舌下络脉诊法的组织学基础

为阐明中医舌下络脉的实质,采用连续组织切片结合局部解剖追踪观察舌腹面粘膜下静脉及肌层血管,并与犬和大鼠相对照。结果:舌下络脉在舌腹面外带为舌神经伴行静脉及其属支;内带为舌下神经伴行静脉及其属支,舌边细络为舌神经伴行静脉与舌根静脉属支。它们均分布在粘膜下层,犬与大鼠有相同分布。舌静脉有丰富的静脉瓣,有的静脉瓣连续出现,其瓣窦扩张,该处静脉管则呈葫芦串状。     

舌脉诊法的血管形态学研究

为整理提高中医的舌脉诊法,对舌的动脉及其分支、静脉及静脉瓣进行了系统研究。结果表明舌脉是舌下神经伴行静脉及舌神经伴行静脉及其属支;囊泡样改变为有静脉瓣部位的静脉壁扩张;舌侧的细络在舌体为舌神经伴行静脉的微小属支,在舌根为舌根静脉微小屑支。舌质红活的根本原因是血供丰富,有50支左右的舌体动脉密布,又有诸多吻合。     

舌静脉瓣的形态学研究

目的;为外科去瓣设计和中医舌诊分析,阐明舌静脉瓣的形态、功能及病理生理中的作用.方法:用32具成人标本进行观测,其中有7例制成舌静脉腐蚀铸型标本.结果:舌静脉内静脉瓣丰富,其瓣窦的外形可分为半球型、全球型和悬球型三类;结构可分为双瓣、单瓣和静脉嵴三种.结论:香静脉瓣多,防逆流功能强,各种影响头颈静脉血循环的因素,可在舌诊得到表达和分析判断;舌瓣设计的蒂部和吻合部位,要顺应静脉瓣的位置和朝向.     

舌瓣设计的解剖学基础

为外科舌瓣的设计提供解剖学基础。用解剖剥制25具(50侧)成人舌动、静脉标本,制作7具(14侧)舌血管铸型标本,观察舌动脉和静脉分布的规律性。结果:舌主要由2条舌动脉供血;舌的静脉每侧有5个流向,多数静脉不与动脉伴行。结论:根据需要舌瓣的蒂部可设在舌体周围的多个部位,多数舌瓣由动脉网供血,但每个舌瓣可获得一个自然的静脉引流渠道。     

门静脉高压患者舌下脉络相关改变的口腔内彩色多普勒超声研究

目的:探讨肝硬化患者门脉高压时舌下脉络(舌下神经伴行静脉)的口腔内超声图像特征。方法:对44例肝硬化门脉高压患者、50例健康者舌下神经伴行静脉,运用腔内探头进行二维彩色多普勒(CDFI)及脉冲多普勒(PW)的超声检查,测量其内径及最大血流速度,并对其结果加以对比。结果:门脉高压组较正常组舌下神经伴行静脉内径明显增宽,血流速度明显减低。结论:口腔内彩色多普勒超声可为肝硬化门脉高压时舌下脉络的观测提供定量指标。     

正常脑池段后组脑神经及相关动脉MRI与断层标本解剖的对比研究

目的获得正常人脑池段后组脑神经及相关动脉血管的MRI和断层解剖资料。方法对59名正常体检者进行三维（3D）积极干预稳态（3D-CISS）序列扫描、多平面重组（MPR）成像，其中22名同时行3D-时间飞跃法（TOF）脑干区血管成像。对这些受检者脑池段后组脑神经的走行和神经血管位置关系进行显示，并将脑池段后组脑神经MRI结果与5具尸体脑断层切片、尸体脑3D-CISS结果进行对照分析。结果（1）显示概率：59名正常体检者脑池段舌咽、迷走、副复合体神经在斜横断面、斜矢状面重组图像上分别以100％（118／118）、99％（117／118）的概率清晰显示；舌下神经在斜横断面、斜矢状面重组图像上分别以90％（106／118）、91％（107／118）的概率清晰显示；3D-TOF序列成像不能清晰显示后组脑神经。（2）神经走行显示：59名正常体检者的双侧舌咽、迷走、副复合体神经均从橄榄后沟发出，自上而下依次为舌咽、迷走、副神经；颈静脉孔为舌咽、迷走、副复合体神经出现的标志层面；45％（53／118）的舌咽、迷走、副神经呈分离平行状走行，55％（65／118）三者呈聚拢状走行；舌下神经从延髓前外侧沟出延髓，舌下神经管为舌下神经出现的标志层面。（3）3D-CISS序列MR影像：椎动脉（VA）是显示率较高的动脉，72％（85／118）的VA与后组脑神经无接触；28％（33／118）的VA与后组脑神经接触。（4）将脑池段后组脑神经成像结果与尸体3D-CISSMRI、断层切片标本进行对照，显示良好的对应关系。结论3D-CISS MRI可以清晰显示脑池段后组脑神经及相关动脉血管。     

MR磁敏感加权成像在舌鳞状细胞癌及静脉畸形中的应用

【摘要】目的：探讨1.5T磁敏感加权成像(SWI)序列对舌鳞状细胞癌及舌静脉畸形的应用价值。方法:搜集经手术病理证实的舌部粘膜鳞状细胞癌23例及经临床介入硬化治疗证实的舌静脉畸形13例。所有病例均行1.5T MRI检查,除常规颌面部MRI平扫及增强外,所有患者均接受SWI扫描。记录并分析病变在常规MRI序列及SWI序列上的信号特征,并比较两者在病灶内部结构显示的差异。对于病理证实的舌癌患者,依据临床分期分成早期、中晚期组,记录病灶内磁敏感区域（ITSS）的数量并对其按照0~3分进行评分,比较ITSS评分与临床分期之间的关系。结果:SWI可清晰显示舌鳞状细胞癌及静脉畸形,且其对疾病内部静脉结构及血液降解产物等微观结构的检出明显优于常规MRI序列,其中舌静脉畸形的ITSS检出率明显高于舌鳞状细胞癌（P<0.05）;在舌癌病理分期方面,早期组舌癌的ITSS检出率为5/12,ITSS评分分别为0分7例、1分4例、2分1例,3分0例;中晚期组中,ITSS检查率为11/11,ITSS评分为0分0例、1分7例、2分3例、3分1例;ITSS评分与舌癌临床分期有相关性。差异有统计学意义（P<0.05）。结论:SWI参数ITSS评分有助于病灶的性质判定及舌癌的病理分期评估,对于指导临床治疗方案的选择及预后评价有重要意义。     

舌脉诊有关的舌动脉形态学研究

观察了50侧舌动脉剥制标本和14侧舌动脉或动、静脉铸型腐蚀标本.根据其走行,舌动脉应分为起始段、舌骨舌肌段、古深动脉升段和舌深动脉水平段.舌根血供来自舌根动脉(平均2.3支)、腰升动脉和扁桃体动脉;舌体血供来自舌深动脉发出的舌体动脉(平均25.1支);舌下动脉供应舌下腺,舌腹侧和口底组织;舌系带动脉由舌深动脉末端分支与面动脉颏下支吻合组成.舌两侧的舌根动脉和舌体动脉被舌中隔完全分开,仅有舌背面粘膜下动脉网越过正中线;舌根、舌体中份背面和舌尖偶可见2.0mm 左右的血管吻合.     

舌神经鞘瘤的MR I特征及鉴别诊断

目的 分析舌神经鞘瘤的MRI特征,提高术前正确诊断率.方法 回顾性分析经术后病理证实的17例舌神经鞘瘤的临床资料及MRI图像.结果 17例舌神经鞘瘤中,舌根5例(1/3),舌体12例(2/3).17例均为舌部单发肿块,其中3例为神经纤维瘤病(Ⅱ型),伴发其他部分多发神经鞘瘤.肿瘤均为类圆形、类椭圆形,最大直径为1.0～...     

下牙槽神经阻滞麻醉应用标本制作法

下牙槽神经阻滞麻醉是口腔科进行下颌拔牙、镶牙和其他某些治疗的一种常用麻醉方式。为了在教学中能真实地模拟这种麻醉，我们利用尸体头部经张口固定，舌神经、下牙槽神经及其伴行动静脉的剥制暴露，并仿真设置固定麻醉注射器等，制成下牙槽神经阻滞麻醉应用型示教标本。该标本可一目了然地显示下牙槽神经阻滞麻醉的进针路径、注药点、注射针与各神经、血管等的毗邻关系。     

大鼠肝硬变门脉高压性瘀证舌脉诊变化的实验研究

用复制的肝硬变门脉高压性瘀证大鼠模型,以探索舌脉变化与合深静脉压、门脉压、门脉血流量之间的关系.结果实验组大鼠形成坏死后肝硬变,以假小叶Ⅲ期病变为主;舌深静脉压力升高,与门脉压升高呈正相关;门脉血流量明显减少,与对照组比较P<0.01.认为肝硬变门脉高压性瘀证的舌脉粗张与细络瘀血主要是因门脉血经门—腔侧支循环回流入上腔静脉,引起上腔静脉阻力增大,压力增高,导致舌的静脉系统回流受阻,舌深静脉压力升高所致.     

大鼠肝硬变瘀证舌脉诊的病理组织学研究

用四氯化碳、脂肪饲料、含乙醇饮料等复合因素复制的肝硬变门脉高压性瘀证大鼠,见其舌脉诊与人肝硬化所见相同.组织学变化有二:①舌腹面粘膜出现局灶性或节段性或广泛性空泡变性,严重者细胞凝固坏死、溶解、结构破坏;②随门(?) 腔静脉侧支循环的建立,门脉压与舌深静脉压升高.镜下见舌粘膜特别是腹面粘膜下毛细血管、微小静脉扩张瘀血,内皮细胞肥大增生,腔内红细胞聚集,舌肌间血管瘀血,偶见小动脉壁坏死,伴间质水肿.     

Case report. Hypoglossal palsy: computed tomography demonstration of denervation hemiatrophy of the tongue associated with glomus jugulare tumor.

In a patient with left glomus jugulare tumor and left hypoglossal nerve palsy, computed tomography demonstrated focal lucency of the left half of the tongue. This was interpreted to represent postdenervation fibrosis and fatty replacement of the intrinsic and extrinsic lingual muscles supplied by the hypoglossal (XIIth cranial) nerve.     

Anomalous unilateral single pulmonary vein: two cases mimicking arteriovenous malformations and a review of the literature

Total anomalous pulmonary venous drainage is a rare congenital anomaly. It usually involves a pulmonary to systemic venous shunt and most cases have a septal defect in order to survive. Anomalous pulmonary venous drainage with pulmonary venous shunting is an extremely rare and entirely benign entity. We present two such cases, in which there was atresia of the left superior pulmonary vein and drainage via a tortuous collateral vein to the left inferior pulmonary vein. This collateral was mistaken on plain film and CT for a pulmonary arteriovenous malformation. Awareness of this anomalous unilateral single pulmonary vein and its radiological appearances may help in avoiding unnecessary pulmonary angiography.     

Hypoglossal nerve palsy in nasopharyngeal carcinoma

The carotid space and the last four cranial nerves are at risk when nasopharyngeal carcinoma (NPC) recurs or spreads posterolaterally. The objective of this study is to document the features of hypoglossal nerve infiltration and the appearance of the paralysed tongue. We reviewed hypoglossal nerve palsy in 16 patients with NPC. The following features were analysed: tumour morphology (submucosal spread), hypoglossal canal erosion, perineural infiltration or intracranial spread, other lower cranial nerve palsies, and appearance of the tongue. These findings were correlated with clinical records. All 16 patients had tumour recurrence following radiation therapy. In 7 patients (44 %), recurrence was submucosal. Hypoglossal canal involvement was seen in 12 patients (75 %). Isolated hypoglossal nerve palsy was noted in 5 patients (31 %) and 7 patients (44 %) had posterior cranial fossa tumour spread. Posterior displacement of the tongue was consistently well seen. In conclusion, tumour recurrence should be suspected in the presence of hypoglossal nerve palsy even when endoscopic findings are negative. Posterior displacement of the tongue, which has not been emphasised in the literature, is an easily recognisable sign and may indicate early hypoglossal nerve palsy. Received: 2 December 1997; Revision received 11 February 1998; Accepted 16 February 1998     

Collateral venous pathways in the transverse mesocolon and greater omentum in patients with pancreatic disease

OBJECTIVE: The purpose of this study was to describe the radiologic findings of the collateral venous pathways in the transverse mesocolon and the greater omentum associated with pancreatic diseases and to correlate these venous pathways and the accompanying arterial anatomy. CONCLUSION: The collateral pathway in the transverse mesocolon consists of the inferior mesenteric vein, left transverse colic vein, marginal vein of the transverse colon, and middle colic vein. The pathway in the greater omentum consists of anastomosis of the left and right epiploic veins deriving from the gastroepiploic vein. The former pathway is the vena comitans of Riolan's arch and the latter is the vena comitans of the arch of Barkow.