本文關(guān)鍵詞：胰十二指腸區(qū)火棉膠包埋薄型化斷層的應用解剖學研究　出處：《天津醫(yī)科大學》2010年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 胰十二指腸區(qū) 火棉膠 CT 斷層解剖 胰頭 十二指腸乳頭 鉤突

【摘要】： 目的應用火棉膠包埋胰十二指腸區(qū),行薄型化水平斷層切片,為臨床影像學檢查和各科診療提供形態(tài)學依據(jù)。 材料方法 1.取經(jīng)福爾馬林固定的成年尸體14具(8男,6女)。腹部做十字切口,肉眼觀察腹腔器官無病變后沿胃大彎側(cè)切開大網(wǎng)膜,然后將胃向上翻起,切開后腹膜充分暴露胰十二指腸區(qū),觀察并記錄該區(qū)域周圍結(jié)構(gòu)的毗鄰關(guān)系。分別經(jīng)第12胸椎上緣和第3腰椎下緣橫斷標本,選取其間的軀干部作為制備斷層標本的材料。根據(jù)研究需要將標本修成18cm×12cm×10cm大小的標本塊,剔除胰十二指腸區(qū)周圍的無關(guān)組織,將該區(qū)及該區(qū)腹后壁組織保留進行火棉膠包埋。采用大腦切片機做連續(xù)水平斷層切片,片厚0.5mm,切片按順序編號后照相,應用3D-DOCTOR軟件進行測量并記錄數(shù)據(jù),對重要的局部區(qū)域在體式顯微鏡下放大8-10倍進行觀察。另選取兩例標本,在十二指腸大乳頭區(qū)進行局部取材,然后對該區(qū)域進行火棉膠-HE染色處理。 2.選取天津醫(yī)科大學第二附屬醫(yī)院放射科及蘭州大學第一醫(yī)院放射科2010年1-3月份期間的15名患者(9男,6女)腹部無明顯病變及1例膽總管擴張患者的CT攝像片與解剖斷層圖片進行了觀察和分析。結(jié)果①胰頭是位于胰腺右側(cè)的膨大部分,前后形扁,其位置的變化范圍較大,主要位于第12胸椎與第2腰椎之間。胰頭上方有肝總動脈及其分支走行；下方鄰接十二指腸水平部；前下方與十二指腸升部連接的空腸毗鄰；前面的中部鄰接橫結(jié)腸系膜根的右端；后面與下腔靜脈、右腎靜脈、左腎靜脈終末部及膽總管毗鄰,門靜脈起點多位于胰頭后上方；右上角緊鄰胃幽門竇和十二指腸上部,胰頭右側(cè)連接十二指腸降部,兩者之間相連緊密,難于分離。 ②火棉膠斷層切片的層厚0.5mmm,大約可獲得128到135個薄型連續(xù)橫斷切片或?qū)用?胰十二指腸區(qū)的可見范圍集中顯現(xiàn)于110個層面。以經(jīng)十二指腸乳頭最大切面為標準層面,胰頭平均分別出現(xiàn)在其上70個層面,其下40個層面。 ③火棉膠切片觀察,胰頭位于十二指腸降部的左前方,其最大前后徑為(20.17±3.19)mm,最大左右徑為(28.14±3.12)mm；鉤突最大前后徑(9.40±1.58)mm,最大左右徑為(12.30±3.04)mm；胰管在腸系膜上靜脈右緣突然轉(zhuǎn)向后,走行在胰頭靠后部,主胰管在胰頭部管徑為(1.04±0.34)mm；膽總管下段行于胰十二指腸溝中,后邊可有胰腺組織覆蓋；十二指腸乳頭在十二指腸降部中1／3處占64.29%。在體式解剖鏡下將胰膽管匯入十二指腸乳頭處局部放大8倍發(fā)現(xiàn),十二指腸左側(cè)與胰頭右側(cè)毗鄰處其肌層不連續(xù),且與胰頭處的胰腺小葉相連,胰管及膽總管末端括約肌清晰可見,壺腹部腔內(nèi)可見鋸齒狀粘膜皺襞。 ④正常CT圖片層厚3mm的圖像相當于含有6個層面0.5mm的火棉膠切片,這就會使得每相鄰兩張CT圖片之間的一些細小結(jié)構(gòu)無法顯示,CT圖像可見胰頭位于十二指腸降部左側(cè),脾靜脈與腸系膜上靜脈在胰頭后上方匯成門靜脈進入肝門,鉤突位于腸系膜上靜脈后方、腸系膜上動脈的右側(cè)。胰管、膽管在不擴張的情況下顯示不充分。 結(jié)論①火棉膠包埋薄型化斷層切片技術(shù)簡單易操作、成本低廉,經(jīng)濟實用。包埋固定后的器官無變形,組織原位固定好。切片過程中組織器官無任何損耗,因而實驗結(jié)果可靠,數(shù)據(jù)可信,為臨床高分辨率影像學觀察研究提供了最佳的形態(tài)學基礎(chǔ)研究平臺。 ②胰十二指腸區(qū)一層CT掃描圖片的厚度相當于火棉膠切片厚度的6倍,且相鄰兩層CT圖像之間的層距為3mm,同樣相當于火棉膠切片厚度的6倍,這就使得相鄰兩層CT圖像之間厚度相當于火棉膠切片厚度的12倍,會造成了一些細小結(jié)構(gòu)的盲區(qū),從而影響對一些小病灶的診斷。在CT圖片上可以清楚的識別胰頭、十二指腸、腸系膜上動靜脈等相關(guān)結(jié)構(gòu),通過腸系膜上動靜脈很容易找到鉤突,并觀察其形態(tài)變化。在胃腸充盈的條件下十二指腸乳頭顯示尚可,胰膽管在不擴張的情況下觀察不佳。 ③在火棉膠薄型化斷層切片上,十二指腸乳頭形態(tài)及胰膽管匯合處表現(xiàn)在斷面上清晰可見；腸系膜上靜脈是區(qū)分胰頭和胰頸的標志,腸系膜上動脈可作為判斷胰頭鉤突是否增大的標志。該實驗可為組織分辨率更高的影像學檢查和臨床各科診療提供詳實的解剖學資料。
[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.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R322

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