人体心脏房室结、房室环及主动脉后结的巨微解剖

Macro-micro-anatomy of the atrioventricular node,atrioventricular ring and retroaortic node in the human heart

目的解剖分离人体心脏房室结和房室环的结构,阐述它们的形态特征及相互关系。方法通过体视显微镜解剖12例人体心脏的房室结、主动脉后结及房室环,再进行组织学观察,并绘图演示它们的结构关系。结果在二尖瓣环和三尖瓣环靠近冠状窦前缘处分别暴露了左、右房室环(12/12),直径分别为(0.69±0.12)mm、(0.78±0.13)mm。此处的左、右房室环穿行在房室隔内的心房肌与心室肌之间的间隙中,向房室结方向延伸。主动脉后结在主动脉根后方的房间隔中被探查到(7/9),它的后上方的房间隔间隙中有肌纤维与其相连,它的前下方分出左、右房室环,并且此处的左环比右环粗。在中心纤维体后方的心内膜下的深部,主动脉后结与房室结之间有直接的心肌组织连接通路,这条通路有别于另两条通路(左、右房室环)。结论主动脉后结和房室环可通过体视显微镜解剖暴露,主动脉后结与房室结之间有3条通路。

Objective To investigate the morphology and correlation of the atrioventricular node and atrioventricular ring by macro-micro-anatomy of human heart. Methods In 12 hearts, the structural relation between the atrioventricular node, retroaortic node and atrioventricular ring was dissected and mapped under a stereomicroscope and they were further examined using histological methods. Results Nearby the mitral ring and tricuspid ring, the left atrioventricular ring [ diameter = （0.69 ±0. 12） mm ], and right atrioventricular ring [ diameter = （ 0. 78 ± 0. 13 ）mm ] at the frontal region of the coronary sinus ostium were exposed through the stereomicroscope （12/12 hearts）. These atrioventricular rings extended to the atrioventricular node through the gap between the atrial and the ventricular myocardium in the atrioventrieular septum. The retroaortic node was explored in the atrial septum that was located in the back of aortic root （7/9 hearts）. Its posterosuperior part was connected with a bundle of myocardium in the gap between the left and the right atrial myocardium. The left and right atriovcntricular rings branched off from the anterior inferior part of retroaortic node. The left ring was thicker than right ring. The retroaortic node was connected directly with the atrioventricular node by the subendocardial myocardium in the back of the central fibrous body. The above connection was different from the left and right atrioventricular rings. Conclusion The retroaortic node and atrioventricular ring can be exposed partly by the stereomicroscope and there are 3 pathways between the retroaortic node and the atrioventricular node.