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  本文選題：食管上括約肌　切入點：火棉膠　出處：《安徽醫(yī)科大學》2005年碩士論文　論文類型：學位論文

【摘要】：目的 通過大體解剖,薄層斷層解剖、組織學觀察、影像學和內窺鏡觀察等方法對食管上括約肌進行研究,為臨床提供解剖學資料,并結合臨床和解剖數據解釋吞咽困難的潛在機制。方法 ①對63例成人頸部咽食管區(qū)標本進行大體解剖觀測;②采取法醫(yī)學推算年齡的方法推算63例成人標本的年齡,并分成青少年組(25歲)、中青年組(25～59歲)、老年組(59歲);③取環(huán)咽后壁增厚和未增厚標本各一例行HE染色,并進行組織學觀察;④對9例不同年齡組的食管上括約肌區(qū)連續(xù)組織切片,每5張切片為一組,選第4張裱片,第5張V-G染色,并在顯微鏡下進行組織學觀察;⑤對門診146例吞咽困難患者進行食道鋇餐檢查,判斷是否有環(huán)咽肌切跡;⑥對3例環(huán)咽肌切跡陽性患者進行食管鏡檢查,判斷切跡的性質。結果 ①食管上括約肌后壁的筋膜根據厚度與組織結合緊密程度可分為三層。②在食管上括約肌區(qū)包括甲咽肌、環(huán)咽肌和近端食管環(huán)形肌三部分。甲咽肌在甲狀軟骨板后緣的寬度為30.60±4.36mm,咽后壁中線的厚度為2.66±0.67mm;環(huán)咽肌在后壁近似菱形,上下角都有弧形和三角形兩種形態(tài),環(huán)咽肌在后壁中線的厚度為1.51±0.35mm,菱形區(qū)的高度為19.23±2.01mm;近端食管環(huán)行肌在后壁中線的厚度為1.18±0.27mm。③食管上括約肌段內腔根據形態(tài)可以分平滑型和緊縮型兩種類型,于環(huán)狀軟骨上緣水平管腔內的寬度為14.97±3.62mm、環(huán)狀軟骨下緣水平管腔內的寬度為11.74±2.21mm、第一氣管軟骨環(huán)下緣管腔內的寬度為13.70±3.19mm,不同年齡組比較有顯著性差異。④食管上括約肌薄層斷層切片能原位、精確地顯示甲咽肌、環(huán)咽肌、近端食管連續(xù)形態(tài)變化。在低倍鏡下能清楚顯示肌纖維的形態(tài)及走行,甲咽肌肌纖維根據起點可以分為三類,第一類起于與環(huán)甲肌相連的結締組織,第二類起于甲狀軟骨側緣,第三類起于后壁粘膜層;環(huán)咽肌根據起止點和肌纖維的走行可分為斜行部和水平部兩部分;食管環(huán)行肌起止點都位于食管前壁中份的結締組織,縱行肌止于環(huán)狀軟骨板下緣及后表面中縫。⑤V-G染色切片能清楚區(qū)分肌纖維和結締組織,并能顯示肌層結締組織的形態(tài),食管上括約肌肌層的結締組織在橫斷面呈網狀,甲咽肌網眼大較
[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 鹵4.36 mm, and the thickness of the middle line of the posterior pharyngeal wall was 2.66 鹵0.67 mm. The thickness of the rhomboid region and the thickness of the central line of the posterior wall were 1.51 鹵0.35mm and 19.23 鹵2.01mmrespectively, and the thickness of the proximal esophageal circular muscle was 1.18 鹵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 鹵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 鹵3.62 mm, the width in the horizontal lumen of the inferior edge of the annular cartilage was 11.74 鹵2.21 mm, and the width of the first tracheal cartilage ring was 13.70 鹵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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2005
【分類號】：R322

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本文編號：1571678