活体肾上腺血管的解剖观测及临床意义

目的：研究活体肾上腺血管的应用解剖。方法：对１８例２４侧肾上腺手术时分离出血管，测量血管外径及长度，对６个完整肾上腺灌注染色。结果：右膈下动脉从下腔静脉右缘至末支肾上腺上动脉长８．５（７．５～１１．０）ｃｍ，外径２．５～３．０ｍｍ；左膈下动脉从腹主动脉左缘至末支肾上腺上动脉长８．０（７．０～９．０）ｃｍ，外径２．５～３．１ｍｍ；肾上腺上动脉１～６支，均源于膈下动脉。肾上腺中动脉右侧长１．７～２．２ｃｍ，外径１．０～１．５ｍｍ；左侧长１．５～２．０ｃｍ，外径１．０～１．５ｍｍ。肾上腺下动脉两侧基本相同，长１．５～２．０ｃｍ，外径１．０～２．０ｍｍ。肾上腺中心静脉右侧长０．４～０．８ｃｍ，左侧长３．０～４．０ｃｍ，外径３．０～４．０ｍｍ。结论：肾上腺血管加部分膈下血管的长度可供带血管蒂肾上腺转位治疗柯兴氏病；活体切取供移植的肾上腺；选择性肾上腺血管造影等。     

多血管神经蒂腹内斜肌瓣修复面瘫的解剖学基础

目的：为多血管神经蒂腹内斜肌瓣修复晚期面瘫提供解剖学基础。方法：在３６侧成尸标本上,对腹内斜肌的形态、血供及神经支配进行解剖观测。结果：腹内斜肌中部上１／２肌腹主要由第１１肋间神经支配,下１／２肌腹主要由肋下神经支配。上１／２肌腹的血供６６．７％来自第１１肋间后动脉,３３．３％来自旋髂深动脉的髂嵴支;下１／２肌腹的血供主要来自旋髂深动脉的腹壁肌支。第１１肋间神经、肋下神经在腋后线横径分别为２．２ｍｍ和２．４ｍｍ,入肌点距腋后线长分别为１３．３ｃｍ和１３．８ｃｍ。第１１肋间后动脉在腋后线外径为１．７ｍｍ,入肌点距腋后线长为１３．１ｃｍ;旋髂深动脉腹壁肌支和髂嵴支的起始外径分别为１．３ｍｍ和１．８ｍｍ,入肌点至起点长分别为５．１ｃｍ和８．６ｃｍ。结论：吻合多血管神经腹内斜肌瓣移植可全面修复晚期面瘫     

股骨内侧髁骨皮瓣移植重建下颌的应用解剖

在４０侧成人下肢标本上，解剖观测了膝降动脉及其伴行静脉。膝降动脉起点距内上髁平均９．１ｃｍ，外径１．８ｍｍ，可游离长度７．７ｃｍ。该动脉以其３支合干型为多见（６５．０％）。其伴行静脉压扁宽度平均２．６ｍｍ。关节支外径为１．４ｍｍ，可游离长度达６．７ｃｍ，分布于内侧髁及膝内侧皮肢，隐支外径平均１．２ｍｍ，可游离长度达９．６ｃｍ，分布于小腿内上１／３￣１／２皮肤。以膝降血管为蒂设计股骨内侧髁骨皮瓣对修     

双肾动脉伴副肾动脉1例

作者在制作标本过程中,发现１例右侧双肾动脉伴左副肾动脉,较为少见。现报道如下,以供参考。 成年男性标本,经仔细解剖后发现：在肠系膜上动脉水平处腹主动脉向右侧分出２支肾动脉（附图）,上支管径５．２ｍｍ,下支管径３．５ｍｍ,均平行向外越隔脚前方、肾静脉后方,分别分２支入肾门。腹主动脉在肠系膜上动脉下 １ｃｍ处向左侧发出左肾动脉,管径６．８ｍｍ,在其下 ３．８ ｃｍ处腹主动脉尚发出管径 ３．５ ｍｍ的副肾动脉至左贤下极附近入肾。两肾形态正常,但左肾位置较石肾低１ｃｍ左右。双肾动脉伴副肾动脉1例@姜华东$浙江大…     

股骨头缺血性坏死介入治疗的应用解剖

目的：为股骨头缺血性坏死介入治疗提供解剖学基础。方法：在５０侧成人尸体上观察了股深动脉的类型，测量了各分支的长度和外径。结果：股深动脉主要从股动脉后方（６０％）和后外侧（２６％）发出，分为深全干型（６０％）、深外干型（２０％）、深内干型（１４％）和深孤独干型（６％）。各主要血管外径为：股深动脉５．７±１．６ｍｍ；旋股内侧动脉３．６±１．０ｍｍ，其升支２．０±０．９ｍｍ；旋股外侧动脉３．７±１．１ｍｍ，其升支２．５±０．８ｍｍ。结论：该项研究为提高股骨头缺血性坏死介入治疗的成功率提供了详尽的解剖学依据。     

以第1或第2穿动脉为蒂骨瓣转位重建股骨距的应用解剖

目的：为带血管蒂骨瓣转位重建股骨距提供解剖学依据。方法：３０侧经动脉内灌注红色乳胶的成人下肢标本，对第１、２穿动脉起始、走行、分支分布和骨膜支进行详细的解剖学观察。结果：股深动脉在小转子尖下４．５±１．３ｃｍ、９．３±２．７ｃｍ处分别发出第１、２穿动脉，外径分别为２．８±０．７ｍｍ、２．４±０．６ｍｍ。穿动脉发出１～３支外径在１．０ｍｍ以上的肌骨膜支，分布于股骨后部中上段骨膜。结论：可以第１或第２穿动脉为蒂设计股骨瓣，可转位重建股骨距或修复股骨颈。     

桡动脉-冠状动脉旁路移植术的应用解剖

目的：为桡动脉与冠状动脉搭桥术提供解剖学基础。方法：２７具成人尸体,上肢标本（其中左侧２７侧;右侧２５侧）,分别进行解剖观察及测量,可作为冠状动脉搭桥术的桡动脉长度、外径。结果：①桡动脉左侧长（１０．３ ±１．２）ｃｍ;右侧长（１０．２ ±１．２）ｃｍ。②左侧上、中、下段外径分别为：（４．２ ± ０．８）ｍｍ;（４． １± ０．８）ｍｍ;（４．０ ± ０．８）ｍｍ。右侧上、中、下段外径分别为：（４．２ ± ０．９）ｍｍ;（４．１ ± ０．９）ｍｍ;（４．５ ± ０．８）ｍｍ。结论：桡动脉下２／３段位置浅表,并有足够的长度和管径,可作为冠状动脉搭桥术的供体。     

腓肠内外侧血管解剖特点及其在小腿创伤修复中的意义

目的：为小腿创伤皮瓣移植修复与腓肠内、外侧血管吻合提供解剖学基础。方法：在７０侧成人下肢标本上解剖观测了腓肠内、外侧血管的长度、外径、血管神经的毗邻关系及其形态特点。结果：①腓肠内、外侧动脉起于动脉，伴行静脉注入静脉；②动脉起点至入肌段的长度内、外侧分别为４．１±０．７（１．８～６．４）ｃｍ、３．７±０．５（２．０～６．５）ｃｍ；③肌门处内、外侧动脉的外径分别为２．２±０．１（１．１～３．４）ｍｍ、２．０±０．１（０．９～３．１）ｍｍ；④肌门处伴行静脉有１～２条，内、外侧静脉外径为２．５±０．３（１．８～４．５）ｍｍ，２．３±０．３（１．５～４．１）ｍｍ。结论：腓肠内、外侧血管恒定、径粗、较长，是小腿创伤皮瓣移植修复受区可供应用的吻合血管     

腓血管蒂比目鱼肌皮瓣逆行转位修复术的应用解剖

目的：为以腓血管为蒂比目鱼肌皮瓣逆行转位修复小腿中、下段组织缺损提供解剖学基础。方法：在３３侧经动脉灌注乳胶的下肢标本及６侧动脉铸型下肢标本上,解剖观测比目鱼肌形态,腓动脉比目鱼肌支的分布及腓动脉与胫前、后动脉之间的吻合。结果：腓动脉发出１～４条比目鱼肌支,外径２．０±０．５（１．０～３．８）ｍｍ,由其发出至皮肤的血管在比目鱼肌内或沿肌间隔穿行,穿出点在腓骨头下９．９±３．０ｃｍ,分布范围１６ｃｍ×９ｃｍ。腓动脉下端与胫前、后动脉间有丰富的吻合支和粗大的交通支,最近端交通支距内、外踝连线５．５±０．８（３．６～７．４）ｃｍ,外径１．２±０．３ｍｍ。结论：以腓血管为蒂可以形成比目鱼肌皮瓣;该瓣逆行转位可修复小腿中下段缺损,具有血供可靠、损伤小、操作简单的优点     

全肝血流阻断切肝术的应用解剖学

目的：为给临床提供肝血流阻断切肝术的解剖学基础。方法：在３７具成人尸体上解剖并观测了与肝血流阻断部位有关的结构。结果：①肝裸区深度４６．６±６．１ｍｍ，下腔静脉的膈上段长１１．７±２．４ｍｍ，外径２６．３±３．０ｍｍ，肝上段长１１．４±２．１ｍｍ，外径２７．４±５．２ｍｍ，肝下段长２７．７±６．７ｍｍ，外径为２８．１±３．８ｍｍ；②肝十二指肠韧带长４０．６±４．７ｍｍ，门静脉外径１４．０±３．４ｍｍ，肝固有动脉长２１．３±５．１ｍｍ，外径４．６±１．０ｍｍ；③膈与腹腔动脉起点间腹主动脉长２４．７±５．２ｍｍ，外径２４．５±３．１ｍｍ。结论：下腔静脉的膈上段、肝上段、肝下段、肝十二指肠韧带内结构、膈与腹腔动脉起点间腹主动脉段作为肝血流阻断的部位是可行的。     

Posterior right diagonal artery

Background: There is general confusion about a branch of the posterior segment of the right coronary artery that has been referred to as 1) the lower trunk of a divided right coronary artery; 2) a posterior reflection of the right marginal artery; 3) the ramus lateralis; and 4) a posterolateral branch or a posterior descending artery. Materials: Three hundred human hearts were studied by direct observation, X-ray films, and corrosion casting. Results: This branch of the right coronary artery arises either after the right marginal artery (in 84% of hearts) or it constitutes the continuation of this artery in the remaining 16%. We named it the posterior right diagonal artery (PRDA). It was found in 14% of 266 hearts of right dominant type. It was present in 39% when the length of the posterior descending artery (PDA) was shorter than half of the length of the posterior interventricular sulcus (PIS) and in 6% when it was longer. When the PRDA originated directly from the RCA, the RMA appeared underdeveloped; the PRDA always occupied the inferior part of the PIS and appears either as continuation of a short PDA or as a replacement for a long PDA from the point where this artery leaves the PIS to enter the posterior wall of the left ventricle. The PDRA when present serves as a bridge between the RCA and the left anterior descending artery. Conclusions: These findings are of practical importance for the correct interpretation of coronary arteriographies and in the field of coronary artery surgery. © 1994 Wiley-Liss, Inc.     

胸廓内动脉冠状动脉搭桥术有关的解剖学

为冠状动脉旁路术,在40具成年尸体上对胸廓内动脉及冠状动脉进行观测。在第四肋间隙,胸廓内动脉外径平均2.3mm,与冠状动脉对角支(2.3mm)、边缘支(2.1mm)、左室后支(2.0mm)、后降支(2.(?)mm)等较为接近。胸廓内动脉自起点至第五肋上缘平均长度为18.6cm,用作游离移植足以桥接升主动脉与任何冠状动脉。用起点原位的胸廓内动脉其有效长度适用于心前、侧壁的冠状动脉搭桥,但不适于与膈面一些血管如右冠状动脉远侧部或后降支搭桥。阐述和讨论了胸廓内动脉与冠状动脉搭桥的各种术式及其解剖基础。     

足背外侧动脉链岛状皮瓣的应用解剖

目的　探讨足背外侧动脉链的组成,为施行足背外侧动脉链岛状皮瓣手术提供解剖依据。 方法　用48侧成尸足,解剖观测外踝后动脉跟外侧支、外踝前动脉降支、跗外侧动脉与第四跖背动脉的外径、走行、吻合和分布范围。 结果　外踝后动脉跟外侧支为腓动脉的终末支,外径（1.0±0.3）mm。外踝前动脉降支外径（1.3±0.3）mm,沿外踝前缘向下走行,在外踝尖的水平分为前、后支,后支与跟外侧支吻合,占97.9%,吻合处的外径（0.8±0.3）mm;前支与跗外侧动脉吻合,占91.6%,吻合处外径（0.6±0.2）mm;跗外侧动脉发出分支与弓形动脉或第4跖背动脉吻合,占95.8%,吻合处的外径（0.6±0.2）mm。足背外侧皮神经与足背中间皮神经司足背外侧皮肤的感觉。 结论　上述4条动脉吻合形成足背外侧动脉链,扩大了足背外侧皮瓣的切取面积,增加了临床应用的灵活性。     

翻转胸廓内动脉冠状动脉旁路术的实验研究

目的 研究翻转胸廓内动脉用于冠状动脉旁路术的可行性。方法 对１０具成人尸体胸廓内动脉的特性进行观察,并测量左、右各助间点到ＩＴＡ起点、冠状动脉左前降支中点的距离。结果 于近端切断胸廓内动脉可以保证该动脉逆向供血,血供来源于下位肋间动脉、肌隔动脉和腹壁上动脉。左侧第３肋间以下的各肋间中点,到ＩＴＡ起点处的长度明显长于其到冠状动脉左前降支中点的距离;右侧第４肋间以下的各肋间中点,到ＩＴＡ起点处的长距离     

The relationship of myocardial bridges to coronary artery dominance in the adult human heart

Myocardial bridging is recognized as an anatomical variation of the human coronary circulation in which an epicardial artery lies in the myocardium for part of its course. Thus, the vessel is 'bridged' by myocardium. The anterior interventricular branch of the left coronary artery has been reported as the most common site of myocardial bridges but other locations have been reported. The purpose of this study was to provide more definitive information on the vessels with myocardial bridges, the length and depth of the bridged segment, and the relationship between the presence of bridges and coronary dominance. Two hundred formalin-fixed human hearts were examined. Myocardial bridges were found in 69 (34.5%) of the hearts with a total of 81 bridges. One bridge was found in 59 of these hearts and multiple bridges were observed in ten (eight with double bridges and two with triple bridges). Bridges were most often found over the anterior interventricular artery (35 hearts). Bridges were also found over the diagonal branch of the left coronary artery (14), over the left marginal branch (five) and over the inferior interventricular branch of the left coronary artery (six). Bridges were also found over the right coronary artery (15 hearts), over the right marginal branch (four) and over the inferior interventricular branch of the right coronary artery (two). The presence of bridges appeared to be related to coronary dominance, especially in the left coronary circulation. Forty-six (66.6%) of the hearts with bridges were left dominant. Forty-two of these had bridges over the left coronary circulation and four over the right coronary circulation. Seventeen hearts (24.6%) were right dominant. Eleven of these had bridges over the right coronary circulation and six over the left coronary circulation. The remaining six hearts were co-dominant with four having bridges over the left coronary circulation and two over the right coronary circulation. The mean length of the bridges was 31 mm and the mean depth was 12 mm. The possible clinical implications of myocardial bridging may vary from protection against atherosclerosis to systolic vessel compression and resultant myocardial ischaemia.     

股深动脉穿支皮瓣应用于乳房再造的解剖学研究

目的　为股深动脉穿支皮瓣应用于乳房再造提供解剖学依据。  方法　5例10侧成人新鲜下肢尸体标本进行乳胶或氧化铅动脉灌注,解剖观察后区域血管的形态及分布,测量股深动脉穿动脉穿支血管数量、管径、血管蒂长度及伴行静脉管径。在此基础上进行了股后区穿支皮瓣切取的手术模拟。 结果　股深动脉第1穿动脉发出4~9支穿支供应股后区皮肤,以肌皮穿支为主,偶可见肌间隔穿支;降支优势较多,优势穿支多发自股后内侧。血管蒂长为(10.6±2.6)cm,其外径为(2.2±1.0)cm,伴行静脉外径分别为(1.8±0.8)mm与(2.1±1.8)mm。   结论　股深动脉穿支皮瓣血供存在个体差异,尤以第1穿动脉对其影响较大,有待进一步研究确保皮瓣切取的安全性与精确性。     

Morphometric study of the human fetal heart. I. Arterial segment

This study measured the dimensions of the great arteries of normal human fetal hearts at an early fetal stage (between 13-20 weeks post-fertilization) in 103 fetuses obtained by necropsy. Different segments of the aorta and the pulmonary artery were dissected and their external diameters measured under stereoscopic magnification. All segments showed linear growth during this period of fetal development. Ranges in median values of external diameters associated with the pulmonary artery were: 2.1-4.2 mm for the valve ring; 2.2-4.2 mm for the main pulmonary trunk; 1.2-2.5 mm for the right pulmonary artery; 0.9-2.18 mm for the left pulmonary artery; and 4.0-8.0 mm for the length of the main pulmonary trunk. Similarly, in the aorta, median diameters were: 2.1-4.2 mm for the ascending aorta; 1.92-3.8 mm for the aortic arch; 1.45-3.0 mm for the aortic isthmus; and 1.75 -3.35 mm for the descending aorta. The diameter of the ductus arteriosus ranged between 1.2-2.45 mm. The growth rates of the pulmonary artery and the aorta were similar. The diameter of the ascending aorta was found to be greater than that of the descending aorta and the right pulmonary artery was wider than the left pulmonary artery. In addition, the magnitude of growth in the various aortic segments was different and the ratios obtained between the aortic isthmus and the ascending and descending aortae, ranged between 0.66-0.93. This study provides important morphometric reference information concerning the dimensions and growth of the great arteries of the fetal heart and has clinical application in pediatric cardiac surgery and echocardiography.     

Blood transfusion requirements in coronary artery surgery with and without the activated clotting time (ACT) technique

Summary Control of anticoagulation during cardiopulmonary bypass (CPB) with the automated activated whole blood clotting time (ACT) and reversal of heparin after CPB using a computerized ACT dose-response curve method resulted in significant reductions of blood transfusion requirements, surgical time, and protamine doses in 150 patients undergoing coronary artery bypass grafting procedures (ACT group) as compared to 200 patients for whom a standard fixed dose protocol for heparin and protamine was used (control patients). Mean transfusion requirements were 1,938±60 SEM ml whole blood and 853±48.3 SEM ml red blood cells for control patients and 1,397±59 SEM ml whole blood (P<0.001) and 695±34 SEM ml red blood cells (P<0.01) in the ACT group. ACT group patients also required less protamine with 26.2±0.60 SEM ml Protamine 1,000 (Roche) as compared to 33.9±0.49 SEM ml for control patients (P<0.001) but more heparin with 31,440±783 SEM I.U. versus 26,760±263 SEM I.U. (P<0.001). Surgical time decreased from 321±5.5 SEM min for control patients to 289±5.4 SEM min for ACT group patients (P<0.001).Abbreviations AB autologous blood - ACD right coronary artery - ACT activated clotting time - ACT_o ACT — before heparin administration - ACT₃₆₀ ACT — 5 min. after 360 I.U. heparin/kg body wt. - CPB cardiopulmonary bypass - Cx circumflex branch of the left coronary artery - DIAG diagonal branch of the left coronary artery - ECC extracorporeal circulation - FB fresh blood - FFP fresh frozen plasma - POD postoperative day - RBC red blood cells - RIA descending branch of the left coronary artery - RIP posterior descending branch of the right coronary artery - WB whole blood     

Terminal branching pattern of the right coronary artery in left-dominant hearts: a cadaveric study

BackgroundLeft coronary dominance has been reported to be associated with increased mortality and severity in case of myocardial ischemia involving left coronary artery. The present cadaveric study was proposed to objectively study and document the termination and branching pattern of the right coronary artery in left-coronary-dominant hearts in relation to the blood supply to the posterior surface of the right ventricle.MethodsSeventy-five cadaveric hearts were studied. The coronary vessels were injected with colored cellulose acetate butyrate and dissected. The coronary dominance was determined. In left-dominant hearts, branches and termination of the right coronary artery were studied.ResultsLeft coronary dominance was found in 13% of the specimens. The number of ventricular branches was found to be present as 0, 1, 2, and 4 in two, four, two, and two of the cases, respectively. The average length of the ventricular branch was 12.7 mm with a range of 5–35 mm. The atrial branch was found in 50% of hearts, varying from 2 to 3 mm in length. In three hearts, the acute marginal artery did not give any posterior ventricular branch, while two, three, and five posterior ventricular branches were seen in four, two, and one heart(s), respectively. The length of the posterior ventricular arteries was between 5 and 15 mm.ConclusionThe RCA is an inconstant and unreliable source of posterior right ventricular perfusion in a significant percentage of population with left-coronary-dominant hearts. This might be the reason for the increased morbidity and mortality seen in the event of left coronary ischemia.     

Functional dominance of the right coronary artery: Incidence in the human heart

After injection of radiopaque medium, 200 human hearts were studied by direct observation and x-ray analysis. The right coronary artery (RC) was dominant in 178 of these hearts as characterized by giving off the typical posterior interventricular artery (PIV), the posterior descending artery. Within this group, 19 specimens had right coronary arteries that gave off both a large posterior interventricular artery (LPIV) and a branch that continued beyond the crux termed a large extension of the right coronary (LERC). The subgroup of hearts supplied thusly was termed real right dominant (RRD). The RC in these hearts supplied the right ventricle and almost half of the left ventricle. These findings explain why proximal lesions of the RC in RRD hearts can be associated with extensive posterolateral ischemia and mitral dysfunction and should be of practical importance when considering angioplasty or by-pass surgery. The diameters and lengths of the arteries of the RC in RRD hearts were measured and compared with the same parameters in typical right dominant hearts. © 1996 Wiley-Liss, Inc.