颈外动脉及其分支异常1例

笔者在解剖一具成年男性尸体时发现其右侧颈外动脉及其分支异常 ,现报道如下 :右颈外动脉在甲状软骨上缘水平由颈总动脉分出 ,伴颈内动脉的内侧上行 ,其长度 1.71ｃｍ ,起始处的外径 9.1ｍｍ。在颈外动脉起始处上方 0 .2 5ｃｍ处 ,自其前壁发出一动脉干 ,长 0 .38ｃｍ ,起始处外径 3.3ｍｍ ,此动脉干末端分出 2个分支 (附图 ) :一为甲状腺上动脉 ,其走向前下方分布于喉和甲状腺的上部 ,其起始处外径为 1.5ｍｍ ;一为舌动脉 ,其先向后外然后呈“Ｕ”字型急转向前 ,穿舌骨舌肌分布于舌 ,其起始处外径为 1.7ｍｍ。颈外动脉本干沿着咽侧壁继续上…     

磁共振3D-Tricks技术在评估舌动脉解剖中的应用

目的 评价MR血管成像技术－三维时间分辨力对比剂动力成像(Three-dimenstional 　time-resolved imaging of contrast Kinetics,3D-Tricks)对舌动脉形态显示能力。 方法　纳入研究对象43例进行3D-Tricks序列扫描,其均无颈部和脑部血管性疾病;利用容积再现(VR)、多平面重组(MPR)及最大强度投影(MIP)技术对舌动脉进行三维重建,观察舌动脉起源、形态、走行,并测量舌动脉起始点、舌骨大角段距颈动脉分叉距离以及舌动脉起始点距舌骨大角段的距离。 结果　43例研究对象共显示86侧舌动脉,其中58侧直接起始于颈外动脉,27侧与面动脉、1侧与甲状腺上动脉共干且起始于颈外动脉。舌动脉在舌骨大角处较恒定,以颈动脉分叉为标志,舌骨大角段舌动脉位于颈动脉分叉上方45侧,平行于颈动脉分叉9侧,低于颈动脉分叉32侧。86侧舌动脉起始部内径为 (2.88±0.46) mm,距离颈动脉分叉处为 (1.33±0.62) cm,距离舌动脉舌骨大角段为 (1.28±0.61) cm。 结论　3D-Tricks技术能无创性显示舌动脉形态,并能获得活体的解剖学资料,在临床应用中具有重要的指导意义。     

11 舌血管构筑的应用解剖学研究

<正>对26例舌的血管构筑用墨汁灌注血管造影碱性磷酸酶及扫描电镜等方法进行较全面系统的观察.本内容系手术显微镜下所见的一部分.舌动脉于舌骨大角处直接起自颈外动脉者多见,其中有25%与面动脉共干起始.起始外径:2.5±0.3mm(2.2～3.2)前行发出舌下动脉后移行于舌深动脉.舌深动脉与舌骨舌肌的局部关系较为恒定,它是舌动脉的直接延续,故其外径变化不明显2.3±0.3mm(2.0～3.1).舌深动脉是看血供的主要血管由后往前至舌尖邻近多以鸦爪状而终,终止处距舌下钱面:2.6±0.6mm(1.8～3.7);其形态特点是行程迂曲明显由后向前与主干几呈直角向上依次分出13.9长支(8～18)至舌背以及不恒定的向下行的小支3支(1～5)至舌底.左右侧舌深动脉分别行于同侧舌肌内未见有跨越正中纤维隔,在舌尖偶可见吻合.舌静脉在解剖观察中就其形成行径和注入个体差异较大,但有二点似较明显:一是舌动脉伴行静脉都较纤细未见有管径大于动脉者;二是舌下神经伴行静脉绝大部分均能见到位于舌下壁的局部位置也相对恒定,从外观可认为是舌引流的主要静脉.从舌位于口腔中特有局部位置有较厚的肌肉和良好的血供舌粘膜下的丰富血管丛,以及舌蒂瓣是口腔内的组织,具有自然的适应性对口腔既有唾液又有细菌的复杂环境将会有较好的抗感染能力等条件.可见口?     

甲状腺上动脉的起始位置及临床意义

目的　探讨甲状腺上动脉的起始情况及其临床意义。 方法　解剖118具用福尔马林固定的尸体的双侧颈区,观察甲状腺上动脉的起始情况以及起始部位到颈总动脉分叉处的距离,并进行统计学分析。 结果　甲状腺上动脉的起始情况可分为颈总动脉分叉处（A）、颈外动脉（B）和颈总动脉（C）三种,所占比例分别为30.93%,37.71%和30.51%;左右两侧甲状腺上动脉起始情况分布有显著差异（P<0.05）;起始于颈外动脉的甲状腺上动脉起始处距颈总动脉分叉处的距离小于起始于颈总动脉的甲状腺上动脉起始处距颈总动脉分叉处的距离。 结论　甲状腺上动脉是头颈部外科手术中具有重要临床意义的动脉,其回顾性分析将为临床应用提供解剖学依据。     

国人锁骨下动脉的分枝类型

1.锁骨下动脉,左侧起于主动脉弓的非常固定,右侧起于头臂干的时有变异,较常见的是成为主动脉弓的第四枝向右过脊柱与食管之间而后经路与一般的相同,这种变异本材料中有3.3±1.6%。血管周径右侧粗的居多。2.锁骨下动脉分枝,个体差异很大,分枝数变动于3—6枝之间,本材料中以四个独立枝的居多为总数的39.3±3.1%,四枝中含有椎动脉、甲状颈干、胸廓内动脉、肋颈干等四个独立枝,而甲状颈干由甲状腺下、颈升、颈浅、肩胛上、颈横等五枝组成的为代表型,为总数的32.7±3.0%。3.锁骨下动脉分枝类型在个体上的分布,变动性很大,有31.1±4.1%是对称型,有68.9±4.1%是不对称型,对称型中以第Ⅱ型之第1分型为多,居总数的16.4±3.3%,不对称中以左侧Ⅱ型右侧Ⅲ型的较多见,为总数的10.6±2.7%,其次是左侧Ⅲ型右侧Ⅱ型的为总数的9.0±2.5%。4.椎动脉两侧起于锁骨下动脉的居多,占总数的92.2±1.7%,左侧椎动脉直接起于主动脉弓的也较常见,本材料中有5.7±1.4%。血管周径两侧等粗的较多,为42.7±3.4%,右侧粗的较少为17.6±3.6%,本动脉向上进入第六颈椎横突孔的为最多,占总数的82.4±2.5%,尚有10.2±2.1%进入第五颈椎横突孔。5.胸廓内动脉,独立由锁骨下动脉起始的占82.4±2.4%共同干中以与甲状颈干同干的为多,占11.0±2.0%,与肩胛上同干的5.7±1.5%,起点居前斜角肌内侧的为98.8±0.6%,位于后方及外侧的较少。6.甲状腺下动脉由甲状颈干起始的非常固定,为94.3±1.4%,有少数起于锁骨下动脉或椎动脉,本动脉有时完全缺如,或特别细弱而不能达及腺体,此时主要由甲状腺最下动脉或本侧甲状腺上动脉代替之。7.颈升动脉的起始,变动性大,有41.0±3.1%起于甲状颈干,有29.1±2.9%起于颈横动脉,15.1±2.2%起于甲状颈干,有8.6±1.7%起颈浅动脉,4.5±1.3%起于肩胛上动脉,少数有双枝存在。8.肩胛上动脉的起始,变动性较大,有37.7±3.1%起于甲状颈干,有30.8±2.9%起于锁骨下动脉。20.5±2.5%与颈横动脉同干起于甲状颈干,还有的起于胸廓内或与颈横动脉同干起自锁骨下动脉的。起点位于前斜角肌内侧的居多,有60.6±3.1%,居后方的较少见,由前斜角肌内侧起始的都过臂丛神经的浅面,反之则穿过或过臂神经丛的下方。9.颈横动脉的起始,各国人间的差异很大,本材料中以起自甲状颈干的为多,占45.5±3.1%,起自锁骨下动脉的有29.1±2.9%,与肩胛上动脉同干起于甲状颈干的20.5± 2.5%,还有的与肩胛上同干起自锁骨下动脉或起胸廓内动脉的。起点居前斜角肌内侧的篇多。10.颈浅动脉由颈横动脉起始的67.2±3.0%,由甲状颈干起始的27.0±2.8%,还有的起于肩胛上动脉或锁骨下动脉。11.肋颈干是锁骨下动脉分枝中非常固定的一枝,本材料中有90.9±1.8%,有少数颈深动脉与最上肋间动脉不成干而独立起始的,肋颈干两侧起点左侧位第一段的有81.1±3.5%,右侧位第二段的有93.5±2.2%,颈深动脉多过第一肋骨上面而最上肋间动脉多过第一肋骨前面分布,仅有少数过肋骨下面或后面的,其分布区域以第一、二肋间隙的为最多见。综合观察材料中,除椎动脉起于锁骨下动脉右侧较多见,(其侧差12.3±3.5%),及胸廓内动脉起始于锁骨下动脉者右侧多于左侧者(侧差18.8±4.7%)外,其它部分男女性差及左右侧差均不显著。     

中国人肺的支气管和血管 四、左肺上叶的支气管和血管

用解剖法观察了50例中国成人左肺上叶的外形、肺段支气管和血管。左肺上叶支气管的分枝型式以二分枝型为主,占96±2.77%。多数上干支气管分为尖后段支气管(B~(1+3))和前段支气管(B~2)两枝(68+6.60%)。讨论了尖后段支气管分枝的命名问题。尖后段支气管分枝型式以B~(1+3)a,B~(1+3)b的型式较多,占68+6.60%。前段支气管分裂的颇多,占48±7.07%,分裂的原因主要是由于B~2a移位所致。舌干及其两个肺段支气管的变异比上干少。左肺上叶的动脉有2—6枝,其中以三枝及四枝的例数较多,共占82±5.43%。左肺动脉的第一个分枝多分布于前段或前段和尖后段,共占76+6.04%。前段动脉来自前部的占60±6.93%,有前、后部两个来源的占40±6.93%。舌段动脉多来自后部,占80±5.66%,来自前部的占10±4.24%,兼有前、后两源的占10±4.24%。在左肺上叶各肺段厢,多有跨段动脉存在,占94±3.36%。分布至舌段的动脉的起点平面,常低于左下叶尖段动脉(A~6)发出点,或与A~6相平,两者共占80±5.66%。左肺上叶的静脉通常汇集为三个干(60±6.93%)。尖后段静脉的后枝(V~(1+3)a)行经B~2后方的较多,占48±7.07%。左肺上叶支气管的变异性较小,静脉次之,动脉较多。三者在分枝数目、分枝型式和分布的关系上,以舌段较为稳定,前段次之,尖后段变化最多。     

胫骨滋养动脉的解剖学研究

用解剖和血管透明方法对32侧成人、5侧婴儿下肢骨滋养动脉的起始、长度、口径、走行及骨内分布进行观测.胫骨滋养动脉一支者占96.88%,起始于胫后动脉者占69.70%, 主干平均长度42.41±9.53mm.起始处外径1.41±0.61mm.人骨处外径0.71±0.14mm.髓腔内,滋养动脉分为升降二支髓动脉,后者向胫骨两端呈树状分支.在骨皮质内,髓动脉与骨膜动脉的分支吻合.     

儿童颈段胸导管与侧脑室分流术应用解剖学

用1—3岁经防腐固定童尸50具,观测了胸导管颈段的类型、行程、汇入、瓣膜及干的数量。单干型占58.0士7.0%;双干型占32.0±6.6%;三干型占10.0±4.2%。汇入静脉的部位有六种,其中汇入颈静脉角占82.0±5.4%。汇入口处均有恒定的一对半月形瓣膜。胸导管弓直径平均2.2±0.2mm,汇入口外径平均为2.0±0.7mm。从皮肤至胸导管弓平均深度为21mm。本组资料颈为段胸导管与侧脑室分流术在儿童的实施提供可能条件。为此,结合临床提出手术设想。     

锁骨上神经营养血管皮瓣的应用解剖

目的 :为锁骨上神经营养血管皮瓣提供解剖学基础。方法 :在 3 2侧成人标本上 ,观测锁骨上神经营养血管及其周围皮肤的供血。结果 :锁骨上神经的血供近侧段 (颈丛根 )来源于颈升动脉神经支 ,起始处外径为 0 .8± 0 .3mm ;中段来源于颈横动脉筋膜皮支 ,起点外径为 1.2± 0 .3mm ;远侧段来源于胸肩峰动脉肩峰支 ,起始处外径为 1.5± 0 .4mm。其神经支在神经束间和神经旁相互吻合成纵行血管网 ,并借分支与筋膜皮支构成丰富的皮下筋膜血管网。结论 :以锁骨上神经及其营养血管为蒂可形成锁骨上神经筋膜皮瓣 ,顺行或逆行转位修复邻近部位的软组织缺损 ;并有设计游离皮瓣的条件 ,可行皮瓣游离移植。     

眼动脉及其分支的显微解剖学研究

目的:研究眼动脉及其分支的显微解剖,为影像诊断、介入治疗和手术方案的制定提供解剖学依据。方法:肉眼及手术显微镜下观测30例(60侧)成人颅底湿性标本的眼动脉及其分支的形态、大小及毗邻关系。结果:①眼动脉分别起自颈内动脉床突上段起始部的前上壁(占93.34%)、海绵窦段前部(占3.33%)或脑膜中动脉(占3.33%),起始处外径为(1.46±0.40)mm。②眼动脉在视神经管内行于视神经下方、管底硬脑膜鞘内,在视神经管颅口处62.50%位于视神经内下方,在视神经管眶口处85.72%位于视神经外下方。③眼动脉眶内段分为3段,并形成2个弯曲。④视网膜中央动脉起始位置不恒定,起始处外径为(0.57±0.12)mm。结论:熟悉眼动脉的行径及其主要分支的正常解剖及变异,有利于眶尖区疾病的影像诊断和手术时避免损伤眼动脉及其分支。     

Variant origin of the superior thyroid artery in a Kenyan population

Variant anatomy of the superior thyroid artery is important during surgical procedures, interpretation of angiograms, and interventional radiography in the neck. Pattern of the variations shows population differences but there is no data from the Kenyan population. This study therefore investigated the variations in origin of the superior thyroid artery in a Kenyan population. Forty six necks (36 males and 10 females) from 46 cadavers of black Kenyans in Department of Human Anatomy University of Nairobi, Kenya were bilaterally dissected to expose the origin of the superior thyroid artery. Pattern of origin of the vessel was determined on both sides in males and females. It originated from the external carotid artery common carotid artery and linguo-facial trunk in 80%, 13%, and 6.5% of the cadavers respectively on the right side. All but one of the superior thyroid arteries were ventral branches. There was asymmetric origin in 6.5% of cases. Origin from the common carotid artery was associated with high carotid bifurcation. Nearly 20% of superior thyroid arteries showed variant origin. Of these, 6.5% arose from the linguo-facial trunk, much higher than in the Caucasian and Oriental populations. Origin from common carotid artery is substantially lower than prevailing figures from other populations. These findings support ethnic variations. Preoperative angiographic evaluation is recommended.     

High bifurcation of common carotid artery, anomalous origin of ascending pharyngeal artery and anomalous branching pattern of external carotid artery

We present a rare case of combined high bifurcation of the common carotid artery, anomalous origin of the ascending pharyngeal artery and unusual branching pattern of the external carotid artery. The right common carotid artery bifurcated at the level between the second and the third cervical vertebrae, giving rise to the ascending pharyngeal artery just below the bifurcation. The right external carotid artery branched directly at its origin into the superior thyroid, lingual and occipital arteries and the distal part of the external carotid artery. The latter gave rise to the right facial artery and finally bifurcated into the maxillary and superficial temporal arteries. The right posterior auricular artery arose from the right occipital artery. The finding was unilateral and other vascular anomalies were not observed. The embryogenesis of such a combination of anomalies is not clear, but the anatomic consequences may have important clinical implications.     

Thyrolinguofacial trunk arising from the carotid bifurcation determined by three-dimensional computed tomography angiography

It is recognized that the branches of the external carotid artery (ECA) can show variation, but the presence of a thyrolinguofacial trunk is extremely rare and always originates from the ECA. We report a case of the thyrolinguofacial trunk arising from the carotid bifurcation (CB) on the left side in a 76-year-old man with advanced tongue cancer, as revealed by three-dimensional computed tomography angiography for vascular mapping of the carotid vessels prior to superselective intra-arterial catheterization. The thyrolinguofacial trunk arose 1.6 mm below the CB from the anterior surface of the left CB. The inner diameter of the thyrolinguofacial trunk at origin was 4.4 mm and the angle between the thyrolinguofacial trunk and CB was 128°. After a 1.7-mm course, the trunk divided into the superior thyroid artery and a linguofacial trunk, the inner diameters of which were 1.5 and 3.4 mm, respectively, at origin. The angle between the two arteries was 88°. After a 9.8-mm course from the bifurcation, the linguofacial trunk divided into the lingual artery and facial artery, the inner diameters of which were 1.8 and 1.9 mm, respectively, at origin. The angle between the two arteries was 61°. It is important to recognize such an anatomic variation of the branches of the ECA prior to superselective intra-arterial catheterization or microsurgical reconstruction for head and neck cancer.     

Thyrolingual trunk arising from the common carotid artery a case report

During a cadaver dissection in the anatomy department of the University of Liege, Belgium, an anatomic variation of the superior thyroid and lingual arteries was observed on the right side in a 68-year-old woman. Both arteries arose from a common trunk located 30 mm beneath the carotid bifurcation. After a 5.2 mm course, the thyrolingual trunk divided into superior thyroid and lingual arteries which followed an unusual course towards their respective organs. Knowledge of this anomaly is important for those who are involved with neck surgery and anatomy.     

Thyrolingual trunk arising from the common carotid artery identified by three-dimensional computed tomography angiography

It is well-known that the branches of the external carotid artery (ECA) can show anatomical variation, but it is extremely rare that thyrolingual trunk originates from common carotid artery (CCA). Here we report a case of the thyrolingual trunk arising from the CCA on the right side in a 73-year-old female as revealed by three-dimensional computed tomography angiography for vascular mapping of the carotid vessels before head and neck microsurgical reconstruction. The thyrolingual trunk arose from the anterior surface of the right CCA, with an origin 14.5 mm (difference between the carotid bifurcation and upper border of the origin 12.7 mm) below the carotid bifurcation. The inner diameter of origin of the thyrolingual trunk was 3.5 mm, and the angle between the thyrolingual trunk and the CCA was 130°. After a 10.2-mm course, the thyrolingual trunk divided into the superior thyroid artery (STA) and lingual artery (LA). The inner diameters of the origins of the STA and LA were 1.7 and 1.9 mm, respectively, and the angle between the branches was 94°. It is important to recognize this anatomic variation of the branches of the ECA before the microsurgical reconstruction or super-selective intra-arterial chemotherapy for head and neck cancer.     

Bilateral aberrant origin of the inferior thyroid artery from the common carotid artery

The thyroid gland is mainly supplied by the superior and inferior thyroid arteries, with the latter being its principal arterial supply in adults. The inferior thyroid artery usually arises from the thyrocervical trunk, and less frequently from the subclavian artery. Rarely, it may originate from the vertebral artery or the common carotid artery. In the present report, we describe a unique case of a 56-year-old patient, undergoing total thyroidectomy and level VI lymph node dissection for papillary thyroid carcinoma, with aberrant origin of both inferior thyroid arteries from the common carotid arteries.     

A case of the thyroidea ima artery arising from the aortic arch

The present report describes a case of the thyroidea ima artery observed in a 65-year-old Japanese male on dissection in 1988. The thyroidea ima artery arose from the aortic arch between the branchiocephalic trunk and the left common carotid artery. The thyroidea ima passed to the left lobe and isthmus of the thyroid gland for the supply of these. The inferior thyroid artery on the right side was of common type in its origin and course, though that on the left side was absent. Either of the superior thyroid arteries arose from the common carotid artery.     

小儿面神经血供的应用解剖学研究

目的探讨小儿面神经的动脉来源及分布。方法10具小儿尸体头颈部标本经双侧颈总动脉插管,加压注入红色乳胶,观察面神经的动脉来源及分布。结果面神经颅外段营养动脉来源于茎乳动脉、颞浅动脉面神经支、面横动脉、颈外动脉上面神经支、颈外动脉下面神经支、面动脉后面神经支和面动脉前面神经支。面神经颅内段营养动脉来源于茎乳动脉、脑膜中动脉的岩支、迷路动脉。结论为面神经血供来源及分布提供形态学基础,避免手术时损伤。