目的 采用微视组织解剖学阐明纵隔区域的致密结缔组织组成的薄膜性结构，为临床提供更详尽的纵隔解剖数据。 方法 收集2例完整的纵隔横切面人体组织标本。采用P45断层塑化技术制作切片和硬组织切片技术及马松染色来确定由致密结缔组织构成的薄膜结构的存在和位置。 结果 在上纵隔，内脏筋膜分布具有完整性特点，在纵隔中央处整体包绕食管和气管，在周围处移行为血管鞘；在下纵隔，内脏筋膜分布较为分散，分别覆盖食管、支气管和降主动脉等，分别形成食管鞘、支气管鞘以及主动脉鞘。并且，食管右侧贴近右纵隔胸膜，食管鞘薄弱或缺失；食管左侧，前后层食管筋膜融合或接近，两侧筋膜间形成食管旁间隙，间隙内有食管的营养血管和淋巴结。 结论 在微视组织解剖学上，纵隔内脏筋膜纤维膜的厚度，随高度的下降逐渐变薄，层次间隙更明显。在下纵隔的食管旁间隙可作为基于膜结构解剖指导食管全系膜切除和淋巴清扫术的解剖学依据。
Abstract
Objective To elucidate the dense connective tissue components of mediastinal region through micro-anatomical dissection, providing more detailed mediastinal anatomical data for clinical practice. Methods Two complete mediastinal cross-sectional human tissue specimens were collected. Plastination 45 sectioning plastination technology was used to prepare sections, along with hard tissue sectioning techniques and Masson's trichrome staining to determine the presence and location of film-like structures composed of dense connective tissue. Results In the upper mediastinum, visceral fascia was characterized by its integrity, enveloping esophagus and trachea centrally and transitioning into vascular sheaths peripherally. In the lower mediastinum, the distribution of visceral fascia was more dispersed, covering esophagus, bronchus, and descending aorta, forming esophageal sheath, bronchial sheath, and aortic sheath, respectively. Additionally, the right side of esophagus was in close proximity to the right mediastinal pleura, with a thin or absent esophageal sheath. On the left side of esophagus, the anterior and posterior layers of esophageal fascia were fused or approximated, forming an esophageal paragastric space between two layers, which contains nutritional vessels and lymph nodes of esophagus. Conclusions In micro-anatomical dissection, the thickness of mediastinal visceral fascia and fibrous membrane gradually decreases with descending height, and the interlayer spaces become more distinct. The paraesophageal space in the lower mediastinum can serve as an anatomical basis for guiding the complete mesoesophageal resection and lymph node dissection based on membrane structure anatomy.
关键词
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纵隔 /
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内脏筋膜 /
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P45 /
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硬组织切片 /
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食管
Key words
Mediastinum /
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Visceral fascia /
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Plastination 45 (P45) /
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Hard tissue section /
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Esophagus
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