本文選題：吞咽　切入點：食管縱行肌　出處：《安徽醫(yī)科大學(xué)》2006年碩士論文

【摘要】：目的 通過局部解剖、組織學(xué)、組織化學(xué)、斷層解剖等技術(shù)分別從大體水平和細胞水平對咽食管段進行觀察，為臨床提供解剖學(xué)資料，探討吞咽及環(huán)咽肌切跡的潛在機制。方法 ①采取法醫(yī)學(xué)推算年齡的方法推算64例成人標(biāo)本的年齡，分成青少年組(＜25歲)、中青年組(25～59歲)、老年組(＞59歲)。②對48例成人頸部咽食管段標(biāo)本局部解剖觀測。③對3例成人咽食管段標(biāo)本火棉膠包埋制作薄層斷層連續(xù)組織切片，并在顯微鏡下進行組織學(xué)觀察。④取成人6例環(huán)咽后壁增厚標(biāo)本和7例正常標(biāo)本行蘇木素—伊紅染色(hematoxylin-eosin，HE)和特殊染色。⑤對7例胎兒咽食管段標(biāo)本行HE染色。⑥對3例25周胎兒咽及食管段標(biāo)本行HE染色和一抗為α-平滑肌肌動蛋白(α-Smooth Muscle Actin，α-SMA)或快肌骨骼肌重鏈(fast myosin heavy chain，MHC-Ⅰ)或慢肌骨骼肌重鏈(slow myosin heavy chain，MHC-Ⅱ)抗體的免疫組化SABC染色。結(jié)果 ①食管縱行肌有三個附著點，不僅止于環(huán)狀軟骨板后正中嵴，食管側(cè)壁的大部分縱行肌纖維向上穿過環(huán)咽側(cè)三角，與腭咽肌直接相續(xù)，小部分縱行肌纖維止于環(huán)狀軟骨弓側(cè)緣。②環(huán)狀軟骨下緣水平內(nèi)腔寬度比鄰近上方內(nèi)腔明顯縮窄，該縮窄的咽腔側(cè)緣與甲狀軟骨板后緣之間形成一個尖朝上的三角形區(qū)域，我們稱之為環(huán)咽側(cè)三角。該三角內(nèi)部主要由疏松結(jié)締組織、血管和神經(jīng)所占據(jù)。三角的底為4.22±2.67mm，高為12.68±2.50mm，，面積為45.1±27.0mm，頂角的角度為26.5±118°。③局解的48例96側(cè)成人標(biāo)本中，29％喉返神經(jīng)(recurrent laryngeal nerve，RLN)主干穿過環(huán)咽肌肌束至致密結(jié)締組織膜下緣，71％RLN主干走行在環(huán)咽肌深面。69％RLN從主干分出一細小的分支，分支處距離甲狀軟骨下角尖端約15.2±5.5mm，主干多于環(huán)狀軟骨側(cè)方下緣距離甲狀軟骨下角尖端約5.9±1.8mm處穿過結(jié)締組織膜，分支入喉點距甲狀軟骨下角尖端約4.8±2.1mm；31％RLN未見分支。環(huán)咽側(cè)三角下緣RLN與甲狀腺下動脈(inferior thyroid artery，ITA)分支的關(guān)系為：66％(63／96)RLN位于ITA前方，27％(32／96)位于ITA后方。④咽食管內(nèi)腔根據(jù)形態(tài)可分為平滑型和緊縮型兩種，環(huán)咽側(cè)三角上緣水平管腔寬度為27.83±3.74mm，甲狀軟
[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 偽 -Smooth Muscle actin (偽 -SMAA) or fast myosin heavy chainine MHC- 鈪

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