经食道心脏断层解剖与超声的应用研究

【作者】 高全胜；

【导师】 应大君；

【作者基本信息】 第三军医大学 ， 人体解剖学， 2001， 硕士

【摘要】 目的：建立一套能满足心脏超声诊断、简便可行且空间方位易于理解的、与经食道超声心动图主要结构常用显示切面相匹配的解剖学资料，为临床超声检查提供最佳检查层面、方位和TEE重点扫查范围的形态学基础。方法：运用自行设计和制作的大体冰冻软组织薄层断面切片机，分别对正常成人心脏标本进行经食道水平切割和以食道为旋转轴的放射状切割（各3例）。用数码相机采集断层图像信息，再将图像编号输入计算机观察。同时用超声仪器对正常成人经食道水平和放射状扫查心脏。将断层解剖所见与超声图像进行综合观察分析，总结心脏主要结构的相互毗邻关系、空间 移行变化以及观察的最佳位置和TEE重点扫查范围。结果：①自行设计、制作了两种软组织冰冻切片机。水平切片机最小切割层厚为0.4mm，旋转放射状切片机能在10°～170°范围内进行旋转切割。两种切片机的初步制作使用成功，为薄层断面解剖增添了新的切割器械。②经食道心脏水平断层每例心脏共切取约160片层面。以主动脉根部水平切面为基准面，观察了心脏主要结构在水平切面上的变化。在该层面上可观察到主动脉根部及主动脉瓣，左、右心房，左室流出道及左房室口和二尖瓣，右心室等结构，是观察主动脉瓣和二尖瓣的理想层面。在该层面上、下方的不同距离内，可较好地观察到冠状动脉口、肺动脉干、左房室口、右房室口室间隔膜部、卵圆窝及左、右肺上、下静脉等重要心脏结构。③经食道心脏放射状断面每例心脏共切取45片断层。以经食道矢状位切面为基准面，观察心脏主要结构在放射状切面上的变化。该层面上可观察到主动脉窦、左心房、左房室口、左心室、左心房、右室流出道、肺动脉口及内可较好地观察到左右房室口及其瓣膜、主动脉口和肺动脉口及其瓣口、肺动脉干、升主动脉、上腔静脉、下腔静脉等重要结构。④获取了2套正常人经食道超声心动图扫查图像资料，该资料包括了心脏备主要结构的切面图像，包括主动脉根部短轴切面、四心腔切面、五心腔切面、两心房切面、左心水平切面、左心耳切面、肺静脉水平切面、主动脉根部长轴切面、右室流出道长轴切面、上腔静脉长轴切面。 结论：①大体冰冻薄层软组织切片机可操作性好，切片厚度和精度都得以准确把握，满足了冰冻薄层切片的要求，为大体冰冻软组织薄层切片提供了经济、简便易行的研究工具。②冰冻薄层断面图像观测性较好，层间数据丰富，在计算机上可观察心脏结构的变化趋势，可为临床影像学诊断提供解剖形态学资料。③从解剖形态学角度印证了临床心脏主要结构显示的层面和方位，并推荐了临床经食道超声心动图的最佳扫查层面和TEE重点扫查范围。④为TEE的临床应用提供了较为完整的经食道心脏水平和放射状扫查的解剖学依据。更多还原

【Abstract】 Objective: to establish a set of anatomic data for ultrasonic cardiac diagnosis, matching the displaying sections of the main structure of transesophageal echoeardiography, and to provide morphological basis for clinical ultrasonic examinations with best examination sections, orientations and examining path. Methods: By application of self-designed cryomicrotome for frozen gross soft tissue, transesophageal horizontal section and radial section centering the esophagus as an axis of the normal heart sample were performed(three examples, respectively). The information of the section was collected by digital camera and images were numbered and input into computer for observation. Ultrasonic instruments were used to scan the normal heart transesophageally and radially. Tomogram was compared with ultrasonic images to conclude the relationship of the major cardiac structures and spatially moving changes and the best location and the main area of TEE scanning. Results:〤ryomicrotome for soft tissue was designed and prepared. The minimum thickness by horizontal microtome was 0.4mm, while the rotating and radial microtome could perform the cutting job in the field of I ~O 170 ~ The preliminary preparation of these two kinds of microtomes has been finished. Consequently, they would be a new kind of cutting instrument for thin section anatomy. ?One hundred and sixty sections were prepared transesophageally and horizontally. Based on the horizontal plane of the root aorta, we observed the horizontal changes of the major cardiac structures. On this plane, the root aorta, the aorta valves, the left and right cardiac atria, the efferent tract of the left ventricle, the left atrioventricular orifice, the bicuspid valve and the right ventricle could be observed. Hence this was the satisfactory plane to observe the aortic valves and the bicuspid valve. At the spots of different upper and lower distances on this plane, the major cardiac structures, such as the coronary orifice, the pulmonary trunk, the membranous septum of the left and right atrioventricular orifices, the fossa ovalis, the superior and inferior vena cavas could be observed. orty-five sections were prepared transesophageally and radially. Based on the transesophageal and sagittal plane, we observed the changes of the major cardiac structures on the radial plane. On this plane, the aortic sinus, the left cardiac atrium, the left atrioventricular orifice, the left ventricle, the right atrium, the efferent tract of the right ventricle, the pulmonary orifice, the pulmonary valve, and the pulmonary trunk, could be observed. At the spots of different upper and lower distances on this plane, the left and right atrioventricular orifice and its valve, the aortic orifice, the pulmonary orifice and its valve, the pulmonary trunk, ascending aorta, the super and inferior vena cavas could be observed. GThree sets of image data of transesophageal echocardiogram of the normal heart were obtained. These data were composed of the section images of the major cardiac structures, including minor axis section of the root aorta, the four cardiac chambers, the five cardiac chambers, the two atria, the horizontal section of the left heart, the left auricle, the pulmonary vein, major axis section of the root aorta, the efferent tract of the right ventricle, and the superior vena cava. Conclusion:㏕he microtome for frozen gross soft tissue is of easy operation and easy to control the thicknes更多还原