家兔喉淋巴管的微细分布

目的进一步明确家兔喉淋巴管的微细分布。方法采用5′-核苷酸酶-碱性磷酸酶双重染色法(5′-Nase-ALP),半薄切片光镜观察,超薄切片电镜观察。结果喉壁除韧带和软骨层外,其粘膜层、粘膜下层、肌层和外膜均可见毛细淋巴管和淋巴管,其分布的密度不同。喉各分区淋巴管分布具有显著差异,其中以会厌喉面分布密度最高,声襞淋巴管的分布密度最低。在喉的三个间隙即会厌前间隙、声门旁间隙和任克氏间隙中均存在淋巴管,但检出率较低。结论喉壁除韧带和软骨层外,其余各层均存在毛细淋巴管和淋巴管,喉各分区淋巴管分布密度不同。     

数字化人体喉的三维重建及其可视化

目的:构建基于PC的喉部三维可视化模型,为喉部解剖教学、虚拟喉科手术及临床喉外科手术治疗方案的选择提供数字化三维解剖学依据。方法:从第三军医大学采集的首例中同数字化可视人体数据集中提取会厌软骨上缘至环状软骨下缘的断层图像,在PC机上经数据分割、对位重建、平滑处理和三维显示等步骤,完成对喉部结构的三维重建和立体显示。结果:完整地重建了喉部各重要结构,可显示喉部各结构的空间位置和毗邻关系,重建结构可以单独或联合显示,可在在维空间位置上绕任意轴旋转任意角度。结论:该数字化可视人体数据集能够较好地重建喉的可视化模型,重建结构逼真,能展示喉的真实面貌,该结果可应用于喉外科手术辅助教学以及手术入路的辅助设计等。     

喉腔的解剖学研究

本文选用喉标本50例(男、女各半),对喉腔进行了测量和研究。测量并对照了喉腔入口周径、前后径及横径;喉腔各部的高度及有关径线;前庭襞和声襞的长、宽、厚度。还测量了声带前连合的位置及其至甲状软骨上、下缘和环状软骨上缘的距离,并结合临床应用进行了讨论。     

喉返神经喉外分支的显微解剖及临床意义

目的探讨甲状腺手术区域喉返神经(RLN)的解剖特点和方法。方法运用大体解剖的方法,对48例成人标本甲状腺手术区域的RLN及其周围毗邻结构进行了观测。结果 48例96侧成人标本中,29%RLN主干穿过环咽肌肌束至致密结缔组织膜下缘,71%RLN主干走行在环咽肌深面。69%RLN在距离甲状软骨下角尖端(15.2±5.5)mm处分为前、后两支,前支多于环状软骨侧方下缘距离甲状软骨下角尖端(5.9±1.8)mm处穿过结缔组织膜,后支入喉点距甲状软骨下角尖端(4.8±2.1)mm;31%RLN未见分支。结缔组织膜下缘RLN与甲状腺下动脉(ITA)分支的关系为:66%(63/96)RLN位于ITA前方,27%(32/96)位于ITA后方。结论大多数RLN具有喉外分支,在以甲状软骨下角作为标志寻找RLN时,要同时找寻RLN及喉外分支的入喉点。ITA与RLN的关系复杂多变,ITA不作为RLN定位的首选。     

人喉的计算机三维重建及显示

对人喉标本连续切片和ＣＴ图像进行综合处理，输入计算机中进行三维重建，所显示的人喉图像形象逼真，立体感强，具备生物器官的自然连、连贯性和光滑性。该系统除可进行一般的旋转，放在等功能，还能模拟会厌软骨和声带的运动。     

环状软骨舌骨会厌固定术后吞咽功能评估研究

目的探讨环状软骨舌骨会厌固定术后吞咽功能评估的方法与效果。方法选择2014年2月至2017年1月就诊的声门型喉癌患者92例,所有患者均给予环状软骨舌骨会厌固定(CHEP)治疗与功能重建,在术后进行改良X射线吞咽造影(MBS)与纤维内镜吞咽(FEES)检查,记录误吸(MPAS)计分,并随访患者的预后情况。结果有1例患者不能拔管,其余91例术后拔气切套管时间为(12.04±5.42)周,术后拔胃管时间为(8.00±2.19)d;术后3个月喉功能良84例,中6例,差2例;术后并发症发生率为6.5%;术后3个月患者的基频与基频微扰都明显低于术前(P0.05)。随着术后时间的延长,MBS与FEES评估患者的MPAS评分都呈现明显降低的趋势(P0.05),MBS评估术后15 d为(3.87±0.98)分,术后30 d为(1.64±0.65)分,术后60 d为(1.09±0.33)分;FEES评估术后15 d为(3.27±1.33)分,术后30 d为(1.73±1.11)分,术后60 d为(1.18±0.89)分。以MBS检查结果为金标准,吞咽食物时FEES检查对于正常、误侵、误吸的灵敏度分别为100.0%、76.7%和86.7%,特异度分别为86.7%、97.1%和98.3%。结论应用声门型喉癌环状软骨舌骨会厌固定对喉缺损修复和功能重建能有效保留喉功能,减少术后并发症的发生,改善发音功能,MBS与FEES评价术后喉功能都较准确,对了解术后误吸程度有临床意义。     

国人环甲膜的调查

选用经甲醛固定的成人死体50具(男46、女4)。尸体取仰卧位,头略后仰使颈伸直,气管居正中位,显露喉部。用大头针定点,依次用游标卡尺测量喉高(喉结顶点至环状软骨弓下缘中点距离)、喉宽(环状软骨左右外缘间最大距离)、环甲膜纵径(甲状软骨下缘中点至环状软骨弓上缘中点距离)、环甲膜横径(环甲膜左右侧甲状软骨与环状软骨相交点间距离)。按环甲膜面积=1/2(环甲膜纵径×环甲膜横径),计算出环甲膜面积。并对环甲膜的横径和纵径分别与喉宽、喉高作相关回归分析及自身比例分析。结果如下:1.男性环甲膜横径平均为2.18±0.24(1.62～2.97)cm;纵径0.89±0.18(0.50～1.24)cm;面积0.98±0.25(0.49～1.46)cm~2。女性环甲膜横径平均为1.59±0.25(1.40～1.95)cm;纵径0.66±0.10(0.56～0.78)cm;面积0.53±0.16(0.43～0.76)cm~2。2.环甲膜横径与喉宽之间经相关分析为中度相关(r=0.551,P<0.0005),回归方程式为:环甲膜     

CT图像上鼻咽下缘至食管开口区域解剖学研究与喉罩尺寸的选择

目的通过研究患者上呼吸道正中矢状位CT图像上鼻咽下缘至食管开口区域的解剖学参数,分析其与患者年龄、性别、身高和体质量等参数的关系,为临床喉罩型号选择提供解剖学依据。方法选择2018年1月至2019年3月在我院实施头颈部螺旋CT扫描的患者281例,测量鼻咽下缘至食管开口的距离(D1)、会厌根部附着点至下颌骨的垂直距离(D2)、甲状软骨最大宽度(WTC),记录患者的年龄、性别、身高、体质量等指标。结果男性患者WTC、D1和D2均显著大于女性患者(P<0.05),分别为(50.34±3.57)mm和(43.59±3.07)mm,(90.75±7.01)mm和(70.70±6.34)mm,(29.21±9.14)mm和(11.78±6.77)mm。线性相关分析显示,患者的性别、身高、D2、WTC与D1显著相关(r=-0.827、0.668、0.829、0.603,P<0.05),多元线性逐步回归分析和Durbin-Watson检验分析显示D1与D2、性别、身高之间具有较好的相关性(模型调整后R 2=0.801)。结论WTC、D1和D2具有性别差异,D1与年龄、身高、体质量、WTC、D2等之间具有相关性,其结果对临床喉罩型号的选择具有参考意义。     

喉鳞状细胞癌中ZNF750的表达及与预后的关系

目的探讨ZNF750的表达与喉鳞状细胞癌临床病理特征及预后的相关性。方法收集115例喉鳞状细胞癌及56例对应癌旁正常喉组织,另收集6对新鲜喉鳞状细胞癌组织及配对癌旁正常喉组织。采用Western blot法和免疫组化法检测喉鳞状细胞癌组织及癌旁正常喉组织中ZNF750蛋白的表达;采用Kaplan-Meier生存曲线和Cox比例风险回归模型分析ZNF750蛋白表达与喉鳞状细胞癌患者预后的关系。结果 ZNF750在喉鳞状细胞癌组织中的表达明显低于癌旁正常喉组织(P0.05),ZNF750蛋白表达与喉鳞状细胞癌的淋巴结转移、TNM分期密切相关(P0.05),同时喉鳞状细胞癌患者中ZNF750蛋白高表达组的总生存率均高于ZNF750低表达组(P0.05)。结论 ZNF750在喉鳞状细胞癌组织中的表达与淋巴结转移、TNM分期有关,其有望成为预测喉鳞状细胞癌患者预后的指标。     

喉切除术相关血管神经的解剖学研究

目的:为喉切除手术提供相关血管神经的形态学依据。方法:在20具(40侧)成人头颈部标本上解剖观测喉的血管和神经的走行及分布。结果:喉上动脉的入喉处在甲状软骨上角前下方左侧(14.91±3.83)mm、右侧(15.96±3.56)mm;喉上神经喉内支的入喉处在甲状软骨上角前下方左侧(12.80±4.42)mm、右侧(13.24±3.68)mm;喉下神经入喉处距离甲状软骨下角左侧(5.38±1.57)mm、右侧(5.69±1.78)mm。进行左右比较时,表现为右侧优势。结论:本研究对喉切除手术以及其他颈前区手术具有一定的参考意义。     

The paraglottic space and transglottic cancer: Anatomical considerations

Transglottic cancer of the larynx crosses the laryngeal ventricle and involves both the vestibular and vocal folds. It has been described to spread within the paraglottic space (PGS). This region of adipose tissue, containing blood vessels and nerves, immediately adjacent to the thyroid laminae, was originally defined by Tucker and Smith (1962). However, the precise topographic relationships of this clinically important space are still controversely discussed. Therefore, a reinvestigation was done in serial sections of 19 plastinated adult human larynges. Laterally, the PGS is bordered by the thyroid cartilage. Superomedially, the PGS is continuous with the preepiglottic space (PES) in most specimens. In some cases, the PGS and the PES are completely separated from each other by a conspicuous collagenous fiber septum. Small projections of the paraglottic adipose tissue extend between the fibers of the thyroarytenoid muscle. Inferomedially, the PGS is bordered by the conus elasticus. Anteroinferior extensions of the PGS escape the larynx beneath the inferior rim of the thyroid cartilage. Posteroinferiorly, the paraglottic adipose tissue extends between the intrinsic laryngeal muscles and towards the cricoarytenoid joint. Dorsally, the PGS is bordered by the mucosal lining of the piriform sinus. A precise knowledge of the topography of the PGS can explain typical symptoms and routes of spread of tumorous growth: extension toward the hypopharynx, extension into the anterior extralaryngeal tissues, invasion of the thyroid cartilage, impairment of vocal cord movements due to infiltration of laryngeal muscles or immobilization of the cricoarytenoid joint. © 1996 Wiley-Liss, Inc.     

杓状软骨的定位研究及其意义

目的为杓状软骨相关手术的术中定位提供解剖数据。方法观测30例60侧正常成人喉标本杓状软骨声带突和肌突形态及其与甲状软骨板的位置关系。结果 (1)测量了顶底间距等10项杓状软骨形态指标,除了甲杓肌附着深度外,其余指标具有性别差异(P0.05)(;2)肌突距甲状软骨下角下端距离:男(13.05±1.92)mm,女(11.76±1.79)mm;距甲状软骨板后缘间距:男(8.11±1.17)mm,女(6.95±1.26)mm;距甲状软骨板内膜间距:男(3.71±1.31)mm,女(3.65±1.23)mm。(3)杓状软骨肌突投影点位于甲状软骨板斜线后下区域,该投影点距甲状软骨下缘距离:男(7.12±1.43)mm,女(5.92±1.26)mm;距后缘距离:男(7.27±1.52)mm,女(5.81±1.47)mm。结论杓状软骨相关手术可根据甲状软骨后缘、下缘、环甲关节下缘来定位肌突。肌突距甲状软骨板内面最近,若从甲状软骨板斜线后区开窗寻找肌突可以缩短手术进路距离。     

Morphometry of the Thyroid and Cricoid Cartilages in Adults on C.T. Scan

In the present study, C.T. scan was done in 60 living subjects (30 males and 30 females) from region of Haryana who were undergoing C.T. scan for some reason other than larynx. Patients were in age group 20–50 years. A total of eleven measurements of thyroid and cricoid cartilages were taken on C.T. Scan to study sexual dimorphism. All parameters of thyroid cartilage except angle were found to be significantly more in males as compared to female. Thyroid angle was significantly smaller in males. Sex difference was also statistically significant for all parameters of cricoid cartilage except antero-posterior diameter. The measurements in living were also compared with those of cadavers. All of the CT measurements were lower than autopsy measurements. However, the difference was not statistically significantfor most of the measurements.     

The morphology and topography of the superior laryngeal artery

The aim of this study was to investigate and correlate the anatomical parameters of the superior laryngeal artery (SLA). For the study, 50 adult, human specimens were used; laryngeal pieces were drawn from 16 cadavers and the arteries were dissected intralaryngeally. In 68%, the SLA originated from the superior thyroid artery and in 32%, directly from the external carotid artery. In five sides, an aberrant superior laryngeal artery (ASLA) was entering the larynx through a foramen thyroideum. The normal superior laryngeal artery (NSLA) had a short extralaryngeal part and continued intralaryngeally, with two segments and a point of inflexion; the first segment ran along the superior border of the thyroid cartilage, the point of inflexion of the NSLA was at a minimal distance of 1.1 cm anterior to the superior horn of the thyroid cartilage and from this point the NSLA continued in the paraglottic space. The ASLA had a constant origin from the superior thyroid artery; it then traversed the foramen thyroideum and reached the paraglottic space–at the superior border of the lateral cricoarytenoid muscle, it ended in two terminal branches. We constantly evidenced the following collateral branches of the NSLA: superior, anterior and postero-medial. The terminal branches are the antero-inferior branches that constantly anastomose with the cricothyroid artery and the postero-inferior branch anastomosed with the inferior laryngeal artery. Occasionally, additional branches of the NSLA were found. In conclusion, the intralaryngeal branching patterns of the NSLA and the ASLA are similar, the differences being given by the entry point into the larynx that will make the superior and anterior branches of the ASLA longer, will eliminate the transversal segment of the NSLA, and will shorten the descending segment in the paraglottic space in the case of ASLA. The base of the upper horn of the thyroid cartilage, the oblique line and its tubercles, the cricothyroid membrane and the cricothyroid joint are constant landmarks that allow a precise intralaryngeal identification of the SLA. These findings can improve performances during surgical manipulations of the larynx and laryngeal transplants.     

Subglottic region: Normal topography and possible clinical implications

A precise definition of clinically important laryngeal regions and compartments is still a matter of controversy. The often neglected subglottic area was reinvestigated in plastinated serial sections of 21 human adult specimens. The superior border of the subglottic region is defined by the transition of squamous stratified epithelium covering the vocal cords into the respiratory epithelium of the caudal airways. It is found at the inferior margin of the vocal fold at variable distance from the free edge of the vocal cord and bears a high risk of carcinogenesis. The anterior border of the subglottic region is the cricothyroid space between the thyroid cartilage and cricoid arch. Medially, it is bridged by the median cricothyroid ligament. Laterally, the gap between thyroid and cricoid cartilage is filled by adipose tissue in most cases. This provides a broad connection of intra- and extralaryngeal connective tissue. There, cancer may escape the larynx. The conus elasticus is often regarded as a firm fibroelastic membrane within the subglottic region, but its structure may be disturbed by piercing blood vessels or age-related changes, facilitating cancerous spread. The cricoid lamina representing the dorsal border of the subglottic space ossifies preferentially in its superior part, which is often attacked by tumor invasion. The inferior border of the subglottic region is defined at the inferior rim of the cricoid cartilage. At this level, the endocricoid submucosal tissue contains loosely arranged collagenous fibers, which probably do not act as an anatomic barrier. Clin. Anat. 11:9–21, 1998. © 1998 Wiley-Liss, Inc.     

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。     

Ontogeny of the Larynx and Flight Ability in Jamaican Fruit Bats (Phyllostomidae) With Considerations for the Evolution of Echolocation

Echolocating bats have adaptations of the larynx such as hypertrophied intrinsic musculature and calcified or ossified cartilages to support sonar emission. We examined growth and development of the larynx relative to developing flight ability in Jamaican fruit bats to assess how changes in sonar production are coordinated with the onset of flight during ontogeny as a window for understanding the evolutionary relationships between these systems. In addition, we compare the extent of laryngeal calcification in an echolocating shrew species (Sorex vagrans) and the house mouse (Mus musculus), to assess what laryngeal chiropteran adaptations are associated with flight versus echolocation. Individuals were categorized into one of five developmental flight stages (flop, flutter, flap, flight, and adult) determined by drop‐tests. Larynges were cleared and stained with alcian blue and alizarin red, or sectioned and stained with hematoxylin and eosin. Our results showed calcification of the cricoid cartilage in bats, represented during the flap stage and this increased significantly in individuals at the flight stage. Thyroid and arytenoid cartilages showed no evidence of calcification and neither cricoid nor thyroid showed significant increases in rate of growth relative to the larynx as a whole. The physiological cross‐sectional area of the cricothyroid muscles increased significantly at the flap stage. Shrew larynges showed signs of calcification along the margins of the cricoid and thyroid cartilages, while the mouse larynx did not. These data suggest the larynx of echolocating bats becomes stronger and sturdier in tandem with flight development, indicating possible developmental integration between flight and echolocation. Anat Rec, 297:1270–1277, 2014. © 2014 Wiley Periodicals, Inc.     

Prenatal and early postnatal morphogenesis and growth of human laryngotracheal structures

Advances in neonatal medicine have resulted in increased care of fetal and neonatal airways. These advances have required an exhaustive knowledge of fetal airway anatomy and development. The aim of this study was to determine the anatomical development of laryngotracheal structures during the fetal and immediate postnatal period and to correlate these observations with other fetal biometric parameters to estimate developmental particularities of the fetal airway. An anatomical prospective study was based on examination of larynx and trachea from 300 routine autopsies of fetuses and infants, free of malformation and never intubated. Anatomical measurements of cricoid cartilage, thyroid cartilage, glottis, arytenoid cartilage and trachea were performed using a precision calliper and precision divider. Statistical analysis was performed to represent the growth of anatomical structures and to evaluate the correlation with biometric data. Raw data and 10th and 90th percentile curves were fitted satisfactorily with a linear model for gestational age. A linear relationship between laryngotracheal measurement and body weight and height was observed except for glottis length, interarytenoid distance and anterior cricoid height. The diameter of the cricoid lumen was significantly less than that of the trachea and glottis lumen. A sexual dysmorphism was noted for thyroid cartilage measurements and interarytenoid distance, with measurements significantly smaller in females. This study reports the anatomical development of normal laryngotracheal structures during the fetal period. Despite the fact that this study was performed during postmortem examination, these observations can be useful to develop criteria, materials and surgical procedures adapted to fetal and neonatal airways as well as for the purposes of early diagnosis and management of laryngotracheal malformations.     

椎基静脉孔及椎体静脉解剖在椎体成形术中的意义

目的　为胸腰椎（T8～L5）椎体成形术减少骨水泥渗漏等并发症提供解剖学依据。 方法　对40例健康成人胸腰椎螺旋CT薄层扫描和重建,观察每节段正中矢状位和横断位图像上椎基静脉孔（basivertebral foramen, BF）和椎体静脉孔道(vertebral vein, VV)出现的频率;测量椎体正中矢状径（VD）和BF宽（BFW）、深（BFD）高（BFH）;测量BF距椎体左右缘距离（VW1和VW2）和距上下终板的距离（VH1和VH2）,应用Stata7.0统计学软件包对上述数据进行统计学分析。 结果 BF及VV出现的频率从T8到L5逐渐增大,BF和VV观察到的频率在性别间差异无统计学意义（P＞0.05）。BFW、BFH、BFD从T8至L5随椎体增大相应增大。在不同椎体上BFD约为VD的1/3。VW1和VW2之间差异无统计学意义（P＞0.05）;VH1和VH2之间差异有统计学差异(P＜0.05)。BF更接近椎体上终板。 结论 熟悉BF和VV在椎体内的分布有助于减少椎体成形术中骨水泥渗漏等并发症的发生。     

The anatomy of the larynx of the bowhead whale,Balaena mysticetus,and its sound‐producing functions

This study describes the morphology of the laryngeal apparatus in bowhead whales (Balaena mysticetus) with respect to respiration, deglutition, and vocalization. We also examined the intrinsic cricoarytenothyroid muscle (Musculus (M.) diverticuli laryngei) which forms the laryngeal diverticulum, to ascertain its interactions with the laryngeal cartilages during respiration and sound production. Five fetal larynges and four from adult whales were studied using noninvasive imaging, as well as macroscopic and microscopic techniques. The larynx extends from the skull base into the thoracic inlet. The dorsally curved laryngeal stalk, supported by epiglottis and the corniculate processes of arytenoid cartilages, is situated within the nasopharynx. The epiglottic cartilage exhibits a prominent medial ridge. The arytenoid cartilages are rod‐shaped, and extend through the laryngeal cavity. The thyroid cartilage possesses a prominent caudal horn with a fibrous articulation to the ventrally incomplete cricoid cartilage. The M. thyroepiglotticus forms the connection between epiglottic and thyroid cartilages. The M. cricothyroideus lateralis connects the caudal horn of the thyroid cartilage with the cricoid cartilage and the M. cricothyroideus medialis connects the cricoid and thyroid cartilage. An extensive laryngeal diverticulum (Diverticulum laryngis), formed by the laryngeal mucosa and M. diverticuli laryngei, is positioned caudo‐ventral to the laryngeal vestibule. The mucosa thickens into a fold medial to the vocal processes of the arytenoid cartilages. Experiments with airflow combined with histological and anatomical evidence strongly suggest a sound producing function for these (vocal) folds. This analysis provides the first account of sound producing structures and function in bowhead whales. Anat Rec, 297:1316–1330, 2014. © 2014 Wiley Periodicals, Inc.