小脑齿状核及其静脉的磁敏感加权成像

目的 利用磁敏感加权成像（SWI）技术显影齿状核及其静脉，探讨齿状核门位置与静脉变异的关系。方法 筛选18～30周岁的健康青壮年51例（男24例，女27例）行3.0T SWI序列头部扫描，利用最小密度投影（mIP）技术对原始图像进行后处理，通过SWI序列的原始图像以及重建后图像，对齿状核门及周围静脉的解剖形态进行观察分析。结果 齿状核长（16.64±0.20）mm，宽（8.36±0.14）mm，两侧长宽均无差异；齿状核长轴夹角中位数为26.80°（四分位间距为34.58°）。齿状核静脉可分为外侧、内侧两组，由水平裂大静脉、核静脉、齿状核中央静脉及蚓静脉引流。齿状核外前部经核静脉引流至岩上窦；外中部由多条小静脉向外侧汇入水平裂大静脉；外后部由很多支极细小静脉引流，汇入蚓静脉或髓质静脉；内前部由蚓旁静脉、齿状核中央静脉共同引流，蚓旁静脉常于齿状核门周围汇入齿状核中央静脉，最终经蚓前静脉至直窦；内后部常汇入蚓静脉属支，蚓旁静脉可与之共同汇入蚓静脉。齿状核门75.49%位于内上象限，24.51%位于内下象限。结论 齿状核及其静脉在SWI图像中清晰可见，齿状核门的位置可能与蚓旁静脉汇入点相关。     

基于CT血管成像及图像融合技术的胃结肠静脉干的解剖学研究

目的 运用CT血管成像(CTA)及图像融合技术研究活体状态下胃结肠静脉干(GCT)解剖学特点。方法 回顾性分析南京医科大学附属无锡市第二医院2017年1月—2018年2月收治的80例术前诊断为胃癌、胰腺癌或右半结肠癌的患者的影像学资料,其中男46例、女34例,年龄39~83(68±10.1)岁。80例均行腹部CT平扫及增强扫描,将原始图像进行CTA和CT结肠成像(CTC)重建,并将图像融合,得到血管及肠道的三维图像。观测指标:(1)GCT的长度、管径、走行及其GCT的组成;(2)中结肠静脉汇入上级静脉的分布情况;(3)胰十二指肠上前静脉汇入上级静脉的分布情况。结果 (1)69例(86.25%)患者出现GCT,长度为2.5~25.2(9.2±3.6)mm;管径为3.3~7.2(4.8±0.9)mm。GCT均自腹侧至头侧向右走行,其属支共有右结肠静脉、中结肠静脉、胃网膜右静脉和胰十二指肠上前静脉4个来源。其中,35例(50.73%)由胃网膜右静脉和右结肠静脉、中结肠静脉构成“2支”型或“3支”型胃结肠干,7例(10.14%)由胃网膜右静脉和胰十二指肠上前静脉构成“2支”型胃胰干,27例(39.13%)由右结肠静脉、中结肠静脉、胃网膜右静脉和胰十二指肠上前静脉构成“3支”或“4支”型胃胰结肠干。(2)77例患者出现中结肠静脉,其中53例(68.83%)汇入肠系膜上静脉,20例(25.97%)汇入GCT,2例(2.60%)汇入肠系膜下静脉,2例(2.60%)汇入脾静脉。(3)46例(57.50%)胰十二指肠上前静脉直接汇入肠系膜上静脉;34例(42.50%)胰十二指肠上前静脉参与了GCT的组成,其中汇入胃网膜右静脉者12例,汇入右结肠静脉者10例,汇入胃网膜右静脉与右结肠静脉合干者7例,直接汇入GCT者5例。结论 CTA及图像融合技术可以直观地显示GCT血管解剖及变异,为临床腹部血管术前评估提供可靠的信息,具有较高的临床应用价值。     

胃贲门附近静脉的外科解剖

在100具尸体上,对贲门附近的静脉进行了观测.胃左静脉以3属支合成者多见(88.0％),其位于脊柱左前方者占89·0％,汇入脾静脉者占55.0％,外科干长2.6±0.9cm,终末部外经3.8±1.1mm。贲门食管支以1支型者最多(89.0％),汇入弓形部者占81.6％,末端距胰上缘2.1±0.9cm。胃右静脉出现率96.0％。胃后静脉出现率87·0％,1支型者92·0％,有76.6％汇入脾静脉中1/3段。     

基于容积CT增强扫描的胃结肠静脉干解剖学研究

目的 探讨容积CT增强扫描观察活体状态下胃结肠静脉干及其属支的解剖学特点。方法 回顾性分析2014年9月—2016年8月首都医科大学大兴教学医院行腹部增强CT检查的124例患者的临床资料,其中,男57例、女67例,年龄19~75岁,平均50.5岁。所有受检者行腹部CT三期增强扫描,容积重建门静脉期图像。观察胃结肠静脉干位置、走行,测量胃结肠静脉干长度、管径;观察胃结肠静脉干各属支的分型、走行以及胰十二指肠上前静脉的汇入点;参照国内动脉血管显示效果评价标准对各属支血管显示效果进行评级。结果 124例患者中,117例(94.3%)形成胃结肠静脉干。胃结肠静脉干位于横结肠系膜内,紧贴胰头前缘走行,均于胰头下缘汇入肠系膜上静脉。其中,胃结肠静脉干向肠系膜上静脉右侧走行者占61.54%(72/117),右前方走行者占36.75%(43/117),前方和右上方走行者各占0.85%(1/117);胃结肠静脉干长度为2.6～21.9 mm,平均(8.6±3.7 )mm;管径为3.2～7.0 mm,平均(5.1±0.9)mm;胃结肠静脉干属支中胃结肠干型16例、胃胰干型23例、胃胰结肠干型78例。124例中显示胰十二指肠上前静脉101例,其中汇入胃网膜右静脉40例,汇入右结肠静脉43例,汇入胃网膜右静脉与右结肠静脉合干4例,直接汇入胃结肠静脉干14例。胃结肠静脉干各属支血管显示效果评定:胃网膜右静脉、右结肠静脉、中结肠静脉显示效果均达到3级,胰十二指肠上前静脉显示效果1级33例、2级61例、3级7例。结论 容积增强CT能够在活体状态下较清晰显示胃结肠静脉干的解剖细节,对于临床手术有重要指导价值。     

胰腺动脉的外科解剖

在50具成人男性尸体,对胰腺动脉的研究表明: 一、胰头上部由胰十二指肠上(前、后)动脉分布;胰头下部由胰十二指肠下(前、后)动脉分布。胰十二指肠下动脉的起源有更多的变异。 二、胰十二指肠上、下动脉在胰头的前、后面构成了“前弓”和“后弓”。在胰头前面由胰十二指肠上前动脉的左支与胰背动脉的右支构成“胰前弓”,出现率为92％。 三、胰背动脉起源于脾动脉的为“常见型”,出现率为46％;起源于脾动脉以外的部位为“变异型”,出现率为50％;缺少胰背动脉的为4％。 四、胰支中最粗大的胰大动脉,出现率为78％,多起于脾动脉的第3段。 五、胰尾动脉有1—4条,以1条的类型居多数(40％),多起于脾动脉下干,缺少胰尾动脉的有8％。     

正常引流肺静脉解剖变异的多层螺旋CT血管成像研究

目的 探讨正常引流肺静脉的解剖变异率及其变异形式。方法 回顾性分析2013年5月—2014年7月中山大学附属孙逸仙纪念医院220例两侧肺静脉均引流至左心房患者的胸部64层螺旋CT血管成像(MSCTA)资料,对肺静脉进行多平面重建(MPR)、最大强度投影(MIP)及VR重建,观察段以上肺静脉引流区域,以及双侧肺静脉与左心房连接模式。两侧肺静脉分别以上、下肺静脉独立开口于左房,右中叶肺静脉回流至上肺静脉者为正常肺静脉引流模式;一侧单支或多于两支肺静脉引流、跨叶引流者为肺静脉解剖变异。结果 220例正常引流肺静脉中,左右肺静脉总变异发生率22.7%(50/220)。右肺静脉解剖变异38例(17.3%,38/220),共见8种变异模式,分别为:(1)上、下叶肺静脉分别汇入左心房,中叶静脉汇入下叶肺静脉 4例(1.8%,4/220);(2)上、下叶肺静脉分别汇入左心房,上叶后段汇入下叶肺静脉2例(0.9%,2/220);(3)上、中、下叶静脉分别汇入左心房16例(7.3%,16/220);(4)上叶后段、尖前段、下叶肺静脉分别汇入左心房,中叶静脉汇入尖前段肺静脉4例(1.8%,4/220);(5)上叶、下叶背段、下叶基底段肺静脉分别汇入左心房,中叶静脉汇入上叶肺静脉2例(0.9%,2/220);(6)上叶、 中叶内段、中叶外段、下叶肺分别静脉汇入左心房6例(2.7%,6/220);(7)上叶后段、上叶尖前段、中叶、下叶肺静脉分别汇入左心房2例(0.9%,2/220);(8)上叶、中叶、下叶背段、下叶基底段肺静脉分别汇入左心房2例(0.9%,2/220)。左肺静脉变异12例(5.5%,12/220),共见2种变异模式,即上、下叶肺静脉组成共干汇入左心房8例(3.6%,8/220),上叶、舌叶、下叶肺静脉分别汇入左心房4例(1.8%,4/220)。220例患者中,左右肺静脉解剖变异率的差异有统计学意义(χ²＝13.533, P<0.01)。结论 MSCTA上正常引流肺静脉解剖变异常见,右肺静脉解剖变异发生率显著高于左肺静脉,且变异模式多样。     

急性坏死性胰腺炎腹膜后引流的应用解剖

在３０具成人尸体标本上对急性坏死性胰腺炎的腹膜后引流途径进行了解剖学观察。探查宜从第１２肋下１￣１．５ｃｍ做横切口深入腹膜后间隙。壁腹膜与肾前筋膜间无肉眼可见的小血管，易分离。胰床内门静脉等管道性结构、肠系膜下静脉、十二指肠空肠曲、降部、胆总管、胰十二指肠后静脉弓的１￣３条小静脉为左右探查时易损伤之结构，应注意保护。左右肾新闻社 前间隙可经肠系膜上动脉与睾丸或卵巢动脉根之间的腹主动前方互相连通。腹     

胰腺破骨细胞型多形性癌一例

患者女 ,4 8岁。 7年前无明显诱因出现上腹部胀痛不适 ,近 1个月病情加重 ,于 2 0 0 0年 6月 8日入院。Ｂ超检查 :胰尾大部分及部分胰体区可见 6 1ｍｍ× 4 8ｍｍ实性回声团 ,边界尚规则。全身骨显像正常。临床诊断 :胰腺肿瘤 ,性质待查。手术所见 :肿瘤位于胰体尾部 6ｃｍ× 5ｃｍ× 4ｃｍ ,囊实性 ,上极达肾后壁小网膜囊 ,有包膜 ;胰尾缩小变硬 ,脾静脉与肿瘤紧密粘连 ,在胰近处切断胰腺组织 ,保留胰头 ,将胰体肿瘤及脾脏一并切除送检。病理检查 :胰腺及脾切除标本 (图 1)。胰腺大小 6ｃｍ×3ｃｍ× 2ｃｍ ,切面灰白 ;在胰体尾部可见巨大…     

复制大鼠门脉高压食管静脉曲张模型的解剖基础

采用血管灌注技术,对４０例成年Ｗｉｓｔａｒ大鼠肝外门脉系统和侧副循环途径作了系统观察。结果表明：大鼠脾静脉多为２条,且具有由胃十二指肠静脉,胃冠状静脉与脾静脉合成的胃脾静脉干,肠系膜后静脉均汇入到肠系膜前静脉。除食管静脉与直肠下静脉外,左肾上腺静脉,精索内静脉或子宫静脉也是门脉高压时门腔侧副循环的重要通道。     

中段胰腺切除术的临床应用（附14例报告）

目的：探讨中段胰腺切除术治疗胰腺中段良性或低度恶性肿瘤的临床应用价值。方法：采用中段胰腺切除术治疗胰腺中段良性或低度恶性肿瘤14例。结果：手术完整切除肿瘤，术后病人胰腺功能无明显变化，症状改善。术后胰瘘发生率14．3％（2／14）。14例均获随访，随访时间为2～54个月，疗效满意。结论：中段胰腺切除术适用于位于胃十二指肠动脉左侧和脾静脉与肠系膜下静脉汇合处之间的良性或低度恶性的胰腺肿瘤；该术式安全、有效、器官功能损伤小，值得推广。     

Course of the short gastric veins and their suitability for pancreatic islet transplantation

Experience is being gained with pancreatectomy for patients with chronic pancreatitis suffering intractable pain. Transplantation of pancreatic islets isolated from the patient's own pancreas reduces the amount of injected insulin required, and research aims to develop treatments to make such patients independent of administered insulin. Claims have been made that the uppermost short gastric vein runs directly to the upper pole of the spleen in about 90% of subjects and that infusion of pancreatic islets by this route would allow them to settle in the spleen. This study investigates these claims. The findings suggest that the short gastric veins are inappropriate as a route of islet administration. Most short gastric veins, including the most superior, drain to tributaries of the splenic vein. Short gastric veins passing to the spleen itself without extra-splenic connections to the splenic vein and its tributaries are relatively rare. Only four examples in 12 specimens were found, and only two of these were the most superior short gastric vein. The short gastric veins run in the fat of the gastrosplenic ligament and are most readily visible as they leave the stomach. In our 12 dissecting room specimens, the short gastric veins ranged in number from 3-17, and in diameter from 0.5-4.5 mm (mean = 1.7 mm; SD = 0.7 mm). The four short gastric veins that drained directly to the spleen ranged in diameter from 0.5-1 mm, significantly narrower than those draining to the splenic vein or its tributaries and small for cannulation.     

Classification of portal vein tributaries in Thai cadavers including a new type V

Purpose

To compare portal vein tributaries in Thai with Thompson classification.

Methods

In 211 Thai cadavers, abdominal regions were dissected to identify the portal veins and their tributaries. The subjects were classified into types based on modes of drainage of the left gastric and inferior mesenteric veins. Percentages of all types of venous drainage were counted.

Results

There are four types of portal tributaries as defined by Thompson, type I_47.87 %, type II_13.27 %, type III_7.58 %, and type IV_29.86 %. There were 1.42 % of whose inferior mesenteric veins entered the joining angle of the superior mesenteric and splenic veins, and were classified as type V. The left gastric vein mostly drained into the portal vein in 79.15 %, while the inferior mesenteric vein emptied into the splenic vein mainly in 55.45 %.

Conclusions

A new variance of portal tributaries in Thai cadavers is reported. The variations of portal vein formations are critical for liver surgery and interventional radiological procedures.

     

Clinical implications of concomitant variations of the testicular, suprarenal and renal veins: A case report

Multiple venous anomalies have been observed during dissection of the posterior abdominal wall in a 65-year-old, white male cadaver. The left testicular and suprarenal veins united inferior to the superior mesenteric artery, coursed anterior to the abdominal aorta and drained into the inferior vena cava (IVC). Further the left renal vein coursed retroaortically and divided into three branches. The superior branch coursed on the vertebral column and drained into the azygos vein while middle and inferior branches drained into the IVC. The right renal vein was double and both drained into the IVC separately. Due to implications for numerous therapeutical and diagnostic procedures in the retroperitoneal region knowledge of these variations could be useful for clinicians in its recognition and protection.     

腹腔镜下活体胃周血管的解剖观察及临床意义

目的 探讨腹腔镜辅助远端胃切除加D2淋巴结清扫术中胃周血管解剖学特点及临床意义。 方法　按照腹腔镜辅助远端胃癌D2切除术的标准化手术步骤,对100例胃癌患者进行腹腔镜下活体胃周血管解剖学观察。 结果　胃周血管虽然存在于不同的平面内,但血液流动的内在联系性使它们围绕胰腺构成了胃周血管网络。在胰尾上缘的胰前间隙,脾动脉第三段可定位胃网膜左血管。在胰颈下缘的胰后间隙,胰腺钩突及十二指肠水平部前方,可定位肠系膜上静脉。在幽门下方与胰头之前的网膜内可定位胃网膜右血管。在胰体上缘的胰后间隙,可定位腹腔干及其分支。胃胰襞、脾胰襞和肝胰襞是分别定胃左动脉、脾动脉和肝总动脉的解剖标志。 结论　胃周血管多存在变异,腹腔镜远端胃癌D2根治术中应以胰腺为中心标志,同时以胃周主要血管及其分叉为参考,“顺藤摸瓜”解剖定位血管。     

A case of an additional right external iliac vein surrounding the right external iliac artery and lacking the right common iliac vein

A case of an additional right external iliac vein lacking a right common iliac vein was found in an 84-year-old female cadaver during a dissection course at Aichi Medical University in 2014. The findings are reported and discussed from the embryological and clinical viewpoints. The right and left iliac venous systems were macroscopically observed with attention to the homonymous arteries and the inferior vena cava. In this cadaver, a preaortic external iliac vein originated from a right external iliac vein and drained directly into the inferior vena cava. The preaortic and right external iliac veins surrounded the right external iliac artery. In addition, the right internal iliac vein drained into the left common iliac vein, and the right obturator vein drained into the right external iliac vein. Our findings suggested that normal external iliac veins developed from the ventral limb of the iliac venous system in this case. Our case has clinical importance for surgical complications such as hemorrhages in pelvic operations, phlebography, and especially central venous cauterization of the right femoral vein.     

Experience in identifying the venous drainage of the adrenal gland during laparoscopic adrenalectomy

Laparoscopic adrenalectomy (LA) is the procedure of choice for most adrenal tumors. An important part of LA is the early identification and ligation of the adrenal veins. The venous drainage from each adrenal gland is usually via a single vein: the right vein draining into the inferior vena cava (IVC) and the left vein into the left renal vein. Although infrequent, variable venous drainage has been documented. The aim of the study was to clarify if LA identified venous drainage and its variants. Between January 1999 and January 2008, 142 consecutive patients underwent LA. Adrenal vein anatomy was documented on a prospective database. In total, 142 patients underwent 162 LA (right = 62, left = 66, bilateral = 17). All adrenal veins were identified at the time of laparoscopy. For 157 LA, the adrenal venous drainage was constant: right vein drained into the IVC and left vein drained into left renal vein. Five patients had adrenal vein variants: two right veins draining separately into IVC (n = 1), two right veins draining into the IVC and right renal vein (n = 1), and two left veins draining separately into the left renal vein (n = 3). Adrenal vein variants were present in patients with phaeochromocytomas (n = 4) or adrenocortical carcinoma (n = 1). The laparoscopic approach allowed an excellent view of the main adrenal venous anatomy. This has helped confirm the constant nature of the venous drainage and successfully identify variant adrenal veins.     

Three patterns of extra-testicular venous drainage in the rabbit. Divergence from a traditional concept

Summary Seventy-eight male New Zealand white rabbits were autopsied and found to have variable left extra-testicular venous anatomy. Our observations reveal that in the rabbit the left testis is drained in one of three ways, identified as either A (18%), B (30%) or C (52%) —type drainage. The right testicular vein in all cases drained directly into the inferior vena cava immediately superior to the right iliolumbar vein.In type A drainage, the left testicular vein drained directly into the inferior vena cava at the level of the left iliolumbar vein. In type B drainage, the left testicular vein emptied into the left iliolumbar vein, which in turn drained into the inferior vena cava. In type C drainage both the left testicular and iliolumbar veins anastomosed to form a lumbotesticular trunk which emptied directly into the left renal vein.These three patterns of left venous vascular anatomy in the rabbit can be explained on the basis of their embryologic development. Our observations suggest that it is the caudal segment of the left pelvic subcardinal vein and its anastomosis with the caudal cardinal complex which persist as the left testicular vein and that the more cranial segment of this vein, heretofore presumed to remain patent, atrophies to the level of the developing left renal vein.     

肺段和亚肺段支气管和血管的冠状断层解剖学研究

目的研究肺段和亚肺段支气管、肺动脉和肺静脉在冠状断面上的配布规律。方法利用加例胸部连续冠状断层标本和4例成人胸部多层螺旋CT图像,追踪观察肺段和亚肺段支气管、肺动脉和肺静脉。结果在冠状断面上有6个识别肺段和亚肺段支气管和血管的关键层面：1．升主动脉层面,切及尖段静脉、后段静脉、外侧段静脉、尖后段静脉、前段静脉和上舌段静脉;2．肺动脉权层面,于肺动脉权或左肺动脉下方可见到左、右上肺静脉注入左心房,在ll例（55％）标本中出现尖后段静脉、前段静脉和舌静脉干同时汇入左上肺静脉的情形;3．气管权层面,于气管权下方可见到左、右下肺静脉汇入左心房;4．中间支气管层面,可见到两肺下叶肺段支气管、肺动脉和肺静脉的起源;5．胸主动脉层面,主要为两肺上段和外后底段的支气管和血管;6．脊柱层面,两肺下叶主要表现为上段、外侧底段和后底段的支气管和血管。结论在胸部冠状断面上,以支气管分支为向导可准确辨认肺段和亚肺段的肺动脉和肺静脉。