Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.
J Anat. 2019 Jul;235(1):88-95. doi: 10.1111/joa.12989. Epub 2019 Apr 12.
In embryology, the infracardiac bursa (ICB) is a well-known derivative separated from the omental bursa. During surgeries around the esophagogastric junction (EGJ), surgeons often encounter a closed space considered to be equivalent to the ICB, but the macroscopic anatomy in adults is hardly known. This study aimed to revisit the ICB using multimodal methods to show its development from the embryonic to adult stage and clarify its persistence and topographic anatomy. Histological sections of 79 embryos from Carnegie stage (CS) 16 to 23 and magnetic resonance (MR) images of 39 fetuses were examined to study the embryological development of the ICB. Horizontal sections around the EGJ obtained from three adult cadavers were examined to determine the topographic anatomy and histology of the ICB. Further, 32 laparoscopic surgical videos before (n = 16) and after (n = 16) the start of this study were reviewed to confirm its remaining rate and topographic anatomy in surgery. The ICB was formed in 1 out of 10 CS17 samples, and in 8 out of 10 CS18 samples. Further, it was observed in all CS19-23 except one CS23 sample and in 25 (64%) out of 39 fetus samples. Three-dimensional reconstructed MR images of fetuses revealed that the ICB was located at the right alongside the esophagus and the cranial side of the diaphragmatic crus. In one adult cadaver, the caudal end of the ICB arose from the level of the esophageal hiatus and the cranial end reached up to the level of the pericardium. The inner surface cells of the space consisted of the mesothelium. In laparoscopic surgery, the ICB was identified in only 11 (69%) out of 16 surgeries before. However, subsequently we were able to identify the ICB reproducibly in 15 (94%) out of 16 surgeries. Thus, the ICB is the structure commonly remaining in almost all adults as a closed space located at the right alongside the esophagus and the cranial side of the diaphragmatic crus. It may be available as a useful landmark in surgery of the EGJ.
在胚胎学中，心下囊（ICB）是一种从网膜囊中分离出来的已知衍生物。在食管胃结合部（EGJ）周围的手术中，外科医生经常会遇到一个封闭的空间，被认为相当于 ICB，但成人的大体解剖结构却鲜为人知。本研究旨在使用多模态方法重新研究 ICB，以展示其从胚胎到成人阶段的发育过程，并阐明其持续性和局部解剖学。通过对 Carnegie 分期（CS）16 至 23 阶段的 79 个胚胎的组织学切片和 39 个胎儿的磁共振（MR）图像进行检查，研究了 ICB 的胚胎发育情况。对来自三个成人尸体的 EGJ 周围的水平切片进行了检查，以确定 ICB 的局部解剖结构和组织学。此外，回顾了本研究开始前（n=16）和开始后（n=16）的 32 个腹腔镜手术视频，以确认其在手术中的剩余率和局部解剖结构。在 10 个 CS17 样本中，有 1 个形成了 ICB，在 10 个 CS18 样本中，有 8 个形成了 ICB。此外，在所有 CS19-23 样本中，除了一个 CS23 样本外，在 39 个胎儿样本中，有 25 个（64%）形成了 ICB。胎儿的三维重建 MR 图像显示，ICB 位于食管右侧和膈脚颅侧。在一个成人尸体中，ICB 的尾端起源于食管裂孔水平，头端可达心包水平。空间的内表面细胞由间皮组成。在腹腔镜手术中，在 16 例手术中，只有 11 例（69%）在手术前识别到 ICB。然而，随后我们能够在 16 例手术中的 15 例（94%）中重复识别出 ICB。因此，ICB 是一种常见的结构，几乎存在于所有成年人中，它是一个位于食管右侧和膈脚颅侧的封闭空间。它可能成为 EGJ 手术中的一个有用的标志。
