摘要
目的:为临床食管中下段肿瘤的微创切除提供气管隆嵴以下食管系膜形态的精细解剖。方法:大体解剖观察成人尸体食管系膜及其包裹的结构;对胎儿尸体进行连续水平面取材后石蜡切片,Masson染色确定食管系膜的位置、形态及其和周围结构的关系;采用Mimics 19.0软件对食管系膜进行三维重建。结果:在大体解剖和组织学上均可观察到食管系膜结构。食管系膜除形成覆盖食管表面的浆膜,还包裹了食管周围的淋巴结、血管和神经丛。Masson染色显示气管隆嵴平面至膈肌食管裂孔平面之间,食管系膜的形态出现了逐渐的过渡,在第4~7胸椎水平食管系膜与胸主动脉外膜关系密切,第7胸椎(T7)以下食管系膜与胸主动脉外膜相对独立。结论:气管隆嵴以下食管系膜在T7上下存在差异,该系膜与胸主动脉外膜关系的改变,能为食管中下段肿瘤切除时手术层次的选择提供形态学依据。
Objective:To provide a precise anatomy of the mesoesophagus below tracheal carina for the clinical minimally invasive excision of middle and lower esophagus tumor.Methods:The mesoesophagus of adult cadavers and its wrapping structures were observed by gross anatomy.Processed transverse sections of thorax were obtained from the fetal cadavers.Paraffin section and Masson staining were performed to identify the location,shape and relationship with surrounding structures of the mesoesophagus.3D reconstructions of the mesoesophagus were realized by Mimics 19.0 software.Results:Mesoesophagus could be observed by gross anatomy and histology.In addition to forming a serous membrane covering surface of the esophagus,the mesoesophagus also wrapped the lymph nodes,vessels,and nerve plexus around the esophagus.There was a gradual transition in the shape of the mesoesophagus observed by Masson staining between planes of tracheal carina and esophageal hiatus.Mesoesophagus was closely related to vascular adventitia of thoracic aorta at 4th to 7th thoracic vertebrae level,and relatively independent with the adventitia below 7th thoracic vertebrae(T7) level.Conclusion:There are differences in mesoesophagus below the tracheal carina plane above and below T7 level.The morphological gradual change of mesoesophagus and thoracic aortic adventitia can provide basis for selection of surgical layer in clinical resection of middle and lower esophageal tumor.
作者
黄一豪
刘殿凤
何雪莲
赵明霄
付元山
Huang Yihao;Liu Dianfeng;He Xuelian;Zhao Mingxiao;Fu Yuanshan(Department of Anatomy,College of Basic Medicine,Dalian Medical University,Dalian 116044,China)
出处
《解剖学杂志》
CAS
2022年第4期305-309,共5页
Chinese Journal of Anatomy
关键词
食管
食管系膜
三维重建
食管肿瘤
esophagus
mesoesophagus
3D reconstruction
esophageal tumour
作者简介
第一作者:黄一豪,E-mail:yihao3748@163.com;通信作者:付元山,E-mail:fuyuanshan@163.com。
