腹腔动脉CT数据三维重建与相关解剖学研究

目的:研究基于CT数据腹腔动脉三维重建方法及相关解剖.方法:利用Mimics软件对120例患者64排螺旋CT数据行腹腔动脉三维重建,评价重建模型的效果并统计各分支的显示率、分支类型、开口位置、走行方向及长度.结果:重建模型形态逼真,能准确显示该血管及其分支的解剖结构,显示率分别为:肝总动脉100%,脾动脉100%,胃左动脉78.3%,胃十二指肠动脉100%,肝固有动脉98.3%,肝左动脉79.2%,肝右动脉95%.胃脾肝共干型分支最多,占89.2%,该型腹腔动脉平均长度为2.76cm.开口位置96.7%位于胸12～腰1之间,83.3%向右走行.结论:利用64排螺旋CT增强扫描数据三维重建腹腔动脉,可真实反应其形态结构并测量相关解剖学数据,对介入插管及虚拟手术研究有较高指导价值,为解剖学教学提供了相关数字化图谱.     

肝动脉解剖变异的DSA研究

目的:进一步探讨肝动脉解剖变异的种类及分型,结合文献提出肝动脉变异的新分型。方法:回顾分析1000例因肝脏疾病而行DSA检查患者肝动脉的起源、走行、分布情况,并分别统计其变异类型和发生率。结果:1000例肝动脉造影中,正常型占72.7%(727例)。肝动脉变异占27.3%(273例)。273例肝动脉变异中肝总动脉分叉变异占5.4%(54例);肝动脉起源变异占21.4%(214例);肝动脉分叉 起源变异占0.5%(5例)。结论:肝动脉解剖变异的种类具有多样性、复杂性。结合文献和本研究结果提出肝动脉解剖变异的新分型:正常型、肝总动脉分叉变异、肝动脉起源变异、肝总动脉分叉变异合并肝动脉起源变异、多种变异共存五大类,共50余种。     

胃小弯侧动脉的应用解剖

目的 解剖观察胃小弯侧的动脉供应及其变异,为临床上腹部手术、胃癌介入治疗提供解剖学依据.方法 随机收集经福尔马林处理过的74具成年尸体,观察胃动脉的起源、行径及其分支分布范围,并进行统计学处理.结果 在本组标本中,胃左动脉起源于腹腔干者72例,占97.3％;起于肝左动脉者2例,占2.7％.胃左动脉发出副肝左动脉者4例,占5.4％;发出替代性肝左动脉者4例,占5.4％.另有4例其变异更为特殊,占5.4％,其中有2例,替代性肝左动脉直接由腹腔干发出,后者再发出3支胃动脉,供应食管下部、胃的贲门部和胃体前壁小弯侧的部分;1例胃左动脉的前、后支直接由腹腔干发出;另1例除拥有常规的胃的动脉来源外,腹腔干还直接发出1支粗大的胃动脉供应贲门部的右上份.胃右动脉起源于肝固有动脉者48例,占64.8％;起于肝总动脉者10例,占13.5％;起于肝左动脉者9例,占12.2％;起源于胃十二指肠动脉者7例,占9.5％.结论 胃小弯侧动脉变异率较高,掌握其变化规律,对临床医生具有十分重要的意义.     

内脏全反位并肝动脉变异1例

内脏全反位并肝动脉变异１例许树林，丁炜肝动脉的血管分支起源变异较多。其中肝左动脉起自腹腔动脉，肝右动脉起自肠系膜上动脉不少见。笔者在进行肝癌介入治疗中发现１例内脏全反位者肝动脉起源与上述完全方向相反。即反位的肝右动脉起自腹腔动脉，反位的肝左动脉起自肠...     

变异肝动脉的解剖学特点及其临床意义

目的　观察变异肝动脉的解剖学特点,为临床相关血管影像学检查、手术及介入治疗等提供形态学资料。 方法　按常规方法解剖25例成人尸体标本,沿肝总动脉追踪、寻找肝固有动脉的分支并观察分布情况。 结果　本组肝固有动脉及其分支变异率为28%。其中有2例属Hitta分型外的变异肝动脉,肝固有动脉右侧壁未见胃右动脉,而是在左侧壁发出1支动脉主干,远端分支分布于肝和胃,本文称为“肝胃动脉（HGA）”;其中标本2从HGA主干后壁发出1分支,远端也分布于肝和胃,本文称为“肝胃副动脉”。 结论　本组2例起于肝固有动脉左侧壁的HGA,是胃小弯右侧的主要动脉来源,并有分支营养肝和胃的其他部位。此种变异补充了变异肝动脉的形态学资料,对临床有一定的指导价值。     

肝总动脉分支变异一例

作者于１９９８年作腹部标本时发现一例肝总动脉分支的变异。该肝总动脉从腹腔于发出后隔网膜囊向右走行在胃后方,而后在近胃窦部上方从左至右依次发出１支肝左动脉,２支肝右动脉及１支胃十二指肠动脉。从肝左动脉发出１支胃右动脉。两支肝右动脉均行于门静脉前方并与之成锐角。左侧肝右动脉继而行经肝总管的前方进入胆囊三角,在此发出１支胆囊动脉浅支。右侧肝右动脉则经胆总管前方绕过胆囊的后方,在此发出１支胆囊动脉深支后径胆囊管的后方进入肝右叶。此种肝总动脉分支的变异给肝胆外科的手术操作及肝的动脉造影增加了难度。故对临床…     

变异肝动脉的解剖学特点及其临床意义

目的　观察变异肝动脉的解剖学特点，为临床相关血管影像学检查、手术及介入治疗等提供形态学资料。 方法　按常规方法解剖25例成人尸体标本，沿肝总动脉追踪、寻找肝固有动脉的分支并观察分布情况。 结果　本组肝固有动脉及其分支变异率为28%。其中有2例属Hitta分型外的变异肝动脉，肝固有动脉右侧壁未见胃右动脉，而是在左侧壁发出1支动脉主干，远端分支分布于肝和胃，本文称为“肝胃动脉（HGA）”；其中标本2从HGA主干后壁发出1分支，远端也分布于肝和胃，本文称为“肝胃副动脉”。 结论　本组2例起于肝固有动脉左侧壁的HGA，是胃小弯右侧的主要动脉来源，并有分支营养肝和胃的其他部位。此种变异补充了变异肝动脉的形态学资料，对临床有一定的指导价值。     

肝动脉解剖变异及其临床意义

目的　解剖肝动脉,分析其变异规律,以期为临床提供形态学基础。 方法　随机选取74具尸体,充分解剖暴露腹腔动脉及其分支,对肝动脉的起源、行径进行仔细观察和记录。 结果　本研究观察到Hiatt六种分型中的三种： Ⅰ型正常型占77.02%（57例）：肝总动脉起于腹腔干,分为胃十二指肠动脉和肝固有动脉,后者又分为肝左、中、右动脉;Ⅱ型占9.47%(7例)：替代性或副的肝左动脉起于胃左动脉;Ⅴ型占1.35%(1例)：肝总动脉起于肠系膜上动脉。除此之外,还观察到三种罕见的类型：Ⅶ型占6.76%(5例)：替代性肝左动脉起于肝总动脉;Ⅷ型占2.70%(2例)：替代性肝右动脉起于胃十二指肠动脉;Ⅸ型占2.70%(2例)：替代性肝左动脉与胃及食管的动脉分支共干,在本研究中,称其为共干动脉,起于腹腔动脉。 结论　本研究在小样本中观察到3种罕见的变异类型,提示肝动脉变异具有极大的复杂性和偶然性。临床医生对此应予以高度重视。     

主动脉弓分支的数字减影血管造影解剖学变异及其意义

目的:讨论数字减影(DSA)下主动脉弓及其分支的解剖变异情况,为血管疾病介入诊断和治疗提供形态学依据.方法:从本院2000年2月～2008年6月行血管造影的所有患者中,选取造影片中主动脉弓及其分支的DSA图像资料完整者共534例,进行观察分析,描述所见主动脉弓及其分支的不同变异情况,统计发生率.结果:主动脉弓分支结构"正常"者占92.17%;左椎动脉迷走者占4.49%;左颈总动脉与头臂干共干者占1.50%;无头臂干,主动脉弓各分支均起自主动脉弓者占1.68%;右位主动脉弓者占0.19%.上述各种类型又有不同的变异亚型.结论:中国人主动脉弓及其分支变异种类繁多,影响血管疾病诊断和治疗.     

基于三维可视化技术对巨块型肝癌肝动脉血管分布规律的分析与研究

目的:基于三维可视化技术对CT数据处理、分析,研究巨块型肝癌肝动脉的分布规律。方法:收集93例正常人（正常组）和93例巨块型肝癌患者（肝癌组）CT数据,利用IPS软件三维重建,研究正常组与肝癌组肝动脉的差异以分析其变化规律。结果:肝癌组肝固有动脉、肝固有动脉左支、肝固有动脉右支和肝中动脉起始处血管平均直径均比正常组相应部位血管管径增粗,差异有统计学意义（P<0.05）;肝癌组肝固有动脉右支血管分支多于正常组动脉血管分支,差异有统计学意义（P<0.05）;巨块型肝癌位于肝左叶者,与正常组对比有76.9%膈动脉分支包绕/嵌入肝癌肿瘤,可认为其为肝癌供血的新生血管;巨块型肝癌位于肝右叶和肝中部者,新生血管呈球状包绕肝癌。结论:巨块型肝癌肝动脉的变化规律可从血管直径、分支及新生血管位置研究,为临床精准介入治疗提供指导价值。     

Superior mesenteric origin of the proper hepatic artery: embryological and clinical implications

The hepatic arteries are subject to a great deal of anatomical variation, potentially complicating hepatobiliary surgical procedures as well as general gastrointestinal procedures that involve foregut and midgut structures. We report a case of a rare variant of the proper hepatic artery discovered during dissection of an 84-year-old male cadaver. In this individual, the common hepatic artery was absent and the proper hepatic artery was replaced directly to the superior mesenteric artery. The gastroduodenal artery and the right inferior phrenic artery took origin from the celiac trunk. In addition, there was no identifiable right gastric artery. The celiac trunk gave off three branches: the splenic, left gastric, and gastroduodenal arteries. The entire arterial blood supply to the liver, therefore, was derived from the superior mesenteric artery. Patterns of regression of the ventral branches and the partial disappearance of the ventral anastomotic arteries during embryonic development play a major role in the variations of the gut arteries. An intraoperative encounter with this particular variant carries a significant risk of iatrogenic injury with potentially devastating ischemia and necrotic results. Accurate depiction and definition of the hepatic arterial anatomy are crucial. Variations like the one described here underscore the importance of pre-operative imaging and knowledge of the embryological origins of variation.     

Three cases of the gastrosplenic and the hepatomesenteric trunks

Three common branches of the celiac trunk are the left gastric artery, the splenic artery and the common hepatic artery. The variation of the three branches of the celiac trunk has an importance for the arterial supply to the digestive organs of the upper abdomen. In this study, we present three cases of the gastrosplenic and the hepatomesenteric trunks in Japanese cadavers. Especially, in Case 1, the left inferior phrenic artery arose from the gastrosplenic trunk and the left hepatic artery arose from the left gastric artery. In Cases 2 and 3, the common hepatic artery penetrated the pancreatic parenchyma before reaching liver. In Case 3, the right hepatic artery arose from the hepatomesenteric trunk.     

A morphometric study of the celiac trunk and review of the literature

The anatomy of the celiac trunk and its branches was examined in 77 adult human cadavers of Caucasian (Hellenic) origin. The celiac trunk followed the normal pattern, namely trifurcation to the common hepatic, splenic, and left gastric arteries, in 90.9% of the dissections (70/77). Two different types of trifurcation were observed: (a) a true tripod when the celiac trunk ended in a complete trifurcation (74.0%, 57/77) and (b) a false tripod when the three arteries did not have a common origin (16.9%, 13/77). Such a clear predominance of the true tripod is not reported elsewhere. Anatomic variations were found in 9.1% (7/77). Bifurcation of the celiac trunk into splenic and left gastric artery (splenogastric trunk) was observed in one specimen (1.3%), whereas the common hepatic artery emerged directly from the aorta. Absence of the celiac trunk was also found in two individuals (2.6%). The celiac trunk presented additional branches (lumbar and inferior phrenic arteries) in 5.2% (4/77). The median level of origin of the celiac trunk was at the upper third of L1 (22.7% to 17/75). The total length of the celiac trunk ranged from 1.1 to 5.0 cm, whereas the mean length was 2.8 cm (standard deviation = 0.80 cm, standard error of mean = 0.09 cm) irrespective of the existence of variations. The mean length of the celiac arteries which formed a false tripod was found to be larger than those of the arteries which formed a true tripod but only a weak statistically significant difference was established (P = 0.073). Clin. Anat. 26:741–750, 2013. © 2012 Wiley Periodicals, Inc.     

Variations of the celiac trunk branches in the fetus

The study was performed on 60 human foetuses, aged between 4 to 9 months, using as methods dissection and plastic and contrast substances injection. We studied the celiac trunk in what concerns the division into its terminal branches, insisting on the possible morphological variations, some rare collateral branches starting from the common arterial trunk, the dimensional relations between the branches at their origin and the level of the celiac trunk origin from the aorta, in relation with the vertebral column, the diaphragmatic passage of the aorta and with the superior mesenteric artery. We also assessed the dimensional relations (calibers at origin) between the branches of the celiac trunk. Ass possible variations of the division of the celiac trunk, we assessed: gastro-hepatic trunk, with the splenic artery directly from the aorta or from the hepatic artery; gastro-splenic trunk, with the hepatic artery originating from the aorta; hepato-splenic trunk, with origin of the left gastric artery either directly from the aorta or from the hepatic artery. Rare variations: celiaco-mesenteric trunk; two arterial trunks, hepato-splenic and hepato-gastric; separate aortic origin for all three "classic" branches of the celiac trunk; two hepatic arteries, one from the celiac trunk and the other from the aorta or superior mesenteric artery; celiac trunk that divides into several terminal branches; one or two suprarenal arteries originating from the celiac trunk.     

Anatomical study of the pancreas in the house musk shrew (Suncus murinus), with special reference to the blood supply and innervation

To examine the macroscopic structure, blood supply, and innervation of the pancreas in the house musk shrew (Suncus murinus), we performed gross anatomical dissection and whole-mount immunostaining of the autonomic nerve of Suncus pancreases based on neurofilament protein (NFP) immunoreactivity. The adult Suncus pancreas is clearly separated into right and left lobes that are not fused. The right lobe of the Suncus pancreas is located in the dorsum of the duodenum and to the right of the common bile duct independently. The right lobe is supplied by branches of the superior mesenteric artery, and is innervated by branches that originate from the superior mesenteric plexus and run along the arterial branches of the superior mesenteric artery. The left lobe occupies 9/10 of the entire pancreas and is located to the left of the common bile duct. It is supplied mainly by branches of the splenic and common hepatic arteries, and is innervated by branches that originate from the celiac plexus and run along the splenic and common hepatic arteries. According to previous studies on the blood supply and innervation of the human pancreas, the right and left lobes of the Suncus pancreas correspond to the pancreatic parts derived from the ventral and dorsal pancreatic buds. The current results suggest that the Suncus pancreas is a suitable experimental model for studying the development of the human pancreas.     

The arteries of the pancreas of the dog. An injection–corrosion and microangiographic study

The ramification of the pancreatic arteries, including the lobular vessels, was studied in 36 mongrel dogs by means of plastic injection and corrosion, as well as microangiography. The left pancreatic lobe receives the left cranial pancreatic artery and other smaller branches from the splenic artery, and two to four twigs from the gastroduodenal artery. In addition, it receives very often a branch from the common hepatic artery. Branches arising from the cranial mesenteric artery and from the first jejunal artery may also be found. The right cranial pancreatic artery and the right gastroepiploic artery give branches to the pancreatic angle. The arteries to the right pancreatic lobe arise from the cranial and from the caudal pancreaticoduodenal arteries. The interlobular arteries give origin to the intralobular arteries. The penetration and the distribution of the latter vessels differ in lobules of different shape. The intralobular course may be straight or curved. Branches arise generally at acute angles, forming Y or fork-like patterns, ending into bundles of arterioles.     

Celiacomesenteric trunk: a short report

The authors describe the case of a 44-year-old male with chronic liver disease in whom celiacomesenteric trunk (CMT) was incidentally detected on routine multidetector row computed tomography of abdomen. The CMT (measuring approximately in diameter 12.3 mm) divided into celiac trunk and superior mesenteric artery (SMA) (measuring approximately 7.5 and 7.2 mm, respectively). The celiac trunk further divided into common hepatic, left gastric, and right inferior phrenic and splenic arteries. The common hepatic artery gave off gastroduodenal arteries before continuing as hepatic artery proper. The SMA was seen running down, deep to the neck of the pancreas to supply the midgut. The incidence and clinical implications of this vascular variation are discussed with a review of the relevant literature.     

腹腔镜下腹腔神经节阻滞术的临床解剖

目的:为腹腔镜引导下腹腔神经节阻滞术提供解剖学基础。方法:解剖人体标本腹腔神经节,观测腹腔神经节的形态、各径及其周围的标志性结构以及神经节与周围毗邻结构的位置关系;探究左、右侧腹腔神经节在以腹腔干中心点建立的三维直角坐标系中的位置(X,Y,Z)。结果:左侧腹腔神经节上下径1.73 cm、左右径1.75 cm、前后径0.38 cm;至贲门右缘4.04 cm、幽门上缘5.79 cm、角切迹上缘3.85 cm、胰上缘1.67 cm、脾静脉上缘1.64 cm;三维直角坐标系坐标为(1.35,-0.03,1.19)cm,易在脾动脉后方附近找到。右侧腹腔神经节上下径1.30 cm、左右径1.52 cm、前后径0.27 cm;至贲门右缘5.48 cm、幽门上缘5.68 cm、角切迹上缘4.90 cm、胰上缘3.04 cm、脾静脉上缘2.41 cm、距肝门静脉内侧缘1.81 cm、距下腔静脉内侧缘1.00 cm;三维直角坐标系坐标为(1.38,0.10,0.99)cm,易在肝总动脉后方附近找到。结论:腹腔镜直视下阻滞左、右侧腹腔神经节,应分别以腹腔干两侧脾动脉和肝总动脉后方为标志寻找。手术时注意保护神经节周围毗邻脏器,防止损伤重要血管和神经。     

胎儿脾动脉（脾外部分）的解剖学观察

本文用30例胎尸,经灌注后进行解剖剥离.在手术放大镜下进行观察,并对脾动脉的分支及侧支循环进行了观察,其结果如下.(1)脾动脉均起于腹腔干并沿胰腺上缘走行,脾动脉发出胰腺支,胃短动脉,胃网膜左动脉,胃后壁动脉,脾叶动脉和脾极动脉.(2)脾动脉的侧支循环十分丰富,脾动脉与胃左动脉,左膈下动脉,胃网膜右动脉,肠系膜上动脉,胰动脉等均有侧支吻合,并且胃网膜左动脉与胃网膜右动脉吻合形成网膜弓.