人心室间隔的动脉及其吻合

本文采用冠状动脉X线造影法、解剖法和腐蚀法研究了14例成人心脏室间隔的动脉及其吻合。供应室间隔的动脉有前中隔动脉,后中隔动脉,房室结动脉,后上中隔动脉和降隔动脉。左、右冠状动脉在室间隔的供应范围分别占40～98％和2～40％。室间隔动脉不仅在室间隔形成丰富的冠状动脉内吻合和冠状动脉间吻合,它们还可与其它动脉吻合于房间隔,心房后壁,动脉圆锥部,心尖部和后室间沟。本文还观察了正常人和心脏病患者室间隔动脉吻合支的形态特点和直径。     

肺内支气管动脉及其与肺血管的吻合

在解剖显微镜下放大3～40倍,观察了30例(成人与儿童)正常和病变肺的肺内支气管动脉及其与肺血管的吻合。支气管动脉伴随支气管呈弯曲、蛇行经过,于支气管分叉的前方或后方分支,常以2支沿支气管支分布,呈对向排列,在支气管外膜中形成动脉网。小支穿支气管壁,在粘膜下层亦形成动脉网。支气管动脉的纵隔面胸膜支与叶间胸膜支位于肺胸膜下,与支气管树分离,在肺外周部管径较粗。在支气管壁与肺胸膜中,支气管动脉与肺动、静脉间存在毛细管前的端一端吻合或端一侧吻合。9例胸膜粘连处的新生胸膜支(发自肋间动脉、最上肋间动脉、心包膈动脉或胸廓内动脉)通过肺胸膜动脉网与支气管动脉吻合,以加强肺病变区的血液供应。此外,对支气管动脉在肺内的经过、分布及其与肺血管吻合的生理功能进行了讨论。     

人心脏房室连接区的动脉吻合

本文利用冠状动脉造影法、显微解剖法和腐蚀法研究了14例成年国人心脏房室连接区的动脉吻合。参与该区吻合的动脉有:房室结动脉、Kugel 动脉、冠状窦口支、第一支和第二支前中隔动脉、后上中隔动脉、第一支后中隔动脉及降隔动脉等。这些动脉在房中隔下部和室中隔上部形成丰富的冠状动脉间吻合和冠状动脉内吻合。在冠状动脉软 X 线造影的心脏标本中,每例都见有吻合,最多一例达9处。就正常人心脏而言,连接区动脉吻合支的内径多在101～200μm 之间。在冠心病和心脏肥大的例子中,吻合支有增粗的趋势,最粗一例其内径达320μm。文中对房室结动脉终末分支的特点作了描述。观察到它与其它七支动脉均可形成吻合,连接区可经这些吻合支接受其它动脉的供应。同时房室结动脉又是联系左、右冠状动脉的重要侧支循环途径。鉴于房室连接区动脉吻合的特点,本文认为一旦出现冠状动脉闭塞并波及房室结动脉时,有可能建立有效的侧支循环以代偿连接区的缺血。     

寇状动脉的解剖学观察 三、冠状动脉的心房支

心房动脉有分支供应窦房结和参与供应房室结(房室结动脉即中隔纤维支,本文不把它列入心房支),心房动脉的吻合是冠状动脉侧支循环的重要途径;在选择性冠状动脉造影时可见心房动脉的优势支。故国内、外文献中关于心房动脉的描述均有详细报导。为充实国人解剖资料,本文对儿童心脏100例和成人心脏10例进行了较详细的观察。     

颈椎椎体的动脉供应

用解剖和透明的方法,观察了74例不同年龄新鲜尸体C_3～C_7椎体的动脉供应。 1.颈椎椎体主要接受椎动脉的供应。此外,在C_6和C_7尚接受甲状腺下动脉、颈深动脉、肋颈干、最上肋间动脉和锁骨下动脉发出的分支。这些动脉在椎体的前外侧面,构成梯形吻合;在背侧面,形成长方形或六边形吻合。 2.每个颈椎椎体的营养动脉,从其前外侧面和背侧面进入,可分为中央支和周围支两组:中央支主干直、无分支,仅末梢发出树枝状分支,伸向椎体中央的上、下、左、右各部,供应相当于髓核投影区部位的椎体;周围支短、分支早,位于椎体周围的骨质内,供应相当于纤维环投影区部位的椎体。 3.前外侧营养动脉的中央支为0～3支,周围支为2～13支;背侧营养动脉的中央支为0～2支,周围支为0～6支。在椎体内,这些动脉的分支互相吻合。所谓终动脉只出现于发育期椎体的软骨区。     

眶上动脉蒂反流轴型耳颞皮瓣的应用解剖

目的：明确额部各供血血管系统之间的吻合情况,为临床各型额部皮瓣特别是跨血管系统反流轴型皮瓣的应用提供解剖学基础。方法：成人尸体头面部肉眼解剖,观察眶上动脉、滑车上动脉和颞浅动脉额支的口径、走行和吻合状况等；成人头部标本制作血管铸型。结果：眶上动脉、滑车上动脉和颞浅动脉额支走行基本恒定,且三者存在众多吻合,吻合支集中区域上距眶上缘(4．9±0．4)cm,下为眶上缘水平,内侧距离前正中线1．0～1．4cm,外侧距离前正中线4．5～2．3cm。结论：额部有眶上动脉、滑车上动脉和颞浅动脉额支供血,吻合支丰富且吻合区域较恒定,故可制成多种类型的跨血管的反流式皮瓣。     

带尺侧上副动脉尺神经转位的解剖及临床意义

目的为临床上带血管蒂的尺神经移植在健侧颈7移位治疗臂丛根性撕脱伤中的应用提供解剖学依据。方法取新鲜经动脉灌注红色乳胶的成人上肢标本22侧进行显微解剖,观察尺神经外部营养动脉的来源。另取患骨肿瘤而截肢新鲜成人上肢6侧作仅保留尺侧上副动脉的尺神经游离,采用动脉灌注墨汁和尺神经组织切片的方法,观察尺侧上副动脉对尺神经内部血供营养的范围。结果尺神经在腋部由胸外侧或腋动脉的分支供应,在内侧肌间隔后方由尺侧上副动脉供应,在尺神经沟由尺侧上副动脉与尺侧返动脉后支的吻合支供应,在前臂由尺侧返动脉和尺动脉的分支供应。尺侧上副动脉灌注墨汁后,尺神经腕部、手背支及腋部的神经束内微血管被墨汁充填。结论以尺侧上副动脉的起始处为血管蒂部旋转点,尺神经可提供平均为(46.5±2.6)cm的有血供的移植长度,可经胸前皮下隧道逆向转位与对侧颈7神经根吻合。以尺侧上副动脉为血供的尺神经移植的设计是合理的。     

结肠缘动脉的解剖观察

目的 了解结肠缘动脉的分支及分布。方法 在70例经动脉灌注红色乳胶的成年人尸体上,解剖观察了由肠系膜上、下动脉所形成的缘动脉。结果 缘动脉的形态不完全相同,各动脉分出的升降支或左右支长短不一,吻合位置也不完全相同,吻合处的血管外径也不完全相同。结论 通过对缘动脉的起源与分支情况的观察,使我们了解缘动脉分布到肠壁的情况。为其临床应用提供解剖学基础。     

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.     

人体骶尾骨的动脉供应——骨外部分

本实验用解剖、透明、X线摄片和腐蚀铸型等方法研究了56例不同年龄新鲜尸体的骶尾骨骨外动脉的配布。骶骨的动脉供应主要来自骶外侧动脉、骶中动脉、髂腰动脉和腰最下动脉。骶中动脉、骶外侧动脉及其分支在骶骨腹侧面相互吻合形成骶前格子状动脉吻合网。椎管前支在椎间孔内侧分为升降二支,相邻升降支间在椎体背面相互吻合,两侧升降支间呈横形吻合。在骶椎椎体背侧形成菱形的骶管腹侧动脉网。椎管后支在椎板腹侧面亦分为升降二支,同侧及两侧升降支间在椎板腹侧形成梯状的骶管背侧吻合网。骶外侧动脉的背侧支出骶后孔即分为内侧支、肌支和外侧支。内侧支在骶中嵴两侧分为上下二支,相邻上下支之间形成骶中嵴动脉网。外侧支在骶骨外侧部分为升降二支,亦形成吻合。尾骨腹侧面的动脉来自骶中动脉和骶外侧动脉,背侧面主要由骶外侧动脉的终支供应。尾骨表面的动脉吻合稀少。     

Observation of root variations in human coronary arteries

In dissection courses conducted from 1999 through to 2003, five specimens were found to have coronary arteries with variant roots and branches, as follows: in specimens 1-4, roots of the right coronary artery (RCA) and right conus branch arose independently from the right aortic sinus (RAS); in specimen 5, the RCA and left coronary artery (LCA) originated from the RAS. The LCA pierced the upper part of the muscular interventricular septum and appeared on the surface, then dividing into the anterior interventricular and the circumflex branches. In the present study, we considered that the right conus arteries in specimens 1-4 were the remnant blood capillaries around the aorta towards the RAS in the embryonic stage. In specimen 5, the vessel near the left aortic sinus was poorly developed as a small thin artery. Instead, the LCA was developed from the anterior and posterior interventricular septal branches.     

Anatomy of the coronary arteries in fetal pigs: comparison with human anatomy

In this study, 94 fetal pigs were used to comprehensively investigate the origins, number, location, and distribution of the coronary arteries to enrich knowledge on the coronary circulation in fetal pigs, and allow comparison with adult pigs and humans. In fetal pigs, the posterior interventricular sulcus branch always arose from the right coronary artery and the circumflex artery was rarely extended to the posterior interventricular sulcus, while it is variable in humans. In fetal pigs, there was sometimes anastomosis (8.5%) between the left and right conus branches as nutrient arteries of the pulmonary cone. Other branches were not significantly different between fetal pigs and humans, including the acute marginal branch, obtuse marginal branch, and sinoatrial nodal artery. Coronary dominance was also similar. In conclusion, compared with adult pigs, dissection of the coronary arteries in fetal pigs provided a more faithful overview of the porcine coronary circulation. The coronary arteries in fetal pigs were also more suitable for comparison with humans when pigs are used as experimental animals for studying the coronary vessels, which could be an important reference for investigation of clinical treatment of the coronary arteries. In summary, our data provide reliable information about the distribution and ramifications of the coronary arteries, and could be useful for clinicians and surgeons who wish to comprehensively understand coronary anatomy.     

冠状动脉-肺动脉瘘的CT冠状动脉造影征象分析

目的 探讨冠状动脉-肺动脉瘘(CPF)的CT冠状动脉造影(CTCA)的影像特点。方法 回顾性分析复旦大学附属华东医院2008年1月—2015年9月经CTCA检查确诊的26例CPF患者的临床资料,采用多平面重组、曲面重组及VR技术观察冠状动脉异常分支(瘘血管)的起源、数目,冠状动脉有无斑块及狭窄,瘘口位置、大小以及瘘管形态、大小、继发改变等。选取其中6例行冠状动脉造影(CAG)检查的患者,比较两种检查方法的结果。结果 26例CPF患者共发现瘘血管44支,起源于双侧冠状动脉13例,均由双侧圆锥支发出;起源于左冠状动脉9例,由左侧圆锥支发出7例,左侧钝圆支发出1例,左主干发出1例;起源于右冠状动脉4例,均由右侧圆锥支发出。瘘血管直径4~11 mm,平均7 mm。11例患者见冠状动脉斑块形成,4例狭窄程度大于50%。5例呈正常血管形态,2例呈蔓状血管网形式,19例伴动脉瘤形成;单发动脉瘤3例,多发16例;共45个动脉瘤形成,椭圆形33个、梭型8个、不规则形4个。瘘口全部开口于肺动脉主干左侧壁,瘘口大小1.2~5.0 mm,平均2.7 mm,18例患者肺动脉内可见造影剂“浓染”或“喷射征”。6例患者CAG所显示的瘘血管起源、瘘管形态、瘘口位置与CTCA观察结果一致。结论 对于CPF患者,CTCA具有无创性,可提供3D图像,反应血管变异的空间关系,能够提供更多的影像学信息,可作为首选影像学检测方法。     

Chondrichthyans have a bulbus arteriosus at the arterial pole of the heart: morphological and evolutionary implications

It has been generally assumed that the outflow tract of the chondrichthyan heart consists of the conus arteriosus, characterized by cardiac muscle in its walls. However, classical observations, neglected for many years, indicated that the distal component of the cardiac outflow tract of several elasmobranch species was composed of tissue resembling that of the ventral aorta. The present study was outlined to test the hypothesis that this intrapericardial, non-myocardial component might be homologous to the actinopterygian bulbus arteriosus. The material consisted of Atlantic catshark adults and embryos, which were examined by means of histochemical and immunohistochemical techniques for light and fluorescence microscopy. In this species, the distal component of the outflow tract differs histomorphologically from both the ventral aorta and the conus arteriosus; it is devoid of myocardium, is covered by epicardium and is crossed by the coronary arterial trunks. In the embryonic hearts examined, this distal component showed positive reactivity for 4,5-diaminofluorescein 2-diacetate (DAF-2DA), a fluorescent nitric oxide indicator. These findings, together with other observations in holocephals and several elasmobranch species, confirm that chondrichthyans possess a bulbus arteriosus interposed between the conus arteriosus and the ventral aorta. Therefore, the primitive heart of gnathostomates consists of five intrapericardial components, sinus venosus, atrium, ventricle, conus arteriosus and bulbus arteriosus, indicating that the bulbus arteriosus can no longer be regarded as an actinopterygian apomorphy. The DAF-2DA-positive reactivity of the chondrichthyan embryonic bulbus suggests that this structure is homologous to the base of the great arterial trunks of birds and mammals, which derives from the embryonic secondary heart field.     

Coronary artery lesions in Atlantic salmon (Salmo salar)

One hundred and fifteen hearts and dorsal aortas were studied in anesthetized or moribund salmon for presence of histological alterations associated with spawning and changing environmental conditions. The control group consisted of 26 fish hatched and raised under experimental and controlled conditions. The study group included 61 prespawners and 23 postspawners. The lesions observed were divided into three grades in increasing order of severity. They consisted of focal or diffuse intimal proliferation of cells resembling smooth muscle cells and frequent alteration of the underlying elastica. The changes were more frequently seen in larger branches of coronary arteries, arterial conus, and atrioventricular sulcus regions. Both the relative incidence and severity of lesions appeared greater in prespawners as compared to postspawners. This study indicates a high incidence of coronary lesions in spawning Atlantic salmon. In addition, the severity of the lesions appeared reduced in postspawners exposed to prolonged starvation. It is suggested that the Atlantc salmon with its exposure to varying environmental conditions may be a useful model to study the epidemiology of coronary artery disease.     

成人冠状动脉解剖的三维CT研究

目的 用多层螺旋CT(MSCT)扫描三维重建方法探讨成人冠状动脉的形态、结构、变异及其与临床冠心病(CAD)发生的相关性.方法 用Toshiba Aquilion 16层螺旋CT行冠状动脉造影,通过工作站Vitrea 2软件三维重建,观察、测量成人冠状动脉的分支、位置、形态及其变异,并分析其临床意义.结果成功行MSCT冠状动脉造影的患者1057例,其中以右优势型为主,共793例;左优势型126例;其他(包括均衡型和变异)138例.MSCT能够发现冠状动脉起源和走行的多种变异,但对冠状动脉瘘的特征未能准确表现.左优势型的冠心病发病数似相对较少;但左冠状动脉主干发出角度较大,主干较短.冠状动脉开口于冠状动脉窦之外的变异与冠心病发生有正相关性.结论 MSCT能够大体准确地显示冠状动脉三维形态结构,但尚不能完全取代基础解剖学;冠状动脉的某些形态、结构变异可能造成血液动力学改变,促进临床动脉粥样硬化病变发生.     

狗冠状动脉的几何形态学

本文采用8例成年狗心,其中5例制成冠状动脉铸型;3例制备血管墨汁灌注的组织切片,测量左、右冠状动脉的分支共1525个。应用Stfahler体系分级方法。对冠状动脉的分支用计算机进行分级归类、分析处理。求得左、右冠状动脉各级分支的一系列几何形态数据以及相应的直径比、长度比和分支比。冠状动脉的直径、长度及分支数目与分支级数呈指致函数关系,其相关有高度显著性(P<0.005)。从几何形态学的定量角度,探讨了狗左、右冠状动脉的形态特征,认为左冠状动脉是狗心首要的供血动脉。     

The arterial blood supply of the conducting system in normal human hearts

The distributing artery of the conducting system of the heart is occasionally injured in cardiac surgery. The aim of this study was to define the anatomic characteristics of the principal arterial source of the sinu-atrial node and atrioventricular node. Furthermore, the morphology of the tendon of Todaro was clarified. Thirty hearts were studied by gross anatomic methods, and the exact area of the conducting system was supported by histologic observations of four hearts. The sinu-atrial node was supplied by the right coronary artery more frequently (73% of cases) than by the left (3%), and in 23% of cases this node was supplied by both coronary arteries. The atrioventricular node was supplied by the right coronary artery (80% of cases) more than by the left (10%), and in 10% of the cases this node was supplied by both coronary arteries. The atrioventricular bundle branch arose from the right coronary artery in 10% of cases, the left coronary artery in 73%, and both coronary arteries in 17%. Most of the blood to the right bundle (the moderator band) was supplied by the interventricular septal branches of the anterior interventricular branch from the left coronary artery. Finally, all the arteries of the right bundle and left bundle were defined to be derived from left coronary arteries.