 cases, 2 cases of male and female age span of 17 to 71 years old), 3 cases of Zhejiang Medical College Department of basic medicine center of the form (2 cases, male 1 cases were female, ages 28 to 70 years of age) of human body heart (preservation of formalin fixed experiment) to verify the feasibility of the new method we designed. In addition, the exploratory research and observation on the detailed anatomy of ACA. The results show that the method of ACA positioning accuracy, using the new method can be successfully dissected and examined the ACA organization, and can learn the general data stereo ACA level examination pathological traditional methods can not get the 1-2 tissue (10 slices / tissue) can obtain enough histological information, reduce the workload of histological examination; 8 cases of head AVN Between the Department and extension area basically no insulating film forming (membranous connective tissue of myocardial tissue package), AVN head is not easy to be dissected; 8 cases of AVN elliptical flat structure, is not consistent with the view of other scholars and specialized organization; atrioventricular ring node suspected between beam (AVN) reflected in the heart the routine tissue sections. Cardiac pathology and forensic examination to help CCS; in-depth study the morphology and function of atrioventricular nodal region.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.7

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