经食道心脏断层解剖与超声的应用研究
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。
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
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。
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
引文
1．郭万学．超声心动图学．人民卫生出版社，1997
2. Seward JB, Khandheria BK, Oh JK, et al. transesophageal echocardiography: technique, anatomy correlations,implementation, and clinical applications.Mayo Clin Proc, 1988, 63:649
3. Nanda NC,Pinherio L, Sanyal RS, et al. Transesophageal biplane echocardiographic imaging: technique, planes, and clinical usefulness. Echocardiography, 1990,7:771
4. Pearlman AS,Gardin JM, Martin RP, et al. Guidelines for optimal physician training in echocardiography: recommendations of the American Society of Echocardiography Committee for Physician Training in Echocardiography. J Am Soc Echocardiogr, 1992,5:187
5．韩景如，周庭永，曾令权等。断面解剖学观测心脏四腔、房室口、动脉口与体表的对应关系。重庆医科大学学报。1998；13(4)：251：254
6．吕衡发，吴德昌，姚树仁等。心脏连续横断断层的解剖学研究。白求恩医科大学学报。1990；16(6)：539：542
7. Schluter M, Hinxichs A,Their W, et al. Transesophageal two dimensional echocardiography: comparison of ultrasonic and anatomy sections. Am J Cardiol, 1984, 53:1173
8．张运，张梅，张薇等。多平面经食管超声心动图探查方法和基本切面的研究。中国超声影像学杂志，1994，10：7
9. Wang XF, Li ZA,,Cheng TO, et al. Biplane transesophageal echocardiography:an anatomic-ultrasonic-clinical correlative study. Am-Heart-J, 1992,123(4): 1027
10. Pandian NG,Hsu TL,Schwartz SL,et al. Multiplane transesophagseal echocardiography:imaging planes, echocardiographic anatomy, and clinical experience with a prototype phased array ominiplane probe. Echocardiography, 1992,9:649
11. Seward JB,et al. Multiplane transesophageal echocardiography: image orietation, exzamination technique,anatomy correlations and clinical applications.Mayo Clin Proc, 1993, 68:523
12. Takenaka S, et al. transesophageal two-dimentional and doppler echocardiography:ten representation views. Am J Noninvas Cardiol 1989; 3:18
13．黄泽奇，左焕深，刘卫民。人心计算机三维重建和显示的研究。解剖学杂志 1991，14(4)：318-321
14．宋志坚，吴国强，左焕深。人心连续切片的计算机三维重建。解剖学杂志 1996，19(5)：377-379
15. Hagens G, Tiedemann K, Kriz W. The current potenial of plastination. Anat Embryol, 1991; 14(4):318
16．张玮，李杉．生物组织连续切片图像的计算机三维重建研究的进展．生物医学工程学杂志．1999；16(3)：377-381
17．Anderson RH,Becker AE. Cardiac anatomy．株式会社南江堂 1981，1-186
18．Ajan S.Pearlman，邓燕。经食道超声心动图医师培训指南：美国超声心动图学会对超声心动图医师培训的建议。实用超声医学，1996，12，10：4(3，4)：41-46
19. Omoto R, Kyo S, Matsumura M, et al. New direction of biplane transesophageal echocardiography with special emphasis on real-time biplane imaging and matrix phased-array biplane transducer. Echocardiography, 1990, 7:691
20．张运，张梅，葛志明。介入性超声心动学。山东科学技术出版社，2000。
21. Stumper O,Elzenga NJ,Sutherland GR. Obstruction of the left ventricular outflow tract in childhood improved diagnosis by transesophageal echocardiography. Int J Cardiol, 1990,28:107
22．杨娅，王新房，李治安。多平面经食管超声心动图观察主动脉瓣病变。中国医学影像技术，1997，01，15；13(1)：8-10
23．张梅，张运，姚桂华等。多平面经食管超声心动图对心脏瓣膜病诊断价值的研究。临床医学影像杂志，1994，5：131
24．王新房。双平面经食管超声心动图切面图像与心脏断层解剖学关系的研究。临床心血管杂志，1991，(2)：98-102
25．张运，钟明，张薇等．经胸和多平面经食管超声心动图诊断房间隔缺损的对比研究．中华心血管病杂志，1995，23：278
26. Morimoto K, Matsuzaki M, Tohma Y, et al. Diagnosis and quantitativ evoluation of secundum-type atrial septal defect by transesophageal Dopplor echocardiography. Am J Cardiol, 1990,66:85
27．姚桂华，张运．经食道超声心动图在瓣膜性心脏病中的临床应用。中国超声影像学杂志，1994，10：60
28．邓东安，丛文玲，邓亚安。双平面经食道超声心动图诊断二尖瓣病变。中国临床医学影像杂志，1999，04，20；10(2)：96-97
29. Joh Y, Yoshikawa J,Yshida K, et al. transesophageal echocardiography findings of mitral valve prolapse. J Cardiol, 1989,Suppl 21;85
30．童晓明，孙刚。多平面经食道超声心动图测定左心耳的解剖和功能。心血管病学进展，1996，07，15；17(4)：254
31. Aschenberg W, et al. Transesophageal echocardiography for the detection of left artial appendage thrombus. J Am Coll Cardiol, 1986,7(1): 163
32. Mugge A, Daniel WG,Hausman D, et al. Diagnosis of left atrial appendage thrombi by transesophageal echocardiography:clinical implications and follow-up. Am J Card imaging, 1990,4:173
33. Maurer G,et al. Transesophageal echocardiography, New York:Mc Graw-Hill Inc 1994
34. Cohen-GI, Chan-KL, Walley-VM. Anatomic correlation of the long-axis views in biplane transesophageal echocardiography, Am-J-Cardiol, 1990 Oct 15; 66(12): 1007-12
35. Nelson NE,Pretorius DH. two dimensional ultrasound imaging. Ultrasound Med Biol, 1998,24:1243
36. Ballal RS,Nanda NC, Gateword R, et al. Usefulness of transesophageal echocardiography in assessment of aortic dissection. Circulation, 1991,84:1903
37．李志安，双平面超声心动图观察右室流出道-肺动脉狭窄。中国医学影像技术，1991；(4)：15-16
38. Seward JB, Khandheria BK,Edwards, et al. Biplane transesophageal echocardiography: anatomy correlations, image orietation, and clinical applications.Mayo Clin Proc, 1990; 65:1193
2. Seward JB, Khandheria BK, Oh JK, et al. transesophageal echocardiography: technique, anatomy correlations,implementation, and clinical applications.Mayo Clin Proc, 1988, 63:649
3. Nanda NC,Pinherio L, Sanyal RS, et al. Transesophageal biplane echocardiographic imaging: technique, planes, and clinical usefulness. Echocardiography, 1990,7:771
4. Pearlman AS,Gardin JM, Martin RP, et al. Guidelines for optimal physician training in echocardiography: recommendations of the American Society of Echocardiography Committee for Physician Training in Echocardiography. J Am Soc Echocardiogr, 1992,5:187
5．韩景如，周庭永，曾令权等。断面解剖学观测心脏四腔、房室口、动脉口与体表的对应关系。重庆医科大学学报。1998；13(4)：251：254
6．吕衡发，吴德昌，姚树仁等。心脏连续横断断层的解剖学研究。白求恩医科大学学报。1990；16(6)：539：542
7. Schluter M, Hinxichs A,Their W, et al. Transesophageal two dimensional echocardiography: comparison of ultrasonic and anatomy sections. Am J Cardiol, 1984, 53:1173
8．张运，张梅，张薇等。多平面经食管超声心动图探查方法和基本切面的研究。中国超声影像学杂志，1994，10：7
9. Wang XF, Li ZA,,Cheng TO, et al. Biplane transesophageal echocardiography:an anatomic-ultrasonic-clinical correlative study. Am-Heart-J, 1992,123(4): 1027
10. Pandian NG,Hsu TL,Schwartz SL,et al. Multiplane transesophagseal echocardiography:imaging planes, echocardiographic anatomy, and clinical experience with a prototype phased array ominiplane probe. Echocardiography, 1992,9:649
11. Seward JB,et al. Multiplane transesophageal echocardiography: image orietation, exzamination technique,anatomy correlations and clinical applications.Mayo Clin Proc, 1993, 68:523
12. Takenaka S, et al. transesophageal two-dimentional and doppler echocardiography:ten representation views. Am J Noninvas Cardiol 1989; 3:18
13．黄泽奇，左焕深，刘卫民。人心计算机三维重建和显示的研究。解剖学杂志 1991，14(4)：318-321
14．宋志坚，吴国强，左焕深。人心连续切片的计算机三维重建。解剖学杂志 1996，19(5)：377-379
15. Hagens G, Tiedemann K, Kriz W. The current potenial of plastination. Anat Embryol, 1991; 14(4):318
16．张玮，李杉．生物组织连续切片图像的计算机三维重建研究的进展．生物医学工程学杂志．1999；16(3)：377-381
17．Anderson RH,Becker AE. Cardiac anatomy．株式会社南江堂 1981，1-186
18．Ajan S.Pearlman，邓燕。经食道超声心动图医师培训指南：美国超声心动图学会对超声心动图医师培训的建议。实用超声医学，1996，12，10：4(3，4)：41-46
19. Omoto R, Kyo S, Matsumura M, et al. New direction of biplane transesophageal echocardiography with special emphasis on real-time biplane imaging and matrix phased-array biplane transducer. Echocardiography, 1990, 7:691
20．张运，张梅，葛志明。介入性超声心动学。山东科学技术出版社，2000。
21. Stumper O,Elzenga NJ,Sutherland GR. Obstruction of the left ventricular outflow tract in childhood improved diagnosis by transesophageal echocardiography. Int J Cardiol, 1990,28:107
22．杨娅，王新房，李治安。多平面经食管超声心动图观察主动脉瓣病变。中国医学影像技术，1997，01，15；13(1)：8-10
23．张梅，张运，姚桂华等。多平面经食管超声心动图对心脏瓣膜病诊断价值的研究。临床医学影像杂志，1994，5：131
24．王新房。双平面经食管超声心动图切面图像与心脏断层解剖学关系的研究。临床心血管杂志，1991，(2)：98-102
25．张运，钟明，张薇等．经胸和多平面经食管超声心动图诊断房间隔缺损的对比研究．中华心血管病杂志，1995，23：278
26. Morimoto K, Matsuzaki M, Tohma Y, et al. Diagnosis and quantitativ evoluation of secundum-type atrial septal defect by transesophageal Dopplor echocardiography. Am J Cardiol, 1990,66:85
27．姚桂华，张运．经食道超声心动图在瓣膜性心脏病中的临床应用。中国超声影像学杂志，1994，10：60
28．邓东安，丛文玲，邓亚安。双平面经食道超声心动图诊断二尖瓣病变。中国临床医学影像杂志，1999，04，20；10(2)：96-97
29. Joh Y, Yoshikawa J,Yshida K, et al. transesophageal echocardiography findings of mitral valve prolapse. J Cardiol, 1989,Suppl 21;85
30．童晓明，孙刚。多平面经食道超声心动图测定左心耳的解剖和功能。心血管病学进展，1996，07，15；17(4)：254
31. Aschenberg W, et al. Transesophageal echocardiography for the detection of left artial appendage thrombus. J Am Coll Cardiol, 1986,7(1): 163
32. Mugge A, Daniel WG,Hausman D, et al. Diagnosis of left atrial appendage thrombi by transesophageal echocardiography:clinical implications and follow-up. Am J Card imaging, 1990,4:173
33. Maurer G,et al. Transesophageal echocardiography, New York:Mc Graw-Hill Inc 1994
34. Cohen-GI, Chan-KL, Walley-VM. Anatomic correlation of the long-axis views in biplane transesophageal echocardiography, Am-J-Cardiol, 1990 Oct 15; 66(12): 1007-12
35. Nelson NE,Pretorius DH. two dimensional ultrasound imaging. Ultrasound Med Biol, 1998,24:1243
36. Ballal RS,Nanda NC, Gateword R, et al. Usefulness of transesophageal echocardiography in assessment of aortic dissection. Circulation, 1991,84:1903
37．李志安，双平面超声心动图观察右室流出道-肺动脉狭窄。中国医学影像技术，1991；(4)：15-16
38. Seward JB, Khandheria BK,Edwards, et al. Biplane transesophageal echocardiography: anatomy correlations, image orietation, and clinical applications.Mayo Clin Proc, 1990; 65:1193
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |