对十二指肠乳头旁憩室形成原因的探讨

目的:探讨十二指肠乳头旁憩室形成的原因.方法:随机选择100例十二指肠-胰标本,发现有乳头旁憩室的标本26例,无乳头旁憩室的标本74例,将26例有乳头旁憩室标本和随机选择的26例无乳头旁憩室标本作为观测对象,对其十二指肠降部、胆总管-胰管汇合部及汇合部穿肠处左侧的胰腺组织进行观测.结果:有乳头旁憩窜标本与无乳头旁憩室标本,在十二指肠大乳头处的肠管周经分别是(110±13.4)、(88.4±8.61)mm,在下曲处的肠管周经分别是(73.3±5.52)、(83.2±6.01)mm;在胆总管-胰管汇合部穿肠处胆总管-胰管汇合部的周经分别是(22.4+1.72)、(16.8±1.32)mm;在胆总管-胰管汇合部的前面,胰腺组织的厚度分别是(4.33±0.82)、(9.13±2.24)mm.结论:十二指肠乳头旁憩室形成的主要原因是十二指肠下曲较细、胆总管-胰管汇合部较粗大及在憩室发生处的左侧胰腺组织较少.     

胸导管壶腹的形态学研究

在52具成人尸体上,对胸导管颈部进行解剖与观察,并测量了胸导管末端的有关数据.且剖开管壁观察了胸导管末端的瓣膜.结果52具尸体中有37具(71.2%)的胸导管末端存在壶腹样膨大,壶腹处的管径平均为4.8±1.4mm,壶腹的长度平均为9.5±2.5mm.在52例胸导管中有瓣膜者33例(63.5%),无瓣膜者19例(36.5%).     

国人足背动脉的解剖学测量及临床意义

目的:研究国人足背动脉的直径和管壁厚度,为足背动脉置管提供解剖学依据。方法:用体视显微镜分组测量31具尸体60侧足背动脉近端、中点和远端的内、外径。结果:足背动脉中点的外径、内径和管壁厚度分别为(2.47±0.49)mm、(1.28±0.50)mm和(0.60±0.16)mm,与近端和远端比较,3组均数差异均有统计学意义。3处足背动脉的内、外径及管壁厚度无侧别差异;男性管壁厚度大于女性;50岁以上者的外径和管壁厚度大于中、青年组。结论:本研究提供了华南地区国人足背动脉的解剖学相关资料,其结果对足背动脉穿刺置管术的开展与应用等具有参考价值。     

经导管主动脉瓣及肺动脉瓣置换的应用解剖

目的为经导管瓣膜置换提供正常人主动脉瓣膜及肺动脉瓣膜的相关应用解剖.方法解剖测量40例(男28,女12)外形大小正常的成年人心标本.结果测得主动脉瓣、肺动脉瓣周径分别为(63.25±8.43)mm、(66.52±11.25)mm;瓣膜游离缘长度分别为(26.25±3.84)mm、(27.51±5.15)mm;瓣膜附着缘长度分别为(20.36±3.51)mm、(21.27±4.64)mm;游离缘距窦底的距离分别为(15.15±2.67)mm、(16.54±4.33)mm左、右冠状动脉开口距主动脉根部距离分别为(16.59±4.16)mm、(17.23±3.26)mm.主肺动脉长度(33.54±8.15)mm.结论带瓣膜支架的大小和形状的设计应根据主动脉以及主肺动脉开口的大小及与周边结构的关系来选择.     

经鼻烟窝桡动脉穿刺行经皮冠状动脉介入治疗术的临床解剖

目的：探讨经鼻烟窝桡动脉穿刺行经皮冠状动脉介入治疗术（PCI）的解剖学基础。方法：选取34 具（68 侧）成人标本,利用游标卡尺分别测量桡动脉位桡骨茎突上5 cm 及入、出鼻烟窝处断面的外径、内径,测量鼻烟 窝桡动脉实际长度和出入点直线距离,观察桡神经浅支分型及其通过鼻烟窝的数量。结果： 距离桡骨茎突上5 cm 处桡动脉断面（SA）外径（2.82±0.35）mm、内径（1.99±0.43）mm、管壁厚度（0.42±0.14）mm ;桡动脉入 鼻烟窝处断面（SB）外径（2.50±0.35）mm、内径（1.71±0.42）mm、管壁厚度（0.39±0.13）mm ;桡动脉出 鼻烟窝处断面（SC）外径（2.23±0.38）mm、内径（1.47±0.43）mm、管壁厚度（0.38±0.13）mm。3 处断面, 桡动脉外径、内径任意2 组差异具有统计学意义,管壁厚度差异无统计学意义。同一断面、不同性别间,SB 和 SC 处外径的差异均具有统计学意义。同一断面、不同侧别之间相同项目比较差异均无统计学意义,不同侧别及 年龄组间鼻烟窝桡动脉弯曲程度比较差异无统计学意义。结论： 本研究比较了桡动脉穿刺点附近3 处断面的解剖 学特性,为提高经桡动脉PCI 的成功率提供了有力的解剖学支持。     

十二指肠小乳头的应用解剖

目的：为内镜下副胰管插管、十二指肠小乳头切开等提供解剖学基础。方法：在30例成人尸体上对十二指肠小乳头的形态、位置、开口以及与大乳头之间的关系进行解剖观察。结果：十二指肠小乳头的出现率为70%。可见明显开口的占55%。小乳头形态有半球形、圆锥形、半颗粒形、扁平形和不规则形。小乳头距离幽门、十二指肠第一环、大乳头的距离分别为(58．69±15．74)mm,(23．21±8．82)mm和(22．75±6．81)mm;大、小乳头开口连线与十二指肠纵襞纵轴线的夹角为(20．80±9．40)°。结论：十二指肠小乳头的出现率与副胰管的发育程度相关,本文结果为内镜下行十二指肠小乳头插管和小乳头切开术提供了参考。     

十二指肠乳头肿瘤局部切除术应用解剖

目的：为十二指肠乳头部肿瘤局部切除术提供解剖学资料。方法：50例正常成人腹部标本，解剖观测胆总管、胰管、肝胰壶腹和乳头区长度、宽度，胆总管与胰管的夹角，肝胰壶腹区的血管分布，十二指肠大乳头位置、乳头小孔开口位置、胆胰管开口形式等。结果：肝胰壶腹和十二指肠乳头区的营养动脉平均为2．2支，均来源于胰十二指肠上动脉、下动脉，其中肝胰壶腹和十二指肠乳头区9—12点钟处的营养动脉出现率为45．9％（50支）。胆总管、胰管、壶腹末端的长度分别为（32．1±8．7）mm、（9．9±4．1）mm、（12．6±2．8）mm；宽度分别为（7．3±2．1）mm、（3．2±0．7mm）、（7．3±1．2）mm。胆总管和胰管之间的夹角平均为35．6°。十二指肠大乳头位于十二指肠降部上1／3段占8．45％±4．39％，中1／3段占72．33％±6．72％，下1／3段占19．22％±4．12％；乳头小孔开口于十二指肠纵襞占74．3％±6．68％。有十二指肠小乳头占41．43％±3．65％。胆胰管开口呈V型占37．1％±7．43％，Y型占62．9％±6．32％。结论：本实验结果为临床在十二指肠乳头部肿瘤切除过程中选择切开部位和切开深度等提供了解剖学依据，对防止术后并发症具有重要意义。     

胃与十二指肠淋巴系的联系

1.在65具尸体上,用多色淋巴管注射的方法,观察了胃与十二指肠壁内淋巴管网的吻合以及二器官的输出淋巴管所汇入的淋巴结。 2.大多数例(87％)的胃粘膜下淋巴管网越过幽门而与十二指肠粘膜下淋巴管网吻合,在胃与十二指肠的粘膜下淋巴管网间不存有明显的界限。 3.在50例浆膜下淋巴管注射标本中,仅见到三例(6％)胃与十二指肠的浆膜下淋巴管相吻合。 4.大多数例(72％)胃的输出淋巴管与十二指肠的输出淋巴管在幽门下淋巴结、幽门上淋巴结、肝淋巴结、胰十二指肠后淋巴结或腹腔淋巴结汇合。     

剑突的临床解剖研究

在20具童尸,108具成尸标本上对剑突和剑突区的血管神经配布进行了解剖观测。1.剑突的长度为48.3±0.8mm,宽度18.2±0.7mm,厚度2.5±0.1mm。剑突呈分叉者21例占16.4％;不分叉者107例占83.6％;剑突有孔者50例占39.1％;剑突末端居中者52例占40.6％;偏左侧者49例占38.3％,偏右侧者27例占21.1％。2.剑突与胸骨体的连结:软骨结合者100例占78.1％;骨性结合者28例占21.9％。3.胸骨下角度数为61.0±1.0°。4.胸廓内动脉—腹壁上动脉在剑突旁垂直下行,距离前正中线为26.0±5.0mm。文中探讨了剑突的临床意义。     

胰腺前及肝蒂前位门静脉一例

报道胰腺前及肝蒂前位门静脉一例:男尸,年龄约40岁,身高174cm,脾脏肿大。一、在胰头前方,肠系膜上静脉与脾静脉汇合而成门静脉(附图),在距汇合处1.5cm处肠系膜下静脉注入肠系膜上静脉。门静脉起端、脾静脉及肠系膜上、下静脉末部外径分别为21.5mm、10.6mm、18.5mm、7.5mm。门静脉起始后经十二指肠上部后方上行入肝十二     

电视胸腔镜下动脉导管闭合术的应用解剖

本文对32例成人尸体的动脉韧带及其毗邻结构进行了观测，为电视胸腔镜下施行动脉导管闭合术提供了以下资料：主动脉窗上、下缘的体表投影；左喉返神经勾绕动脉韧带的部位；左迷走神经与胸主动脉的毗邻关系及左支气管动脉与左肺动脉的毗邻关系。另外对胸腔电视镜孔的置入部位提出了建议。     

Studies on the obliteration of the ductus arteriosus in rat embryos

Summary Wistar rat embryos weighing over 3 g obtained by Caesarean section can adapt to extrauterine life. The ductus arteriosus of such embryos is obliterated within 2 hours after the first breath. However, the d.a. of embryos weighing 3 to 4 g does not obliterate continuously but distends again after about 40 to 60 minutes.The finding is in accordance with the inconstancy of the blood circulation through the vessels in the critical period stated by Doerr. The inconstancy of the closing process is characteristic in the ductus arteriosus of premature embryos. Further, it is shown in this study that the degeneration of intimal cells, disruption of elastic lamellae and protrusion of the intimal tissue are essential for the complete obliteration of the ductus arteriosus. In addition, the tonus of the outer circular muscle layers is increased. The degenerative changes in the vascular wall are observed at first in the subendothelial cells, and these cells seem to play a principal role in the modification of the architecture of the d.a. The transformation of smooth-muscle cells and the change of cytoplasmic organelles were characteristic depending on the period after the first breath.The other factors concerning the obliteration of the d.a. are discussed.     

Complications after transcatheter closure of patent ductus arteriosus

To evaluate the short- and mid-term results and complications ensuing the transcatheter closure of patent ductus arteriosus (PDA). Between October 1999 and December 2005, 117 patients (34 males and 83 females) underwent attempted percutaneous closure of PDA with a minimum diameter of more than 3 mm. Follow-up evaluations were conducted at 1 day and 1, 3, 6, 12 months after the performance of the transcatheter closure. The median age of patients at catheterization was 11 yr (range, 0.6 to 68 yr), median weight was 30 kg (range, 6 to 74 kg), and the median diameter of PDA was 4 mm (range, 3 to 8 mm). This procedure was conducted successfully in 114 patients (97.4%), using different devices. Major complications were detected in 4 patients (3.4%); significant hemolysis (2), infective endocarditis (1), failed procedure due to embolization (1). Minor complications occurred in 6 patients (5.1%); mild narrowing of the descending aorta (2) and mild encroachment on the origin of the left pulmonary artery (4). Although the transcatheter closure of PDA may be considered to be effective, several complications, including hemolysis, embolization, infective endocarditis, and the narrowing of adjacent vessels may occur in certain cases.     

The physiological closure of ductus arteriosus in the rat

Summary The evolution of morphological changes in the wall of the ductus arteriosus during its physiological closure in newborn rats was examined by electron microscopy. The contraction of smooth muscle cells in the tunica media seems to be the primary mechanism which leads to the physiological closure of the ductus arteriosus. For this reason our attention was centred mainly on the morphology of the tunica media.No important changes in the ultrastructure of smooth muscle cells can be observed in the early phases of the closure. Most of them exhibit ultrastructural features of cells with enhanced synthetic activity during all phases of the closure.The permanent contraction of smooth muscle cells results in their morphological changes. The most striking is the herniation of smooth muscle cell cytoplasm into the endothelial and later into adjoining muscle cells. These changes together with signs of degeneration of the smooth muscle cells are already clearly discernible 120 min after birth.The elastic component of the tunica media exhibits surprisingly fast changes. As soon as 60 min after birth, the fragmentation of elastic membranes and their structural changes provided evidence about the degradation of elastic material. The matrix vesicles, probably derived from the lysosomal apparatus of the muscle cells, may play an essential role in this process.     

Anatomical and experimental study of the ductus venosus

Summary The authors report an anatomical study of the ductus venosus in the stillborn fetus based on resin-corrosion casts and angiography. Study in adult material was done by dissection. In the first part of this paper the classical anatomy of the ductus venosus is described and an anomalous case of a hepatic parenchymal bridge between the left and caudate lobes of the liver is reported. In the second part of this paper study of patency and dilation of the ligamentum venosum to a diameter exceeding 10 mm in adult cadavers is presented. A brief study of portal flow demonstrated that an increase in flow of 30% can be obtained by experimental induction of patency. A patent ligamentum venosum was grafted onto the abdominal aorta in the rabbit. The transplanted segment was fully patent and competent immediately after grafting, but showed thrombosis when the animal was sacrified two months after the operation. In the opinion of the authors, it may be possible to use the patent ductus venosus in man once the problems of long term resistance and patency have been solved. The latter problems are currently under investigation in our laboratory.

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Etude anatomique et expérimentale du canal d'Arantius ou ductus venosus

Résumé Les auteurs rapportent une étude anatomique du canal d'Arantius chez le ftus mort-né, à partir de moulages et d'angiographies, et chez l'adulte à partir de dissections. Ils rappellent l'anatomie classique du Canal d'Arantius et rapportent un cas de pont parenchymateux hépatique entre le lobe gauche et le lobe de Spiegel. Dans une deuxième partie ils réalisent des reperméabilisations et des dilatations jusquá un diamètre de plus de 10 mm sur des cadavres d'adulte. Une courte étude débitmétrique a montré la possibilité d'augmenter le débit portal de 30 %. Un ligament veineux reperméabilisé a été utilisé comme greffon sur une aorte abdominale de lapin. Perméable et étanche d'emblée, il est retrouvé thromboséá deux mois. Les auteurs pensent possible l'utilisation du ligament veineux reperméabilisé chez l'homme lorsqu'auront été résolus les problèmes de résistance et de perméabilité à long terme. Une étude est en cours.

     

我国11种野鸭胰叶及胰管的比较解剖

对我国１１种野鸭胰叶及胰管的比较解剖学观察结果：１１种野鸭的胰都分为背侧胰叶、腹侧胰叶和脾胰叶。脾胰叶连于背侧胰叶前端，背侧胰管和腹侧胰管分别来自背侧胰叶和腹侧胰叶的头端。上述野鸭均有１条第一胰管，自背侧胰叶尾端发出。在绝大多数标本上，该胰管在十二指肠升袢和降袢的转折处，于靠近升袢一侧入肠。在大多数标本上，背侧胰管和腹侧胰管以左、右向并列进入十二指肠末端；少数鸭以其他不同方式入肠。在十二指肠粘膜面     

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

The purpose of this study was to evaluate prognostic factors associated with surgical ligation for patent ductus arteriosus (PDA) in extremely preterm infants born at the limits of viability. Ninety infants who were born at 23-25 weeks of gestation and who received surgical ligation were included and their cases were retrospectively reviewed. Infants were classified into two different groups: survivors with no major morbidity (N), and non-survivors or survivors with any major morbidity (M). Clinical characteristics were compared between the groups. Possible prognostic factors were derived from this comparison and further tested by logistic regression analysis. The mean gestational age and the mean birth weight of M were significantly lower than those of N. Notably, the mean postnatal age at time of ligation in N was significantly later than that of the other group (17±12 vs 11±8 days in N and M, respectively). An adjusted analysis showed that delayed ligation (>2 weeks) was uniquely associated with a significantly decreased risk for mortality or composite morbidity after surgical ligation (OR, 0.105; 95% CI, 0.012-0.928). In conclusion, delayed surgical ligation for PDA (>2 weeks) is associated with decreased mortality or morbidities in extremely preterm infants born at 23-25 weeks of gestation.

Graphical Abstract

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