食管胸部下段器官外供血动脉的解剖学观测

为探讨食管胸部下段供血动脉的来源及分支形态,以期为临床应用补充解剖学资料,本文利用成、幼尸体25具,红色乳胶灌注后剥离,进行解剖学观察与测量,得出该段供血动脉主要来源于胸主动脉的分支,占该段食管供血动脉总支数的68.33%;供血动脉可游离长度平均为(20.46±14.37)cm,起点外径平均为(1.32±0.40);分支主要有两种类型,分支间存在吻合。结论为食管腹段来源相对恒定,分支比较复杂,其血供评价单纯从器官外角度是丰富的,但应综合考虑器官内外的血管构筑。     

食管胸部上段器官外供血动脉的解剖学观测

目的为探讨食管胸部上段供血动脉的来源及分支形态,以期为临床应用补充解剖学资料。方法利用成人、婴幼儿尸体25具,红色乳胶灌注后剥离,进行解剖学观察与测量。结果得出该段供血动脉主要来源于支气管动脉的分支,占该段食管供血动脉总支数的69.84%;供血动脉可游离长度平均为(20.46±14.37)cm,起点外径平均为(1.32±0.40)cm;分支主要有两种类型,分支间存在吻合。结论食管腹段来源相对恒定,分支比较复杂,其血供评价单纯从器官外角度是丰富的,但应综合考虑器官内外的血管构筑。     

食管颈段器官外供血动脉的解剖学观测

目的探讨食管颈段供血动脉的来源及分布情况,为临床应用补充解剖学资料。方法利用成、幼年尸体25具,红色乳胶灌注后剥离,进行解剖学观察与测量。结果得出该部供血动脉主要来源于甲状腺下动脉的分支,占该段食管供血动脉总支数的71.43%;供血动脉可游离长度平均为(16.01±9.15)cm,起点外径平均为(0.94±0.26)cm。结论其血供评价单纯从器官外角度是丰富的,但应综合考虑器官内外的血管构筑。     

膈肌代食管手术可行性的动物解剖学研究

目的　研究猪膈肌的结构和动脉血供,探讨对猪行膈肌代食管手术实验的解剖学可行性并为其提供理论依据。 方法　杂种长白猪6头经动脉灌注明胶-氧化铅混悬液,CT扫描后将图像导入计算机行三维重建,并观察膈肌各条供血动脉的起源、走形、和分支;完整切取膈肌组织行X线摄片,观察各动脉在膈肌上分支、供血范围及相互的吻合;同时对膈肌进行大体解剖和测量。 结果　猪膈肌位置及结构与人类存在部分差异,其血供主要来自肌膈动脉、后肋间动脉、心包膈动脉及膈动脉,其主干和主要分支在重建图像上基本可显示,在X线图上可见其在膈肌上的分支丰富,相互吻合广泛。 结论　从猪膈肌的结构、动脉血供来看,具备作为带蒂组织瓣行食管替代的解剖可行性;而以膈动脉为血管蒂取组织瓣应为该手术最佳选择。     

带血供第2跖骨瓣重建外踝缺损的应用解剖

目的：为带血供第2跖骨瓣修复外踝缺损提供解剖学依据。方法：30侧经动脉内灌注红乳胶成尸下肢标本，对足背动脉外侧的分支、走行、吻合及其与第2跖骨的血供关系进行解剖学观察。结果：第2跖骨有明显的多源性供血特点，其背侧血供源于不同出现率的以下动脉：足背动脉1～4支，跗外侧动脉1～2支，第1跖背动脉1～3支，第2跖背动脉1—2支，弓状动脉2～4支。上述动脉的骨膜支分布于第2跖骨的内、外侧骨面与邻近皮肤，外径0．3～1．0mm。在足背的外侧区，诸动脉的分支问有恒定的直接吻合。结论：依据足背动脉外侧分支的解剖学规律，可以酌情选用血管蒂，设计4种有血供的第2跖骨瓣，用于移植或移位重建外踝缺损。     

胆总管和肝总管的血供及其临床意义

根据胆总管的解剖学分段，观察了各段的营养动脉及其走行和分布。其中胆总管十二指肠后段，上段和肝总管的血供来源较多，相互吻合形成纵行吻合链，链的主干包括左，右边缘吻合动脉和Ⅱ型门静脉后动脉。位于胆总管胰段后面的动脉吻合环，是该段胆管血供的重要来源。针地胆总管血供的形态特点，讨论了临床应用要点。     

颌面部血管的应用解剖

目的对人体颌面部血管进行巨微解剖及血管铸型,为临床皮瓣设计提供解剖学依据。方法①3例正常成人头颈部标本,经颈总动脉灌注红色乳胶,由浅入深逐层解剖,观测并记录颌面部血管的起始处外径、走行、分支、分布、吻合及伴行情况;②3例正常成人新鲜头颈部标本,加压注入红色过氯乙烯填充剂,经腐蚀后观察颌面部血管的来源、走行、分支、分布、吻合及伴行情况。结果颌面部的血供主要来源于面动脉、眼动脉、上颌动脉和颞浅动脉的分支。面动脉的分支主要供血面颊部、唇部、鼻部和颏区;眼动脉的分支主要供血眼球、眼球外肌、泪腺、鼻背和眼睑;上颌动脉的分支主要供血牙及牙龈、颊部、下颌关节、鼻腔、腭、咀嚼肌;颞浅动脉的分支主要供血腮腺、眼轮匝肌、上下睑外侧皮肤、颞部的软组织及面神经颧支、上颊支和颞支。结论颌面部动脉血管系统的解剖学资料,可为临床颌面部整形美容术提供了应用参考依据。     

下颈椎血供的解剖研究及其临床意义

目的为颈椎前路减压手术中减少出血量,改善显露和减少手术并发症的发生提供解剖学基础。方法在15具成人尸体标本上,解剖观测C3～7椎体前后部血供的起源、走行、分支及吻合。结果椎体前部血供来自颈升动脉脊支、甲状腺下动脉和颈深动脉脊支,C4～7椎前动脉在椎体上的分支相互吻合,在颈长肌的内侧缘处常吻合成一纵行动脉链;椎体后部血供来自椎间动脉发出的椎后动脉,其分支在颈椎体后部吻合形成节段性弧形动脉吻合链。结论阻断术椎的椎前动脉及其与相邻椎前动脉的纵行动脉吻合,并在颈椎后部减压时注意对硬膜囊外侧缘及椎体中部处的椎后动脉及其分支的处理,可减少颈椎前路减压手术的术野出血,改善手术显露。     

成人食管胸腹段血管走向观察及其临床意义

目的：观察成人食管下胸段及腹段血管走向。重点观察食管下括约肌（ＬＥＳ）区血管走向及与下胸段血管吻合关系。方法：１５例成人尸体血管灌注红色乳胶后在２倍双目放大镜下解剖观察并测量动脉分支、长度和口径。结果：下胸段食管以１支食管动脉多见，其直径平均为１．４±０．５ｍｍ。腹段食管动脉以双重支配多见。进一步解剖发现贲门区附近食管动脉呈半环状行走，其血管直径为２．１±０．７ｍｍ，长度为５．５±１．５ｃｍ，并发出３～８支小分支进入ＬＥＳ或与食管下胸段动脉发生吻合。结论：食管腹段血供较下胸段血供丰富。贲门附近半环状行走食管动脉与ＬＥＳ结构和功能有密切关系。     

背阔肌肌皮瓣的血管解剖及其临床应用

目的 探讨背阔肌肌皮瓣与血供的关系,为肌皮瓣的再划分、转位及移植提供解剖学基础。方法 用大体解剖学、血管X 线造影方法,对48例尸体背阔肌进行观察,并回顾背阔肌肌皮瓣进行临床应用31例的效果。结果 背阔肌肌皮瓣有多个血供来源,其中胸背动脉主干分布于背阔肌外上部。恒定地分出内侧支和外侧支,具有各自分布区域。背阔肌内下部由肋间动脉和腰动脉供应。据X 线造影所见,它们与胸背动脉分支间吻合明显,口径在320～550 μm之间。背阔肌表面皮肤血供均来自深方肌皮穿支,越向内下方,穿支间吻合稀疏,口径亦细小。临床应用肌皮瓣做肿物切除后创面修复,乳房再造,修复小腿缺损等共31例,术后肌皮瓣30例完全成活,1例肌皮瓣远端早期出现部分血运障碍征象,经对症处理后,血运逐步改善,伤口延期愈合。 结论 背阔肌肌皮瓣,按其动脉分支及其吻合特点可分为3个部分,为整体或部分分离、转位或移植,保持肌功能提供血管解剖基础。     

人食管壁内血管和神经的分布特点

目的探讨人食管壁内血管和神经的分布特点及两者之间的关系。方法幼年尸体标本14例和成人标本4例,共计18例,采用硅胶血管灌注和再改良Sihler神经染色法相结合来显示人食管壁内血管及神经。结果人食管壁内血管整体分布以胸下段及腹段较密集,而颈段和胸上段相对较稀疏,整体前壁内血管较后壁内稀疏,壁内血管的细小分支间形成广泛的网状吻合。人食管壁内神经整体分布以腹段分布最稀疏,胸段壁内神经分布最多密集,但颈胸段壁内神经均衡分布,颈段上部可与来自于咽丛的神经分支形成吻合,食管壁内神经形成网状环路吻合。食管壁内血管与神经之间无明显的伴行关系。结论人食管壁内血管和神经分布均呈现网状吻合,但两者之间无明显伴行关系。     

手掌部动脉的构筑

本文在手术显微镜下,观察和测量了50侧成人手掌部的动脉。手掌部的动脉,以掌浅层动脉、掌深层动脉和手背动脉形成3个主要血管层次。各层次间的吻合有:1.边缘吻合:位于手掌桡侧和尺侧缘,有浅,深2组。2.中央吻合,包括掌侧浅、深层间的直接交通支和间接交通支;掌侧和背侧间的近侧穿支、掌骨间隙穿支和远侧穿支。掌深弓及分支住手掌动脉构筑中居中间联系位置,对手掌部侧副循环的调节有重要作用。根据Poiscuille定律的流量公式,结合手掌动脉的形态特点推论,手掌部动脉的血液灌流,浅层以尺动脉为主,深层以桡动脉为主;边缘吻合的血液是从掌侧流向背侧;中央吻合的血流主要来自掌深弓及其分支。手掌部动咏的配布存在优势区域。深弓区优于浅弓区和手背动脉网区;中央吻合优于边缘吻合;边缘深层吻合优于浅层吻合。本文还讨论了指动脉的配布。     

Anatomical contribution to the surgical construction of the sartorius muscle flap

The sartorius muscle (SM) is frequently used as a surgical flap. This study intends to describe sartorius nerve and artery distribution in adult men. Fifty-three specimens obtained from fresh cadavers were prepared as described: 32 specimens were injected with a red-colored gelatin solution through the femoral artery so that intra-muscular arteries and nerves were dissected; six specimens were injected with barium sulfate solution through the femoral artery for radiography; seven specimens were injected with a Chinese ink solution, also through the femoral artery, for diaphanization; seven specimens were injected with a solution of vinyl acetate, through the femoral artery, to obtain an arterial cast and one specimen was cut and colored by Masson’s Trichrome. Sartorius branching patterns of the nerve and artery were schematized. The following measurements were taken for each dissected muscle: total length, arterial pedicle length and distance between each arterial pedicle to the proximal muscle extremity. Five to nine arterial pedicles were found in the sample. In their trajectories, these arteries may give rise to many branches to form a dense and elongated net of anastomoses. Intra- and inter-pedicular anastomoses were observed in the inner part of the muscle. The nerve supply originated from one or two branches, which enter the muscle together with the first or second arterial pedicle. The nerve branches were divided into two or three territorial branches, and then into four or five segmental branches, running longitudinally inside the muscle. The muscles showed an average length of 44.81 cm. SM is a segmented structure and it can be divided into as many as five arterial and nervous segments. In the proximal and middle parts, the muscle has better arterial supply. The segments can be filled by adjacent pedicles, due to an elongated net of anastomoses, which allow a longer arc of rotation in the construction of pedicled flaps.     

The arterial vascularization of the lateral tibial condyle: anatomy and surgical applications

The contribution of the inferior lateral genicular artery (ILGA) and the anterior tibial recurrent artery (ATRA) in the arterial supply of the lateral tibial condyle (LTC) has not been comprehensively studied and remains controversial. Eleven knee joints were injected with colored latex and the arteries were dissected macroscopically. The ATRA yielded several osseous branches supplying the tibial metaphysis and the anterior part of the tibial epiphysis and several rami supplying the anterior tibial tuberosity and the lower part of the patellar tendon. The ILGA ran under the lateral collateral ligament and had a horizontal direction towards the retro-patellar fat pad. The ILGA yielded 4–6 branches ascending or descending perpendicularly to its main direction. Full anastomoses between branches derived from the ATRA and the ILGA were observed in front and behind the lateral intercondylar tubercle in all the specimens, but each vessel seemed to provide predominantly the blood supply to a specific area. The anterior part of the LTC drew its blood supply from the ATRA, the posterior part from the ILGA and the mid-portion from both arteries. The standard anterolateral approach to LTC fractures with sub-meniscal arthrotomy appears particularly harmful to epiphyseal vascularization since it interrupts many of the branches deriving from the ILGA and ATRA. The recent development of arthroscopy in the treatment of LTC fractures may be particularly advantageous as it spares the vascularization of the LTC.Presented on 12.11.1999 at the "Société Française d’ Arthroscopie" meeting.     

颅外椎动脉侧支吻合的观察及其临床意义

目的：观察椎动脉颅外段的仙支吻合情况,并探讨其临床意义,方法：17具防腐尸体标本并结合5具头颈部血管铸型标本,观察椎动脉与颈 脉,锁骨下动脉分支之间的血管吻合,结果：椎动脉与颈动脉的分支颈升动脉,咽升动脉以及颈深动脉等有广泛的吻合,一般为细小的肌支吻合,椎动脉与枕动脉间的血管吻合比较恒定,有两种类型：直接吻合（10％）和肌支吻合（占90％）。结论：颅外椎动脉侧支吻合是椎动脉代偿机制的重要解剖学基础之一,在椎基底动脉供血不足发病中有重要的意义。     

The cephalic arterial system in dogs, especially on the anastomoses between the intracranial and extracranial circulations

The cephalic arterial system with a special reference to the anastomoses between the extracranial and intracranial circulations was investigated by means of the corrosion casts of 30 dogs. We researched into the cephalic arterial system in dogs according to Bugge's theory. His theory is as follows: ontogenetically it is composed of 4 arterial systems (the internal and external carotids, vertebral and stapedial arteries), although these arteries trans-figure from the primitive basic pattern to the adult one with particular anastomoses between the branches in each of the species. The modification of this basic pattern occurs as a result of the obliteration or persistence of certain parts of the 4 original arterial systems when they are accompanied with various anastomoses. And he emphasizes that the mode of the appearance of each anastomosis is constant in each of the species. In this paper the obtained result is as follows. The stapedial artery that occurred in an early stage of embryonic period obliterates the proximal part except for the supraorbital, infraorbital and mandibular branches. Anastomosis X between the vertebral and external carotid arteries is formed in all the cases. Anastomosis Y between the internal carotid and ascending pharyngeal arteries is found at 20% on the right side and 30% on the left. Anastomosis a1 between the internal ophthalmic artery and each of the orbital arteries derived from the supraorbital branch is recognized at 93% on the right side and 97% on the left, and the other a1 between the internal ophthalmic artery and anastomosis a6 is formed in 7% on the right side and 3% on the left. Anastomosis a2 between the supraorbital and infraorbital branches is recognized in all the cases. Anastomosis a3 between the distal part of the external carotid artery and the proximal portion of the mandibular branch is found out in all. Anastomosis a4 between the distal portion of the internal carotid artery and the supraorbital branch or each of its distal branches in the orbita is recognized at 90% on both sides. Anastomosis a5 between the distal part of the internal carotid artery and the proximal part of the infraorbital branch or the middle meningeal artery is found at 97% on the right side and 87% on the left.(ABSTRACT TRUNCATED AT 400 WORDS)     

Arterial patterns in the thoracic and abdominal segments of the esophagus: anatomy and clinical significance

Cadaver studies were made to obtain more details about the arterial patterns in the thoracic and abdominal segments of the esophagus, with emphasis on the arterial supply to the lower esophageal sphincter (LES). The results showed that the inferior thoracic segment of the esophagus usually received blood supply from a single artery, with an average diameter of 1.42 ± 0.49 mm (X ± s), whereas the abdominal segment was commonly supplied by two arteries. The abdominal esophageal arteries coming from the left gastric artery were semi-circular in shape with an average diameter of 2.06 ± 0.70 mm. From these semi-circular esophageal arteries, 3 to 8 smaller arteries branched off and penetrated into the muscle of the abdominal segment of the esophagus or anastomosed with arterial branches from the inferior thoracic segment. Thus, the blood supply of the abdominal segment was richer than that of the inferior thoracic segment. This richness of blood supply, characterized by semicircular esophageal arteries in the abdominal segment, may be important for the function of the LES.     

胸腹段食管动脉的观测

解剖观测了32例(男20,女12)成人胸腹段食管动脉,发现胸上段、胸下段和腹段的食管动脉干支分别为112支、158支、75支,平均为3.53支、4.96支、2.34支.长度为3.0-82.88mm.各支多数贴食管上升、下降或水平方向走行,沿途分为1～9小支至食管壁.食管动脉的管径较细,胸段270个分支中,管径大于0.2mm者有206支.各段血管分布的观察结果,未见明显的乏血管区.本文认为游离食管结扎动脉时,只宜结扎直接进入食管的分支.     

Facial subdermal vascular network flap: anatomic study and clinical application

Despite the numerous flaps for facial reconstruction that have been described, the search for the ideal flap with good color matching and minimal donor-site morbidity continues. In the past 3 years we have repaired 13 facial defects with success using the lateral genicervical flap - a type of facial subdermal vascular network flap (SVNF) - with a pedicle located on the preauricular region. An anatomic study of the facial SVNF, including blood supply and vascular distribution of the face and anatomic characteristics of facial vessels, based on 14 cadaver dissections, was carried out. The blood supply of the facial skin basically originated from the branches of the facial, superficial temporal and infraorbital arteries. The lateral genicervical skin was supplied basically by the branches of the facial, superficial temporal and occipital arteries, but also by the terminal branches of the superior thyroid artery. The branches diverging from these arteries became superficial and formed a subcutaneous arterial network. The arterioles from the network went to the corium layer and formed a subdermal arterial network whose arterioles anastomosed with each other in a honeycomb-like structure. The vascular distribution presented certain directivity on different areas. The blood supply of the pedicle originated from the subdermal vascular network formed by the perforator branches of these arteries. The arterioles from the facial and superficial temporal arteries anastomosed in the lateral genicervical region. From the anatomic study, we think that the viability of the facial SVNF depends basically on the subdermal vascular network formed by the perforator branches of the pedicle, and that the anastomoses between the facial and superficial temporal arteries provide a solid anatomic basis to the lateral genicervical flap. The clinical data also indicated that this flap is a useful alternative for facial, especially superficial temporal, defects. But the directivity must be taken into account in its clinical application.