本文關(guān)鍵詞：體視顯微鏡下檢查人體心臟房室傳導(dǎo)軸　出處：《浙江大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 心傳導(dǎo)系統(tǒng) 人體心臟 體視顯微鏡 房室傳導(dǎo)軸 解剖 法醫(yī)病理學(xué) 形態(tài)學(xué) 檢查方法

【摘要】：先前的研究者們對(duì)心傳導(dǎo)系統(tǒng)(cardiac conduction system, CCS)做了大量研究,但因人類CCS的體積小,而且包裹的結(jié)締組織鞘不豐富,在肉眼下不易辨認(rèn),對(duì)人類CCS的大體解剖研究并不多,對(duì)CCS的研究多用實(shí)驗(yàn)動(dòng)物的心臟進(jìn)行比較研究。研究猝死的法醫(yī)病理學(xué)界在鑒定猝死案例的死因時(shí),總有一些尸體(約15%)找不到死因�，F(xiàn)普遍認(rèn)為CCS的病變?cè)阝腊咐杏邢喈?dāng)?shù)闹匾?一些尸體解剖找不到死因者,檢查他們的CCS后,有些案例可能有重要發(fā)現(xiàn)。但是目前對(duì)人類CCS的法醫(yī)學(xué)研究主要通過(guò)對(duì)竇房結(jié)(sinuatrial node, SAN)、房室結(jié)(atrioventricular node, AVN)這幾個(gè)主要部位的局部取材之后做連續(xù)組織切片,跳躍抽取切片檢查。由于對(duì)CCS取材部位過(guò)于局限,不能系統(tǒng)的連續(xù)觀察它的組織形態(tài)結(jié)構(gòu),更無(wú)法得到它的大體形態(tài)學(xué)資料,導(dǎo)致還有一些尸體找不到死因,比如His束或左、右束支出現(xiàn)斷裂、纖維化,脂肪變性或浸潤(rùn)等局部病變情況就很難被發(fā)現(xiàn)。更重要的是目前的方法需要做大量的連續(xù)切片,以及有的甚至因取材部位不夠準(zhǔn)確,沒取到CCS組織,即使做了切片,也找不到什么,在成功率上存在一些不足,在法醫(yī)鑒定部門得不到普遍推廣。至今,國(guó)內(nèi)外均無(wú)完善的人類CCS全方位立體層面的系統(tǒng)性病理學(xué)檢查方法。此外,AVN的形態(tài)和功能還有待進(jìn)一步的明確；有關(guān)CCS結(jié)間束(竇房結(jié)與房室結(jié)之間的傳導(dǎo)束)的特化傳導(dǎo)組織的有無(wú),還存在一些爭(zhēng)議；動(dòng)物組織切片上發(fā)現(xiàn)的房室環(huán)(atrioventricular ring, AVR)的形態(tài)特征有待在人類心臟上得到驗(yàn)證和研究,它的功能有待進(jìn)一步明確。顯然,房室傳導(dǎo)軸(atrioventricular conduction axis, ACA)的形態(tài)學(xué)檢查在解剖學(xué)和法醫(yī)病理學(xué)上對(duì)CCS的識(shí)別鑒定、檢查、診斷有著重要的作用。我們?cè)O(shè)計(jì)了一套ACA的檢查新方法體系：試著定位ACA組織的解剖入路,在體視顯微鏡下解剖分離出ACA組織,并進(jìn)行觀察、記錄、取證被充分暴露后的ACA組織形態(tài)特征,然后取出被分離出來(lái)的ACA組織做平行于心內(nèi)膜面的組織切片,行不同染色后對(duì)它的形態(tài)特征進(jìn)行光學(xué)顯微鏡下觀察。收集了浙江大學(xué)病理學(xué)與法醫(yī)病理學(xué)研究所司法鑒定中心的5例(男性3例,女性2例,年齡跨度17歲至71歲),浙江醫(yī)學(xué)高等專科學(xué)�；A(chǔ)醫(yī)學(xué)部形態(tài)中心的3例(男性2例,女性1例,年齡跨度28歲至70歲)人體心臟(福爾馬林固定保存)進(jìn)行實(shí)驗(yàn),驗(yàn)證我們?cè)O(shè)計(jì)的新方法的可行性。另外,對(duì)ACA的解剖結(jié)構(gòu)進(jìn)行詳細(xì)的探索性觀察和研究。結(jié)果發(fā)現(xiàn)：新方法對(duì)ACA組織定位準(zhǔn)確,采用新方法能全部成功地解剖分離和檢查ACA組織,并能獲得傳統(tǒng)的檢查方法無(wú)法獲得的ACA立體層面的大體病理學(xué)數(shù)據(jù),1-2個(gè)組織塊(10張切片／組織塊)即可獲得到足夠的組織學(xué)信息,明顯減少了組織學(xué)檢查的工作量；8例AVN頭部與擴(kuò)展區(qū)之間基本沒有成形的絕緣膜(包裹心肌組織的膜狀結(jié)締組織),AVN頭部不易被解剖分離；8例AVN為扁平的橢圓結(jié)構(gòu),與其他學(xué)者觀點(diǎn)不一致；疑似的房室環(huán)特化組織和結(jié)間束(AVN端)在人心常規(guī)組織切片上得到體現(xiàn)。為心臟病理學(xué)及法醫(yī)學(xué)檢查CCS提供幫助；房室結(jié)區(qū)的形態(tài)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.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R541.7

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