右肺尖段支气管开口于气管1例

患者女,32岁。因左颈部包块20天来院就诊,怀疑诊断左肺癌。于1991年4月29日行纤维支气管镜检查,镜下见:声门正常,隆突尖锐;在气管的右侧壁、距右主支气管开口上方约5mm 处,可见一肺段支气管开口,其内并可见亚段支气管开口,于右肺上叶内仅见前、后段2个支气管开口;左肺上叶支气管开口粘膜轻度红肿,其余未见异常。纤维支气管镜诊     

右主支气管与右上叶支气管交汇区的MSCT影像学研究

目的　对正常成年人右主支气管与右上叶支气管交汇区的径线进行测量，分析右主支气管、右上叶支气管、中间支气管径线的相关性。 方法　分析300例正常成年男性与300例正常成年女性的胸部MSCT图像，利用多平面重建技术（Multiplanar reconstruction，MPR）测量右主支气管、右上叶支气管、中间支气管的内径、长度、横截面积和夹角，并进行相关性分析。 结果　男性和女性右主支气管长径（Z）与右上叶支气管长径（X）、中间支气管的长径（Y）相关性分别为Z=0.379X+0.955Y-0.691（r=0.763，P<0.05）和Z=0.386X+0.358Y+6.340（r=0.745，P<0.05）。 结论　正常成年人右主支气管内径、右上叶支气管内径、中间支气管内径存在较高的相关性，可以为右主支气管与右上叶支气管交汇区域内径的准确测量和估算提供参考。     

多层螺旋CT三维成像行国人气道径线分析

目的探讨国人气管和主支气管各种解剖径线的长度与角度.方法用多层螺旋CT三维成像法测定300例成年健康体检者锁骨胸骨端水平气管内径、锁骨胸骨端水平到隆突的气管长度,左、右主支气管和右中间支气管内径与长度,以及左、右主支气管长轴与矢状面的夹角.结果男性气管、左、右主支气管、右中间支气管内径与长度,以及右上肺叶支气管开口内径均大于女性,而女性左、右主支气管长轴与矢状面夹角均大于男性(p<0.05或0.01).成年人与老年人上述各解剖径线值差异无显著(p>0.05).左主支气管内径值与右主支气管内径值呈高度相关,且分别与气管内径值和身高呈高度相关(p<0.01).结论通过多层螺旋CT三维成像法测定国人气管、左和右主支气管径线值,获左、右主支气管内径值与患者身高和气管内径测量值的回归方程,可预测其左、右主支气管内径值.     

320排CT容积扫描对支气管动脉的解剖学研究价值

目的:探讨320排CT容积扫描对支气管动脉解剖的研究价值。方法:对144例支气管动脉CTA图像进行最大密度投影、多层面重组及容积再现等三维后处理,观察并记录支气管动脉的分支类型、起源及开口位置等解剖信息,并将支气管动脉与支气管树图像融合,更加直观、立体显示支气管动脉的三维空间结构。结果:144例共显示支气管动脉393支,其中右侧支气管动脉177支,左侧支气管动脉216支,支气管动脉分支类型以R_1L_1型最多,占45.8%;右侧支气管动脉多与肋间动脉共干,占54.2%,左侧支气管动脉多起自胸主动脉和主动脉弓,占87.5%;右侧支气管动脉多开口于胸主动脉右侧壁和前壁,左侧支气管动脉多开口于胸主动脉前壁;气管隆突定位时,左右支气管动脉多开口于气管隆突上2 cm至隆突下1 cm区间内,分别占88.1%和84.7%。结论:320排CT容积扫描可以在满足低剂量的同时,很好地显示支气管动脉的起始、分支数目、开口位置等情况,为经支气管动脉开展的介入治疗提供详尽的三维影像解剖信息,具有很好的解剖学研究价值。     

多层螺旋CT三维成像行国人气道径线分析

目的探讨国人气管和主支气管各种解剖径线的长度与角度.方法用多层螺旋CT三维成像法测定300例成年健康体检者锁骨胸骨端水平气管内径、锁骨胸骨端水平到隆突的气管长度,左、右主支气管和右中间支气管内径与长度,以及左、右主支气管长轴与矢状面的夹角.结果男性气管、左、右主支气管、右中间支气管内径与长度,以及右上肺叶支气管开口内径均大于女性,而女性左、右主支气管长轴与矢状面夹角均大于男性(p<0.05或0.01).成年人与老年人上述各解剖径线值差异无显著(p>0.05).左主支气管内径值与右主支气管内径值呈高度相关,且分别与气管内径值和身高呈高度相关(p<0.01).结论通过多层螺旋CT三维成像法测定国人气管、左和右主支气管径线值,获左、右主支气管内径值与患者身高和气管内径测量值的回归方程,可预测其左、右主支气管内径值.     

纤维支气管镜检对支气管结核的诊断价值(与病理对照)

报道了33例经纤维支气管镜检查并最后诊断为支气管结核病例,其纤维支气管镜下形态表现多样性。以腔内肿物表现,在老年人易误诊为肺癌,经纤维支气管镜粘膜活检病理、刷检PCR检测结核菌,以及纤维支气管镜检查术后查痰菌对提高支气管结核的诊断有价值。     

糖尿病足的防治

目的 探讨纤维支气管镜检查在肺不张的病因诊断中的价值.方法 我院2003年5月～2009年6月收治163例放射影像学诊断为肺不张的患者,行纤维支气管镜检查明确病因.结果 163例肺不张患者中,以右肺中叶发生肺不张的比率最高,发生62例,占38%,右下肺次之,发生43例占26.38%;病因肿瘤97例,占59.95%,为首位;炎症34例,占 20.8%,次之;结核26例占15.9%.支气管肺癌好发的部位在右中叶及右下叶,占33.5%,炎症多发生于右中叶支气管,占所发生炎症的62.5%,结核好发部位在右上叶及右中叶支气管.结论 纤维支气管镜检查对明确诊断肺不张的病因及部位至关重要,同时还能有效治疗某些肺部的炎症性阻塞性疾病及取出气管异物.     

163例肺不张患者纤维支气管镜检查结果分析

目的 探讨纤维支气管镜检查在肺不张的病因诊断中的价值.方法 我院2003年5月～2009年6月收治163例放射影像学诊断为肺不张的患者,行纤维支气管镜检查明确病因.结果 163例肺不张患者中,以右肺中叶发生肺不张的比率最高,发生62例,占38%,右下肺次之,发生43例占26.38%;病因肿瘤97例,占59.95%,为首位;炎症34例,占 20.8%,次之;结核26例占15.9%.支气管肺癌好发的部位在右中叶及右下叶,占33.5%,炎症多发生于右中叶支气管,占所发生炎症的62.5%,结核好发部位在右上叶及右中叶支气管.结论 纤维支气管镜检查对明确诊断肺不张的病因及部位至关重要,同时还能有效治疗某些肺部的炎症性阻塞性疾病及取出气管异物.     

多排螺旋CT重建技术测量贵州成年小型猪支气管

目的 :通过多排螺旋CT(MDCT)及其后处理软件测量贵州成年小型猪支气管各径线值,建立贵州小型猪支气管正常数据,为临床研究提供技术支持。方法 :选取健康成年贵州小型猪,采用MDCT对其进行扫描,并采用后处理软件Singo.via进行多平面重建(MPR)、最小密度投影(MinIP)、容积再现(VR)图像重建,在MPR、MinIP及VR冠状位图像上测量支气管长度、直径、角度,记录数据并对MPR、MinIP及VR 3种重建技术上支气管各径线值进行单因素方差分析。结果 :MPR上隆突上2 cm处主支气管直径(D1)为(17.6±0.62)mm、右肺上叶支气管开口距隆突(L)为(34.67±2.90)mm、隆突水平左主支气管直径(D2)为(10.82±0.61)mm、右主支气管直径(D3)为(12.42±0.96)mm、左右主支气管角度(@)为(45.01±4.73)°;MinIP上D1、L、D2、D3、@分别为(17.63±0.49)mm、(34.54±3.16)mm、(10.75±0.59)mm、(12.77±0.91)mm、(44.46±3.70)°;VR上D1、L、D2、D3、@分别为(17.93±0.57)mm、(35.27±2.93)mm、(11.02±0.68)mm、(12.95±0.83)mm、(45.55±3.95)°;比较MPR、MinIP及VR3种重建技术测量支气管各径线值,差异均无统计学意义。结论 :MDCT及其后处理技术可清晰显示支气管及其周围组织结构关系,并准确测量支气管径线值,为建立小型猪支气管正常解剖模型提供基础数据。     

金属网状支架治疗支气管结核1例并文献复习

目的：探讨支气管内膜结核的临床表现,纤维支气管镜检查及治疗的意义,提高对本病的诊治率及治疗方案的总结。方法通过1例支气管内膜结核导致呼吸困难的病人给予暂时性金属网状支架治疗的诊治体会,结合国内文献复习,提出支气管镜对支气管内膜结核的治疗意义。结果纤维支气管镜对支气管内膜结核诊断和局部治疗有非常重要的作用。结论对于主支气管结核瘢痕狭窄,给予暂时性金属网状支架置入联合多次球囊扩张和气管内注药,操作简单安全,疗效可靠,无明显并发症,花费低,改善呼吸功能立竿见影,取得满意疗效,是一种值得推广的好方法。     

A rare complication of tracheal intubation

Accidental endobronchial intubation is a frequent complication in critically ill patients requiring tracheal intubation (TI). If such complication occurs, it is more often the right main bronchus that is intubated due to anatomical reasons. Left main bronchus (LMB) intubation is rare. Here, we report a case with auscultatory, bronchoscopic, and radiographic evidence of accidental LMB intubation in a pregnant woman with dengue shock syndrome. We highlight this case to increase awareness about this possible-but-rare complication of TI.     

右肺肺段和亚肺段支气管和血管的矢状断层解剖学研究

目的：研究右肺肺段和亚肺段支气管和血管在矢状断面上的配布规律.方法：利用15例胸部连续矢状断层标本和2例多层螺旋CT图像,追踪观察了右肺肺段和亚肺段支气管和血管,并据此寻找在矢状断面上划分右肺肺段的方法.结果：在右主支气管杈层面上,右肺上叶动脉发出尖段动脉和前段动脉,右肺下叶支气管向后发出上段支气管、向下发出内侧底段支气管.在叶间动脉层面上,右肺上叶支气管发出尖、后、前段支气管,基底干支气管发出前、外侧和后底段支气管.在叶间动脉分叉层面上,后段静脉居前、后段支气管之间,尖段静脉与前段静脉合成尖前静脉,中叶支气管分为外、内侧段支气管,下叶动脉发出的段级动脉居相应支气管的上方.在右心房右侧第二层面上,右肺上、中叶的支气管和血管已为亚段级,在右肺下叶内,肺段支气管居中,其上、下方分别为相应的肺动脉和肺静脉.结论：在矢状断面上,右侧肺段内支气管和血管相对集中,且容易显示其发出处和长轴,故矢状断面是显示右肺肺段和亚肺段支气管和血管的优势断面.     

经鼻内镜下视神经管减压术的应用解剖

目的 通过对视神经管及其毗邻结构的研究,为临床视神经管减压术提供解剖学依据.方法 结构完整的成人头颈部标本12例,经红色乳胶灌注、10％的福尔马林固定,观察和测量如下指标:①观察视神经管的形态;②视神经管隆突的类型;③视神经管颅口、眶口及管中部的横径、纵径及横截面;④测量视神经管上、下、内、外侧壁的厚度;⑤视神经管内侧壁毗邻关系;⑥视神经管内眼动脉与视神经的位置关系.结果 视神经管由两口(颅口、眶口)和四壁(上壁、下壁、内侧壁、外侧壁)组成,其横截面积在眶口最大,管中部最窄;视神经管的内侧壁最薄,内侧壁的毗邻结构主要有3种类型:①前为同侧后筛窦、后为同侧蝶窦;②全为同侧蝶窦;③全为同侧后筛窦,眼动脉在视神经管的颅口、眶口分别以视神经的内下方和外上方多见.结论 本研究结果为经鼻内镜视神经管减压术提供了解剖学参数;当打开视神经管骨壁,鞘膜的切开选择内侧壁稍上方.     

Variations of the tracheobronchial tree: Anatomical and clinical significance

Tracheobronchial variations can be found during routine bronchoscopy or computed tomography. Previous sources estimate an incidence of 1–12%; however, these variations are often asymptomatic. Symptomatic patients present typically with cough and lower respiratory tract infection. Knowledge and understanding of tracheobronchial variations have important implications for diagnosis of symptomatic patients and performing certain procedures, including bronchoscopy and endotracheal intubation. In this review, we describe the most commonly encountered variations, tracheal bronchus and accessory cardiac bronchus, along with three minor abnormalities of this region. We also review the various imaging modalities in the diagnosis and treatment of these conditions. Clin. Anat. 27:1223–1233, 2014. © 2014 Wiley Periodicals, Inc.     

Sialadenoma papilliferum of the bronchus: Rare tracheobronchial tumor of salivary gland type

Presented herein is the second case of sialadenoma papilliferum of the bronchus in a 75-year-old man. The bronchial tumor had an exophytic papillary lesion protruding into the lumen of the ostial region of the right superior lobe bronchus on chest CT and bronchoscopy. Grossly, the resected tumor was pedunculated, 5 × 3 × 3 mm in size and consisted of both an exophytic papillary lesion protruding into the bronchial lumen and a glandular component in the bronchial submucosa. Histologically, the papillary structures were lined by ciliated or non-ciliated columnar epithelium and metaplastic non-keratinizing stratified squamous epithelium. The submucosal glandular components were well circumscribed beneath and in continuity with the papillary lesion. The glandular components of cysts and duct-like structures were lined by a double-layer epithelium composed of luminal cells and basal cells. Sialadenoma papilliferum is a rarely recognized salivary gland tumor, mostly occurring at intraoral mucosal sites including the hard and soft palate and buccal mucosa. There have been sporadic cases of sialadenoma papilliferum of the esophagus, nasopharynx and nasal cavity. To the authors' knowledge only one case of sialadenoma papilliferum of the bronchus has been reported previously.     

Anatomical basis for clamping of the right hepatic vein outside the liver during right hepatectomy

The possibility and value of clamping the right hepatic vein (HV) outside the liver during right hepatectomy remain a matter of debate. We carried out an anatomical study on ten fresh cadaveric subjects with no abdominal scarring or hepatic lesions, to determine the biometry of the extraparenchymatous segment of the right HV. One or several accessory right HVs were found in 90% of cases on release of the right edge of the inferior vena cava (IVC). These accessory right HVs had a diameter greater than that of the superior right HV in 10% of cases. In 70% of cases, the extraparenchymatous segment of the vein was free of collateral branches, and in 30% of cases, it was joined by a branch close to its point of exit from the hepatic parenchyma. The length of the vein that can be clamped (length between the point of exit from the hepatic parenchyma and the point of entry of the right HV into the IVC) was 8.6 ± 1.8 mm (6–12). The right HV entered the vena cava, at an acute angle, in 100% of cases. Clamping of the right HV was possible in all cases. Knowledge of these anatomical points makes it possible to isolate an extraparenchymatous segment of the right HV more safely. The right HV can be isolated and clamped outside the liver in more than 80% of cases, making it possible to carry out right hepatectomy on an exsanguinous liver.     

Location of the coronary arterial orifices in the normal heart

We examined the coronary arterial orifices in relation to the aortic valve to determine the range of normality in 23 normal hearts from autopsied adults. We determined the position of the zones of apposition between leaflets, the size of the leaflets, the number, position, and shape of the coronary arterial orifices, and their relation to the sinutubular junction. The aortic valve had three leaflets in all specimens, nearly equally spaced around the aorta. The left coronary artery arose within the left posterior aortic sinus (of Valsalva) in 16 (69%) specimens, above the sinutubular junction in five (22%), and at the level of the junction in two (9%). The distance of the left orifice from the zone of apposition between the left posterior and anterior aortic leaflets was between 13% and 61% of the width of the aortic sinus at the sinutubular junction. The right coronary artery arose within the anterior aortic sinus in 18 (78%) specimens, above the junction in three (13%), and at the level of the junction in two (9%). The distance of the orifice from the zone of apposition between the leaflets hinged from the anterior and right posterior aortic sinuses was between 5% and 62% of the width of the aortic sinus at the sinutubular junction. An accessory coronary orifice was found in the anterior aortic sinus in 17 (74%) specimens, whereas a third orifice in this sinus was found in five hearts. The coronary arterial orifices are usually located within the aortic sinuses below the sinutubular junction, but are rarely centrally located. Accessory coronary arterial orifices are found in the majority of the anterior aortic sinuses. Clin. Anat. 10:297–302, 1997. © 1997 Wiley-Liss, Inc.     

Ectopic bronchus: An insufficiently recognized malformation causing respiratory morbidity in VATER association

An 11-month-old boy presented with recurrent wheezing and atelectasis in the right upper lobe of the lung. Bronchoscopy and bronchography confirmed an ectopic bronchus arising from the right main bronchus. The diagnosis of VATER association was made on the basis of multiple vertebral and rib anomalies, imperforate anus with a perineal fistula, unilateral hydronephrosis, atrial septal defect, and a preauricular tag, he did not have tracheo-esophageal fistula. We emphasize the importance of recognizing tracheobronchial anomalies in VATER association. Am. J. Med. Genet. 82:140–142, 1999. © 1999 Wiley-Liss, Inc.     

Recovery of periodontopathogenic bacteria from embalmed human cadavers

There is recent interest in recovery of periodontopathogenic bacteria from arterial and bronchial tissues to identify a link between periodontal and cardiovascular or pulmonary diseases. This interest could provide a useful clinical correlation exercise for gross anatomy. Our objective was to perform a feasibility study to determine whether these bacteria could be recovered from two sites within eight (4 dentate, 4 edentulous) human embalmed cadavers from an anatomical dissection laboratory. Bacterial samples were collected from the right coronary artery and the right superior secondary bronchus and assayed for the presence and concentrations of the DNA of A. actinomycetemcomitans, E. corrodens, C. rectus, P. intermedia, P. gingivalis, B. forsythus, T. denticola, and F. nucleatum. Frequencies were compared using a Kruskal-Wallis H-test. Correlations between the presence of teeth, bacterial species, and site were determined by a Spearman's rho correlation test. A. actinomycetemcomitans and B. forsythus frequencies were different between the sites in edentulous subjects (P <0.05); the frequency of B. forsythus was different in dentate and edentulous subjects at the bronchus site (P <0.05). Numerous significant correlations were identified between strains of bacteria, site, and presence of teeth. Thus, it is possible for the DNA of periodontopathogenic bacteria to be recovered from human embalmed cadavers. Collection and identification of these bacteria from these cadavers could be a useful clinical correlation exercise for dental students in a gross anatomy class.