对75例高血压病患者左室肥厚和颈动脉粥样硬化斑块的观察

目的 :观察高血压患者左室肥厚和颈动脉粥样硬化斑块的形成。方法 :本研究根据北京部分高血压患者靶器官损害的情况 ,按照 1 993年世界卫生组织和国际高血压同盟 (ＷＨＯ/ＩＳＨ)标准进行临床调研。结果 :75例高血压病患者中发生左室肥厚 1 5例 ( 2 0 0 0 % )比发生颈动脉粥样硬化斑块 37例 ( 4 9 33% )的发生率为高。原发性高血压病患者中 ,单侧发生颈动脉粥样硬化斑块中 ,右侧颈动脉斑块发生率明显高于左侧颈动脉斑块发生率 ;发生颈动脉粥样硬化斑块的位置 ,以颈动脉分叉处发生率最高 ,颈总动脉处和颈内动脉起始部的发生率次之 ;后壁斑块…     

颈动脉硬化的彩超表现与中风

目的：探讨颈动脉粥样硬化的好发部位、狭窄程度及与脑梗塞的关系。方法：对150例脑梗塞患者进行颈动脉超声检查，了解有无斑块形成及颈动脉狭窄程度。结果：150例中发现存在不同程度的颈动脉粥样斑块108例，斑块好部位依次为颈动脉分叉部(47．71％)、颈总动脉(39．45％)和颈内动脉(12．84％)。结论：颈动脉超声检查可早期发现颈动脉粥样硬化；颈动脉粥样斑块与脑梗塞有密切的相关性.     

对高血压病同步观察左室肥厚和颈动脉粥样硬化斑块的研究

目的 :心脏左室肥厚和颈动脉粥样硬化斑块形成是有关高血压病临床治疗的转归和患者生存质量的重要问题。方法 :本研究按照 1 993年世界卫生组织和国际高血压同盟 (ＷＨＯ/ＩＳＨ)标准对 75例高血压病患者同步观察左室肥厚和颈动脉粥样硬化斑块 ,并进行二者的对比研究。结果 :75例高血压病患者中发生左室肥厚 1 5例 ( 2 0 0 0 % )比发生颈动脉粥样硬化斑块 37例 ( 4 9 33% )的发生率低。原发性高血压病患者中 ,单侧发生颈动脉粥样硬化斑块中 ,右侧颈动脉斑块发生率明显高于左侧颈动脉斑块发生率 ;发生颈动脉粥样硬化斑块的位置 ,以颈动脉分…     

北京中老年人颈动脉超声的解剖学

目的:研究北京市中老年人颈总动脉、颈内动脉和椎动脉的超声结果,为预防动脉硬化提供临床依据。方法:对2 083例中老年人进行颈动脉和椎动脉超声检查,检查动脉中膜增厚、斑块和狭窄并进行统计学分析。结果:男性在年龄、性别、血压、腰围、抽烟和饮酒习惯上与女性有显著差异;男性颈动脉内膜增厚、斑块形成和狭窄的发生率分别是49.10%、48.55%和20.69%,女性为28.57%、29.01%和13.55%,两组各项相比差异均有统计学意义;双侧颈动脉增厚情况男性均高于女性,两组人群左侧颈动脉增厚较右侧明显;颈动脉单发、多发、规则、不规则、均质和不均质斑块情况,男性均高于女性;男性右侧椎动脉狭窄高于女性,其他各组动脉差异对比无统计学意义;颈动脉轻度狭窄方面,两组对比无差异,中、重度狭窄中,左右椎动脉和右侧颈内动脉在男性高于女性;将两组分成5个年龄段,两组人群颈动脉硬化呈增龄性变化,各年龄段发病率差异比较有统计学意义。结论:北京中老年人颈动脉硬化发生率较高,男性明显高于女性,和年龄、血压、腰围、抽烟和饮酒习惯有关。     

健康成人颈动脉和椎动脉颅外段的超声特征解剖学分析

目的:探讨成人颈总动脉、颈内动脉、椎动脉彩色多普勒超声检查的内部结构特征,分析其与年龄、性别、身高、体质量的关系.方法:对144例20～39岁健康成人采用彩色多普勒超声检查,检测血管内径、颈总动脉中膜厚度,并进行统计分析.结果:经相关分析,年龄与颈总动脉中膜厚度的相关系数左侧为0.345,右侧0.270;身高与颈总动脉内径的相关系数左侧为0.345,右侧0.346;体质量与颈总动脉内径的相关系数左侧为0.358,右侧0.337;身高与颈内动脉内径的相关系数左侧为0.341,右侧0.264;体质量与颈内动脉内径的相关系数左侧为0.345,右侧0.309;以上侧间差异均有统计学意义.性别对颈内动脉内径的影响更大一些,并且通过影响身高、体质量而间接影响颈总动脉内径.两侧颈总动脉、两侧椎动脉内径常有不同,左侧椎动脉的狭窄比例为6.25％,右侧为24.31％.结论:对颈总动脉中膜厚度影响的主要因素是年龄和体质量;对颈总动脉内径影响的主要因素是身高和体质量,同时,颈总动脉内径大小两侧经常不同;对颈内动脉内径影响的主要因素是性别、身高和体质量;而对椎动脉内径影响的因素较复杂,两侧椎动脉内径不同.     

右颈总动脉异常分支伴甲状腺峡部缺如

我们在解剖标本中,发现一男尸,约50岁,身高165cm,颈部皮肤未见切口及手术疤痕,见其右侧颈总动脉发出甲状腺上动脉直至甲状腺侧叶上端并伴有甲状腺峡部缺如,现报道如下:该尸体右侧颈总动脉在舌骨体平面才分为颈内动脉和颈外动脉,比左侧颈总动脉分支高2.49cm。而甲状腺上动脉却在甲状软骨右板右上方,距下颌下腺下缘0.67cm处直接由颈总动脉发出,其起始部外径为0.26cm。起始后在胸锁乳突肌深面直接跨过甲状软骨右板沿胸骨甲状肌、肩胛舌骨肌、胸骨舌骨肌深面斜行向下至甲状腺侧叶尖端处分为3条终支,供应甲状腺。而左侧颈总动脉分支及甲状腺上动…     

大脑动脉环后交通动脉的形态观察

目的　观察大脑动脉环后交通动脉的形态变异。　方法　取 5 0例经福尔马林处理的台湾地区成年男性大脑 ,用光学摄像系统摄取后交通动脉影像 ,冲映成照片后 ,再经扫描仪存入计算机并放大至 2 0倍 ,用打印机映出影像后测量并统计外径值。　结果　左侧后交通动脉近颈内动脉端外径为 1 72± 0 77(0 7～ 4 3)mm ,右侧则为 1 6 9± 0 78(0 8～ 3 3)mm。左侧后交通动脉近大脑后动脉端外径为 1 5 9± 0 5 8(0 8～ 3 0 )mm ,右侧则为 1 5 9±0 6 8(0 5～ 3 2 )mm。　结论　台湾地区测量值与大陆地区测量值有差异 ,是由于两地采用的测量方法不同造成的     

喉、甲状腺手术的应用解剖

目的:为颈前部手术提供相关血管、神经的形态学依据.方法:在16具32侧成人头颈部标本上解剖观测喉和甲状腺的血管和神经的走行及分布.结果:甲状腺左、右叶平均长度分别为(49.5±8.2)、 (50.1±7.8) mm,有锥形叶者7例,占43.7%;16例中有1例甲状腺最下动脉(出现率为6.3%);甲状腺上动脉与喉上神经伴行,甲状腺下动脉与喉返神经相交叉.喉上动脉入喉处在甲状软骨上角的前下方左侧为(13.91±2.83) mm,右侧为(14.96±2.56) mm,两侧差异有统计学意义;喉上神经喉内支入喉处在甲状软骨上角前下方左侧为(11.80±3.42) mm,右侧为(12.24±2.68) mm;喉下神经在甲状软骨下角后下方入喉,距离甲状软骨下角左侧(5.38±1.56) mm,右侧(5.69±1.77) mm,两侧差异有统计学意义.结论:熟悉喉、甲状腺血管、神经的应用解剖学是有效预防甲状腺手术并发症的基础     

后交通动脉的显微外科解剖及其临床意义

目的 探讨后交通动脉及其分支血管的显微解剖结构特点及其临床意义。方法取15例(30侧) 10%甲醛固定的成人尸头标本,男9例(18侧),女6例(12侧)。开颅后自桥脑水平离断脑干取出大脑,保留Willis环的完整性;显微镜下观察后交通动脉的起始部位、分支血管数量,测量后交通动脉的长度、起始部外径,并根据其管径进行分型;观测后交通动脉最粗大分支乳头体前动脉的起始部位及起始部外径,并根据其形态特点进行分型。结果 30侧后交通动脉均发自颈内动脉外侧壁。左侧长度(13.63±0.42)mm,直径(1.72±0.56)mm,发出分支血管(6.92±0.55)支;右侧长度(14.42±0.46)mm,直径(1.81±0.60)mm,发出分支血管(6.22±0.48)支。后交通动脉为胚胎型4侧,过渡型2例,发育不全型7侧,成人型17侧。15例30侧标本中,乳头体前动脉缺如1侧,其余29侧后交通动脉均发出乳头体前动脉,其中单干型24侧、双干型3侧、多干型2侧。29侧乳头体前动脉中,起自后交通动脉的前1/3者7侧,中1/3者15侧,后1/3者6侧,后交通动脉与大脑后动脉汇合处者1侧。结论 后交通动脉的管径及其分支血管的数量、起始部位、管径等均存在一定的变异;处理鞍区病变,特别是显微夹闭后交通动脉瘤时,应详细了解后交通动脉的解剖结构特点,并注重分支血管的保护,对患者的预后具有重要的临床意义。     

缺血性脑血管病患者颈动脉粥样硬化的研究

目的:探讨颈动脉粥样硬化与缺血性脑血管病的关系。方法:将缺血性脑血管病患者99例分成TIA组,脑梗塞组,均接受颈部动脉多普勒超声检查,观察指标为动脉粥样硬化斑块的好发部位,超声分型及颈内动脉(ICA)颅外段狭窄度。结果:颈部动脉多普勒超声检查显示TIA组和脑梗塞组异常率均明显高于健康人,差异有显著性(P<0.01),TIA组与脑梗塞组异常率相比也有显著性差异(P<0.05)。病变血管分布与症状间有相关关系P<0.01)。从动脉粥样硬化斑块好发部位及超声分型来看,动脉粥样硬化斑最多见于颈总动脉分叉处(BIF).其次是颈总动脉(CCA),再其次是ICA起始部,TIA组与脑梗塞组均以扁平斑多见,其次是软斑和硬斑,溃疡斑少见。另外ICA颅外段狭窄度与症状间呈显著相关(P<0.01)。结论:颈动脉粥样硬化班块,是缺血性脑血骨病发生的重要危险因素之一。颈动脉粥样硬化程度越重.发生严重缺血性卒中的危险性越高。     

颈动脉分叉部的三维CT血管成像解剖测量

背景：解剖测量是临床医学的基础,可为临床影像学诊断与外科手术提供依据与参考。利用三维CT血管成像技术进行相关解剖测量具有明显的技术优势与很好的应用前景。 目的：应用64排螺旋CT血管成像对颈动脉分叉部的形态结构进行测量,为相关研究提供解剖基础。 方法：查阅2008年6月至2010年6月于厦门大学附属中山医院影像科行头颈部64排螺旋CT血管成像受检者的扫描图像,随机选取颈动脉分叉部无明显病变者92例。其中男45例,女47例;≤40岁者40例,> 40岁者52例。利用其断面图像进行三维成像处理,获得满意的三维图像后,对颈动脉分叉部相关结构进行解剖学测量。 结果与结论：三维图像可清晰显示颈动脉分叉部结构,实现其结构的单独和多结构、多方向观察及测量。测量结果显示受试者颈动脉分叉角为(43.5±12.3)°,颈总动脉远端内径(6.83±0.65) mm,颈内动脉膨大区近端内径(7.25±1.04) mm,颈内动脉膨大区最大内径(8.15±1.35) mm,颈内动脉膨大区远端内径(5.03± 0.55) mm,颈外动脉内径(4.22±0.60) mm。与≤40岁组比较,>40岁组颈动脉分叉角度、颈内动脉膨大区近端内径、颈内动脉膨大区最大内径、颈内动脉膨大区远端内径均明显粗大,颈外动脉内径明显细小(P < 0.05),而颈总动脉内径差异无显著性意义(P > 0.05)。与男性组比较,女性组颈动脉分叉部各测量指标均显著细小(P < 0.05)。左、右侧组测量值比较,除颈动脉分叉角左侧明显大于右侧外,其他测量指标差异均无显著性意义(P > 0.05)。三维CT可客观、准确测量颈动脉分叉部相关解剖值,具有个体化特征,可为相关应用解剖、疾病诊断及介入或手术治疗提供客观依据。     

超声观察单侧颈总动脉结扎前后心血管指标变化的实验研究

目的应用超声检查了解单侧颈总动脉结扎后不同时间对侧颈总动脉形态、血流参数及左心室形态、功能的变化。方法选择12只健康新西兰大白兔,体质量2.0~2.5 kg。结扎兔的右侧颈总动脉,在结扎前、结扎后第3天和结扎后第6周末,分别应用超声检测兔左心室及左侧颈总动脉结构和功能的各项参数。结果对比结扎前与结扎后3 d各项指标,其中左侧颈总动脉最大内径[(1.67±0.26)mm vs(2.18±0.24)mm;P<0.05]、左侧颈总动脉最大血流速度差异具有统计学意义[(54.12±9.71)cm/s vs(68.44±7.04)cm/s;P<0.05],其余指标差异无统计学意义。对比结扎前与结扎后6周末各项指标差异均无统计学意义。结论单侧颈总动脉结扎后短期内,对侧颈总动脉最大血流速度及最大管径有所增加。经过较长时间后,对侧颈总动脉最大血流速度及最大管径不再出现明显地增加,同时左心室形态及收缩功能在结扎前后始终没有明显的变化。     

Topography of carotid bifurcation: considerations for neck examination

Clinical examination and surgical procedures require the knowledge of anatomical structures of such a complex area as neck, especially the developmental anomalies in vascular drainage may occur. The aim of this study was to describe the common carotid artery bifurcation to its surrounding structures to locate it properly by using external and internal landmarks. Measurements were performed on 43 Thai cadavers by the direct inspection method. Carotid bifurcation level was compared to the level of cervical vertebra, isthmus of thyroid cartilage, angle of mandible and origins of superior thyroid artery, and lingual artery. Most of carotid bifurcations were found at the level of C3, between C3 and C4, and C4 vertebra, as well as the tendency to lower position in men was noted. Measurements to the angle of mandible on the left sides were significantly different in studied groups (P = 0.02), also with lower position of bifurcation in men. The mean level of carotid bifurcation was approximately 6 mm above ITC, which literally is at the level of the superior border of thyroid cartilage. Moreover, in four cases, common carotid artery did not bifurcate bilaterally, and in four cases, no bifurcations were found at the right side of neck. Further, many superior thyroid arteries originated from common carotid artery. To sum up, during the clinical procedures, the level of thyroid cartilage is mostly advised to follow to locate the carotid sinus. Further, the described variations in topography of carotid bifurcation and arteries origins may have important clinical implications.     

Anomalous artery directly connecting the external and internal carotid arteries

An anomalous artery directly connecting the external with the internal carotid artery was encountered on the right side of a 68-year-old Japanese female cadaver. This anomalous artery (5 mm in diameter, 12 mm in length) branched out from the posterior aspect of the external carotid at the level of the origin of the lingual artery, ran obliquely upward posteriorly along the course of the hypoglossal nerve, and was confluent with the anterior aspect of the internal carotid artery. No other variations were found in the morphological aspects of, or in the anatomical relationships between, the carotid arteries and their surrounding structures on either side. The carotid body-like structure was observed at the carotid bifurcation and was innervated by small branches of the glossopharyngeal, the vagus and the sympathetic trunk. Embryologically, it is conceivable that this anomalous artery may have derived from the right second branchial arch artery, although there is no abnormality in other derivative structures of the second pharyngeal arch. There may have been no effect from this anomaly on the functions of the arterial blood flow and blood supply under normal circumstances in the present case, but this report may be of embryological significance and contribute some insight into the mechanisms of the formation of the carotid circulation systems.     

彩色多普勒超声对颈动脉粥样硬化与脑梗死的相关性分析

目的探讨颈动脉粥样硬化与脑梗死的关系。方法应用彩色多普勒超声检测82例脑梗死患者和46例非脑梗死患者颈动脉内-中膜厚度（intima-media thickness,IMT）、斑块检出率、管腔狭窄率,并观察斑块性质。结果脑梗死组斑块检出率及颈动脉内膜厚度较对照组明显增加,两组比较差异有统计学意义（P〈0.01）,脑梗死组斑块检出率（70.7%）明显高于对照组（32.6%）;脑梗死组颈总动脉（CCA）内膜厚度（1.38±0.14）明显高于对照组（0.89±0.16）,脑梗死组颈内动脉（ICA）内膜厚度（1.16±0.27）明显高于对照组（0.78±0.17）。斑块多发生于颈动脉分叉处（44.4%）,以软斑块、溃疡斑块（59.2%）居多。结论颈动脉粥样硬化程度与脑梗死的发病关系密切,彩超评估颈动脉粥样硬化程度,对脑梗死的早期预防和治疗具有重要的临床价值。     

垂体腺瘤对颈内动脉影响的MRI观测

目的：旨在探索颈内动脉与垂体腺瘤的关系。方法：通过对３０例垂体腺瘤患者ＭＲＩ的观测,测量颈内动脉在海绵窦段的间距。结果：间距２０．１ｍｍ,而且随垂体腺瘤左右径的增大,颈内动脉间距随之增大,肿瘤对颈内动脉向外侧推移、包裹、粘连可能性亦增加。结论：结果表明临床经鼻—蝶窦垂体腺瘤手术时,向两侧海绵窦方向探查和刮除腺瘤距中线平均不应超过１ｃｍ。     

Internal carotid artery agenesis with stenosed intercavernous anastomosis:a case report

We report a rare case of internal carotid artery agenesis with stenosed intercavernous anastomosis.A 59-yearold male patient presented with a new infarction in the left basal ganglia.Magnetic resonance angiography and cerebral angiography showed that the right internal carotid artery disappeared from the origin to the foramen lacerum segment,and there was an anastomotic artery with severe stenosis passed through the floor of the sella and in front of the cavernous sinus.The right A1 segment of the anterior cerebral artery was absent and A2 segment was supplied by the normal contralateral internal carotid artery via the anterior communicating artery.     

The diameters of common carotid artery and its branches in newborns

The common carotid artery (CCA) bifurcation is of clinical importance due to its vascular access site for intravascular intervention. Additionally, it is also one of the most common sites of atherosclerotic plaque formation. There are numerous studies on the diameters of CCA, internal carotid artery (ICA), and external carotid artery (ECA) in adults, but few studies on newborns. Cadaver and angiographic studies have shown dimensional variations in the carotid arteries within/between individuals and also between different sexes. It is well known that the initial lesions of atherosclerosis begin very early in fetal life. Therefore, it is important to know the anatomical details of the CCA and its branches. In the present study, the neck regions of 20 (11 males and 9 females) fixed newborn cadavers were dissected. The CCAs were cut below the bulb of the carotid bifurcation further; ICA and ECA were cut above the bulb of the carotid bifurcation. The internal diameters of the CCA, ICA, and ECA were measured using a light microscopy. ECA/CCA, ICA/CCA, ICA/ECA ratios, and outflow to inflow area ratio were calculated. The mean outflow to inflow area ratio was 1.14±0.28. Our results highly correlated with the defined optimal ratio (1.15). The ECA/CCA, ICA/CCA, and ICA/ECA ratios were 0.78±0.12, 0.71±0.13, and 0.93±0.16, respectively. There were no statistically significant differences between male and female and also between right and left sides. These findings are of importance in understanding the anatomy of carotid artery during newborn period.     

Anatomic evaluation of the carotid artery bifurcation in cadavers: implications for open and endovascular therapy

Knowledge of carotid bifurcation (CB), common carotid artery (CCA) and its branches and their recognition during diagnostic imaging are also important for vascular surgical procedures in the region, such as carotid endarterectomy or radical neck dissection, catheterization and aneurysms. The surgical anatomy of the carotid arteries was studied in 20 cadavers. Micrometric values of the CB and its relation with surrounding structures, measurements belonging to the external carotid artery (ECA) and internal carotid artery (ICA), and metric data, such as lower face including the greater horn, laryngeal prominence have been evaluated by making linear measures. The diameter of the CCA at the CB under 2 cm and CB diameter was measured as 8.1 +/- 2.24 mm and 12.79 +/- 2.87 mm, respectively. Evaluating data related to the ICA and the ECA in samples, the aspect was measured the ICA and the ECA in the CB discrimination point as 21.52 +/- 20.53 degrees . In the most location of the ECA origin according to the ICA has been determined as medial position in 35 specimens. The origin of the superior thyroid artery (STA) was found to be at the same level with the CB in 40% and below it in 25% specimens. This study has provided measured objective criteria for the arterial features of the neck region, which are crucial during surgery. The origins of the branches of the CCA act as key landmarks for adequate and appropriate placement of the cross-clamp on the carotid arteries.     

颈内动脉床突段的解剖特点及毗邻关系

目的　观察颈内动脉床突段的解剖特点,探讨该结构的毗邻关系,为临床工作的开展提供依据。 方法　成人尸头标本7例,分别以红色和蓝色硅胶对动脉、静脉进行灌注;应用显微解剖技术,观察并测量颈内动脉的床突段及与眼动脉、远/近侧硬膜环等重要毗邻结构的位置关系。 结果　(1)与颈内动脉床突段相关的参数：床突段的外径为（5.11±0.81）mm,床突段外侧面远、近侧硬膜环中点间距离为（5.46±1.90）mm,远侧硬膜环形成颈内动脉窝的出现率约为78.6%。(2）床突段与眼动脉的关系：①眼动脉起点与远侧硬膜环的位置关系为近侧约7.1%、恰于远环处约14.3%、远侧78.6%;②眼动脉起点与颈内动脉横截面的位置关系为内1/3约78.6%、中1/3约21.4%（未观察到外1/3的情况）。 结论　(1)术前影像学检查十分必要。(2)对侧翼点入路有利于眼动脉起点处病变的暴露。(3)提出两点术中注意事项：①环切远侧硬膜环时,应注意避免伤及眼动脉或其它视神经管内结构;②磨除前床突时注意其内侧的重要血管、神经组织,应以邻近硬膜瓣加以保护。