人胚胎早期肛门直肠周围三肌管发育的组织学研究  

Histological study of three layers of muscle tube around anorectum in human embryo and fetus

作　　者：刘雪来[1] 叶茂 张奇 何峰[3] 张世伟 普健 李旭[1] 金哲悟 李龙[1] Liu Xuelai;Ye Mao;Zhang Qi;He Feng;Zhang Shiwei;Pu Jian;Li Xu;Jin Zhewu;Li Long(Department of Surgery,Capital Institute of Pediatrics Affiliated Children Hospital,Beijing 100020,China;Department of Anatomy,Wuxi School of Medicine,Jiangnan University,Wuxi 214122,China;Department of Biochemistry and Immunology,Capital Institute of Pediatrics,Beijing 100020,China;Department of Surgery,Heilongjiang Hospital Branched by Capital Medical University Affiliated Children Hospital,Harbin 150010,China)

机构地区：[1]首都儿科研究所附属儿童医院外科,北京100020 [2]江南大学医学院人体解剖学教研室,无锡214122 [3]首都儿科研究所生化免疫研究室,北京100020 [4]首都医科大学附属北京儿童医院黑龙江医院,哈尔滨150010

出　　处：《中华小儿外科杂志》2024年第11期1018-1023,共6页Chinese Journal of Pediatric Surgery

基　　金：北京市自然科学基金项目(7222015);首都儿科研究所所级课题(LCYJ-2023-07);张家港市科技局产学研项目(ZKCXY2123)。

摘　　要：目的分析人体发育中肛门直肠周围三肌管的发育情况。方法收集15例医学科研与教学用人7~15周胚胎,对其进行组织切片,常规HE染色,并对染色切片进行扫描和记录。在矢状面上观察盆底三肌管发育的时序和形态特征。结果胚胎7周时内括约肌管已经形成,直肠纵肌纤维处于分化中,可见盆底间充质细胞向成肌前体细胞和成肌细胞分化;胚胎第8周内括约肌管和直肠纵肌纤维清晰可见,耻骨和直肠侧壁之间耻骨直肠肌纤维已经形成;胚胎第9~10周在肛提肌纤维远端出现肛门外括约肌原基;胚胎第14~15周肛周分化出可识别的肛门外括约肌纤维,可见耻骨直肠肌发出骨骼肌纤维,与直肠纵肌纤维共同构成纵肌管。结论三肌管在解剖学上存在,并在胚胎早期开始发育;内括约肌管发育最早,之后是纵肌管的平滑肌层(内层),肛提肌的发育晚于纵肌管的平滑肌层,最后才是外括约肌的发育。伴随着外括约肌的发育成熟,耻骨直肠肌发出纤维构成纵肌管的横纹肌层(外层)。Objective:Accurate understanding of the anatomy for the muscles with function of controlling defection around the anorectal region,is the key to reduce the complications after laparoscopic-assisted anoplasty.Previously,our research group has observed and described the structure of three layers of muscles tube anorectum in normal neonates,furthermore,we observed and described the developmental defects of three layers of muscles tube in anorectal malformation.However,regarding to the normal development of three layers of muscles tube in human body,there is no report so far.Methods:This study was approved by the hospital and university ethics committee.The research focuses on the 7-15 weeks of embryo for teaching and research were targeted to carry out the sectioning,routine HE staining,scanning and recording of staining section.Temporal and spatial development,as well morphological characteristics of the development of the three-layers of muscle tubes were observed on the sagittal plane.Results:In the 7th week of the embryos,the internal sphincter tubehas formed,longitudinal muscle fibers were differentiating,and mesenchymal cells in the pelvic floor started to differentiate towards the myoblasts;In the 8th week of embryos,the internal sphincter tube and longitudinal muscles tubes fibers were clearly visible,andrhabdium between pubic bone and lateral wall of rectum has formed;In the 9-10th week of fetuses,the external anal sphincter primordium appeared at the distal end of levator ani muscle fiber;In the 14-15th week of fetuses,external anal sphincter fibers were identifiable around the anus.The fibers frompuborectalis jointed into rectal longitudinal muscle fibers and constituted the longitudinal muscle tube.Conclusions:The three layers of muscle tube around anorectum are anatomically present and start to develop at early phases of embryo;The development of the internal sphincter tube is the earliest,followed by the smooth muscle layer(inner layer)of the longitudinal muscle tube,and levator ani muscle,and developm

关 键 词：胚胎 肌管 纵肌 横纹肌 内括约肌管 

分 类 号：R657.1[医药卫生—外科学]