Histological study of the thin membranous structure made of dense connective tissue around the esophagus in the upper mediastinum
Histological study of the thin membranous structure made of dense connective tissue around the esophagus in the upper mediastinum
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DOI：
10.1007/s10388-018-0625-9
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发表时间：
2018-10-01
期刊：
影响因子：
2.4
通讯作者：
Kinugasa, Yusuke
中科院分区：
文献类型：
--
作者：
Tokairin, Yutaka;Nakajima, Yasuaki;Kinugasa, Yusuke
背景Sarrazin已经从大体解剖学的角度报道了上纵隔筋膜的结构。但对胸腔镜或纵隔镜手术有必要了解细致的解剖。因此，我们从组织学上研究由致密结缔组织组成的薄膜结构。方法取3具尸体纵膈半连续横切面。采用苏木精和伊红染色、Elastica van Gieson染色和Masson三色染色确定由致密结缔组织组成的薄膜结构的存在和位置。结果在组织学上观察到Sarrazin先前描述的“内脏鞘”和“血管鞘”。这两个薄膜结构并没有圆柱状地包围食道和气管。此外，与左侧相比，右侧上纵隔的“内脏鞘”不清楚。“内脏鞘”（左侧）逐渐变得不清晰，似乎几乎消失了；食道在气管分叉的尾侧非常靠近胸导管。虽然所有尸体左侧返神经均位于“内脏鞘”内，但1号尸体左侧返神经淋巴结位于“内脏鞘”内，3号尸体左侧返神经淋巴结位于“内脏鞘”与“血管鞘”之间。结论上纵隔食管周围有明显的“内脏鞘”；然而，研究结果并非一成不变。
Background The structure of the fascia in upper mediastinum has already been reported from gross anatomical viewpoints by Sarrazin. But it is necessary to understand meticulous anatomy for thoracoscopic or mediastinoscopic surgery. So herein, we investigate histologically the thin membranous structure made of dense connective tissues.Methods Semi-sequential transverse sections of the mediastinum were obtained from three cadavers. Hematoxylin and eosin staining, Elastica van Gieson staining, and Masson trichrome staining were performed to identify the presence and location of the thin membranous structure made of dense connective tissues.Results The "visceral sheath" and "vascular sheath," as previously described by Sarrazin, were observed histologically. These two thin membranous structures do not surround the esophagus and trachea cylindrically. In addition, the "visceral sheath" on the right side of the upper mediastinum was unclear in comparison to the left side. The "visceral sheath" (on the left side) gradually became unclear, and seemed to almost disappear; the esophagus was found to be very close to the thoracic duct on the caudal side of the bifurcation of the trachea. Although the left recurrent nerve was located inside the "visceral sheath" in all cadavers, the left recurrent nerve lymph nodes were located inside the "visceral sheath" in cadaver 1 and between the "visceral sheath" and "vascular sheath" in cadaver 3.Conclusion The "visceral sheath" around the esophagus in the upper mediastinum was histologically demonstrated; however, the findings were not constant.