右心耳壁厚及梳状肌间凹深度测定对起搏电极定位的意义

目的通过测量右心耳壁厚度及梳状肌间凹深度,为临床心房起搏电极的定位提供解剖学基础.方法将50具经福尔马林处理尸体的右心耳,按水平距离和垂直距离分成内上、外上、内中、外中、内下、外下6个区域,测量各区的心肌壁厚度及梳状肌间凹.另用5具尸体于福尔马林处理前后行上述数据测定,以获得心壁厚度和梳状肌间凹深度的增减百分率,并对50具处理尸体的测值作校正.结果 50具经福尔马林处理尸体和5具未经福尔马林处理尸体的心耳壁厚度和梳状肌间凹的深度作比较,无统计学差异(P>0.05);但女性右心耳较男性小(P<0.05).结论经福尔马林处理尸体的测值校正后能反映新鲜尸体的情况.右心耳内上、外上区域(梳状肌间凹的深度>6 mm)适宜翼状电极定位.内上、外上及内中区域(心耳壁厚度≥2 mm)用螺旋电极定位是安全的;女性患者电极定位要注意安全.     

缺盆穴针刺安全深度的应用解剖研究

在46具成人尸体上．采用钢针标定法和层次解剖法．研究缺盆穴的解剖结构和针刺深度与角度，结果显示：向下直刺的解剖结构依次是皮肤、浅筋膜、颈筋膜浅层、肩胛舌骨肌下腹、臂丛及锁骨下血管、前锯肌、肋间外肌、肋间内肌、壁胸膜。向下直刺的平均危险深度．男性为34．97mm，女性为31．41mm。为了保证安全，建议缺盆穴针刺的深度控制在22．50mm内。     

成年男性下颌角间宽与颧弓深度、长度及下颌角厚度的关系

目的：测量下颌角间宽与颧弓深度、颧弓长度及下颌角厚度并进行相关分析，以期在活体上通过测量下颌角间宽来推算颧弓深度、颧弓长度、下颌角厚度，为临床行颜面美容矫治术及复合体的制作提供相关资料。方法：经福尔马林固定、颜面骨正常的成人男性尸体50具，按《人体测量方法》，用游标卡尺直接测量下颌角间宽、左右两侧颧弓深度与长度、下颌角厚度。结果：颧弓深度、颧弓长度、下颌角厚度与下颌角间宽其相关系数分别是，颧弓深度为0．649(P=0．001)，颧弓长度为0．584(P=0．001)，下颌角厚为1．0(P=0．001)，颧弓深度、长度左、右无明显差别。结论：临床采用测量下颌角间宽来推算颧弓深度、颧弓长度及下颌角厚度具有显著性意义。     

天突穴针刺安全深度的应用解剖研究

在60具成人尸体上,采用钢针标定法和层次解剖法,研究天突穴的解剖结构和针刺深度与角度,结果显示:天突穴的解剖结构由浅入深依次是皮肤,浅筋膜,颈深筋膜浅层,左、右胸锁乳突肌起端之间,胸骨颈静脉切迹上方,左、右胸骨舌骨肌之间,胸骨甲状肌,气管前间隙,胸腺,胸膜前界与肺的前缘。向下直刺的平均危险深度为22.5mm,为了保证安全,建议天突穴针刺的深度控制在13mm内。     

听诊三角的解剖学观测

目的对左、右听诊三角进行解剖学观测,探讨纵隔手术的理想入路。方法选择40具经福尔马林固定的成人尸体,让上肢处于解剖位和外展90,°解剖、观测并比较左、右听诊三角的解剖学特征。结果在外展90°时左、右听诊三角面积均显著增大,左听诊三角内髂肋肌的面积显著变小;左听三诊的上角位置较高,它的上角、内侧角距后正中线的距离较近。结论纵隔手术入路经左听诊三角较好。     

男性闭孔内肌超声诊断分析

目的应用超声和解剖对照的方法,对闭孔内肌进行超声识别,以期为男性闭孔内肌的影像学检查提供一种有效的新方法。方法先对10具防腐尸体进行解剖,了解闭孔内肌位置、形态、结构及周围的毗邻关系,然后对一例新鲜男性成人尸体进行经直肠超声检查,观察闭孔内肌声像图表现,测量其厚度,在超声引导下对疑似闭孔内肌的肌肉进行穿刺定位,解剖后确认。结果经解剖证实,超声所定位的肌肉为闭孔内肌,声像图表现为两头稍尖,中央略膨隆的纺锤形。超声测量闲孔内肌的平均厚度,右侧：13．6min．左侧：13．7mm。新鲜标本防腐处理后耻骨直肠肌的平均厚度为,右侧：13．16mm,左侧：13．17mm。结论采用经直肠超声对男性闭孔内肌进行识别和观察,是影像学的一种新手段。     

B超测量子宫肌层厚度预测未足月胎膜早破临产时间的研究

目的 探讨B超测量子宫肌层厚度能否预测未足月胎膜早破（PPROM）的临产时间。方法 选择2005年9月至2006年1月成都市妇幼保健院住院治疗的PPROM孕妇共28例，破膜后1d内B超测量子宫底部、子宫体前中壁、子宫体后壁和子宫下段肌层的厚度。同期选择相应孕周胎膜完整且未临产的孕妇29例作为对照组。结果 PPROM组子宫体肌层显示出相似的厚度，子宫底部、子宫体前中壁、子宫体后壁组间无差异性（P〉0.05）。PPROM组子宫底部、子宫体前中壁、子宫体后壁和子宫下段肌层的厚度较对照组明显变厚，差异有显著性（P〈0.05）。PPROM组子宫底部肌层厚度与临产明显相关，厚度越厚，临产时间越早，子宫底部肌层厚度〉11mm，5d内临产的敏感性及特异性分别为92.7％，62.0％。结论 B超测量子宫肌层厚度有助于预测未足月胎膜早破的临产时间。     

人胫骨前肌神经入肌点定位与肌内神经分布

目的 探索胫骨前肌神经入肌点定位与肌内神经分布.方法 用成人尸体(20 ～ 50岁)20具和童尸(2～10岁)5具,分别采用大体解剖法和改良Sihler's肌内神经染色法观察胫骨前肌神经入肌点定位与肌内神经分布.结果 胫骨前肌是一环羽肌.肌外神经支配多为3支型(77.5％).神经支入肌点距腓骨头2.10 ～9.40 cm.肌内神经分布:神经入肌后3条初级支分别司肌前上部、前下部和后下部的纤维,各支间未见吻合.结论 胫骨前肌可分出三个神经肌亚部.     

人腮腺管开口部附近的形态学特征

作者报导1978～1979年度,对东京医科大学学生解剖实习尸体50具的100侧腮腺管的肉眼解剖学、铸型解剖学、组织学及实体显微镜下的观察结果。 (1)腮腺管由咬肌间内弯曲后,至口腔前庭腮腺乳头开口止,出现七次弯曲。 (2)导管粘膜上皮的环行襞,其导管呈扁平状,使颊肌急剧弯曲成S状的贯穿部位最明显,在沿导管长轴的断面上呈园锥锯齿状,至后口腔前庭开口处的管壁粘膜襞,右腮腺管和左腮腺管都呈现右向回旋性。 (3)导管粘膜上皮为含有多数杯状细胞的     

冠状动脉左旋支起源左心室合并肺动脉四瓣变异1例

在解剖实验教学中我们发现心脏冠状动脉左旋支直接始于左心室合并肺动脉 4个瓣膜的变异 1例 ,该变异实属罕见 ,报道如下。男尸 ,约 5 0岁 ,心脏大小正常 ,左冠状动脉旋支起始于左室前壁的上部 ,血管内口位于左心室梳状肌之间与左室腔通 ,距主动脉根部 3.0 5ｃｍ ,距后瓣基底部 1.0 2ｃｍ ,此血管在左室的起始处分两支 :一支血管开口于梳状肌 ,另一支血管深入在心肌间 ,两支肌间血管在汇合处形成一个锥形漏斗样结构。血管起始端距汇合处 1.0 6ｃｍ ,汇合处到心肌外血管长度是 1.94ｃｍ ,外径为 0 .2 1ｃｍ。肌外血管行于心外膜与心肌之间 ,由…     

胫后动脉的解剖学测量

目的 测量胫后动脉的内径、外径及血管壁厚度,为临床介入治疗下肢尤其膝下动脉闭塞提供解剖学依据.方法 用体视显微镜分组测量30具标本,记录60侧胫后动脉的近端(内踝最高点上5 cm)、中点(内踝最高点)、远端穿踝管后(足底内、外侧动脉分支前)内外径及动脉壁厚度.按年龄分为3组:青年组(年龄30岁以下,n=16);中年组(年龄30～50 岁,n=26);老年组(年龄50岁以上,n=18),并进行性别、年龄、侧别的比较.采用PEMS3.0进行统计学分析.结果 胫后动脉中点的外径(2.74±0.51)mm,内径(1.29±0.47)mm,管壁厚度(0.62±0.18)mm,与近、远端比较,三组数据差异均有统计学意义.两侧的远、中、近三处胫后动脉的内、外径及管壁厚度值无显著差异;男性管壁厚度大于女性;50岁以上者的外径及管壁厚度大于中、青年组.结论 本研究提供了胫后动脉解剖学相关资料及数据比较、分析,其结果为临床对胫后动脉穿刺置管术的开展与应用提供了参考依据.     

彩超测量膀胱壁厚度的实验研究

目的了解彩超经腹壁测量（体外）狗膀胱壁厚度与开腹后探头从膀胱壁外直接测量（体内）膀胱壁厚度有无差异。方法选用10条成年狗用彩超测量膀胱壁厚度。比较经腹壁测量（体外）狗膀胱壁厚度与开腹膀胱壁外直接测量（体内）有无差异。结果 10条成年狗的膀胱壁在不同的容量时,经腹壁测量（体外）与开腹膀胱外直接测量（体内）相比,差异无显著性（P〉0.05）。结论健康成年狗彩超经腹壁与经开腹膀胱壁外直接测定,膀胱壁的厚度基本相同。     

右心室起搏阈值对病态窦房结综合征患者心功能的影响

目的：研究右心室起搏阈值对病态窦房结综合征患者心功能的影响。方法选择2013年1月至2015年12月在我院行双腔心脏起搏器植入术的病态窦房结综合征患者91例,术前使用临时起搏电极在右心室底部、游离壁和流出道分别测定心脏起搏阈值,取三者平均值,根据平均值分为正常起搏阈值组55例(起搏阈值≤1V)和高起搏阈值组36例(起搏阈值>1V),术中测得中心静脉压力(CVP),两组患者术前和术后一周均行B型脑钠肽(BNP)和心超检查测定心功能[左室舒张末内径(LVEDD)和射血分数(EF值)]。结果正常起搏阈值组术前CVP、BNP、LVEDD和EF分别为(10.13±1.12) mmHg、(103.42±10.12) pg/mL、(42.56±5.67) mm和(51.21±6.43)%,高起搏阈值组分别为(13.36±1.45) mmHg、(121.42±12.24) pg/mL、(45.68±5.89) mm和(48.02±5.89)%,术前两组患者的上述各项指标比较差异均有统计学意义(P<0.05);正常起搏阈值组术后BNP、LVEDD和EF分别为(81.36±8.07) pg/mL、(40.12±5.18) mm和(53.87±7.09)%,高起搏阈值组分别为(98.79±9.81) pg/mL、(44.51±5.32) mm和(50.83±6.15)%,术后两组患者的上述各项指标比较差异均有统计学意义(P<0.05)。结论高右心室起搏阈值对病态窦房结综合征患者心功能有不利影响。     

视神经管外侧壁涉及相关结构的应用显微和影像解剖研究

目的 详尽了解国人视神经管外侧壁减压术涉及相关结构入路中的显微和影像解剖学的相关问题,进一步为临床手术应用提供直观的详细的解剖参数和路径实物图.方法 应用10%甲醛充分固定的国人成人尸头湿标本10例20侧,漂白的国人成人颅骨干标本15例30侧,供骨性结构的观察和测量.模拟手术入路在手术显微镜下逐层解剖,结合影像解剖学即成人尸头行头颅CT三维断层扫描+颅底重建,对视神经外侧壁相关解剖结构进行了详细地显微解剖、拍摄、测量和统计.结果 视神经管管内段有上、下、内和外侧4个壁和颅口、眶口2个口组成.视神经管管内段外侧壁主要由前床突构成,其长度为(9.87±1.34)mm,宽度(11.66±2.35)mm,根部厚度(5.35±1.07)mm,中部厚度(4.50±1.06)mm.外侧下方有分隔视神经管和眶上裂的视柱.前床突尖至颈内动脉沟上缘中点的距离(4.25±2.30)mm,前床突有过度气化及床突间骨桥等变异,术中操作可能出现脑脊液漏、继发视神经管损伤和颈内动脉、眼动脉损伤.相关解剖和影像测量前床突两者的长、宽、厚,均数差值为(0.08～0.48)mm,两组间差异无统计学意义(P＞0.05).结论 通过磨除外侧壁可以得到显露清晰的视神经、眼动脉及颈内动脉显微解剖结构.视神经管管内段外侧壁的磨除程度对骨性视神经管减压的充分与否有决定性作用,影像测量及三维颅底重建对观察某一部位及其病变、选择手术入路有重要临床意义,测量值可为临床医师进行手术及相关研究提供一定的参考.

Abstract：

Objective To investigate the key microanatomic and radiological structures of optic canal comprehensively so as to provide anatomic parameters and procedural flows for the decompression of optic canal. Methods Gross observations and microscopic measurements were applied on 10 (20 sides)formalin-treated cadaveric specimens and 15 (30 sides) adult skulls. Using multislice helical CT( computed tomography)-aided three-dimensional reconstruction in combination with direct anatomic measurement, the investigators dissected, photographed, measured and analyzed the shape of optic canal and analyze its anatomic relationship with the adjoining structures. Results Optic canal was formed by the superior,inferior, medial and external walls and distal proximal opening. The lateral wall of optic canal was formed by anterior clinoid process with a length of ( 9. 87 ± 1.34 ) mm, a width of ( 11.66 ± 2. 35 ) mm, a base thickness of (5. 35 ± 1.07) mm and a middle thickness of ( 4. 50 ± 1.06) mm. Optic strut separating the optic canal from the superior orbital fissure was located inferiorly. And the distance between the apex of anterior clinoid process and the middle of ICA (internal carotid artery) groove was (4. 25 ±2. 30) mm. The CSF (cerebrospinal fluid) leakage and secondary injury of optic nerve and injury of ICA, ophthalmic artery might occur during the surgical procedures due to the variation of anterior clinoid process. The microanatomic figures and radiological measurements had a mean difference very close to each other at (0. 08 -0. 48) mm.No statistical difference was found ( P ＞ 0. 05 ). Conclusion Optic nerve, ophthalmic artery and ICA may be exposed by a high-speed drilling of the lateral wall of optic canal. The drilling dissection of lateral wall plays a vital role during a successful optic canal decompression. Radiological measurement and threedimensional reconstruction of skull base may be of great clinical significance in lesion visualization. And it helps to make a better choice of surgical approaches. The measurements provide valuable references for surgeons and researchers.     

不同部位起搏对心室间电机械同步性的对比观察

目的 比较右室心尖部(RVA)、右室流出道间隔部(RVS)和左室流出道间隔部(LNS)起搏对心室间电机械同步性的差异,评价出保持心室间电机械同步的理想起搏部位.方法 选择2008年1-12月在我院行射频消融术(左侧隐性旁道)后患者30例,术后分别将标测电极放置于左室后侧壁(LVPLW)及右室前侧壁(RVALW),大头消融电极依次放置于RVA、RVS、LVS起搏.通过测量起搏点至LVPLW及至RVALW的传导时间差来反映心室间电激动的同步性,不同部位起搏主动脉射血前间期(APEI)与肺动脉射血前间期(PPEI)差来反映心室间机械收缩同步性,并比较两者相关性.结果 RVA起搏时至LVPLW及至RVALW的传导时间差为(34±7)ms,RVS起搏为(18±4)ms,LVS为(12±4)ms,差异有统计学意义(P＜0.01).RVA起搏APEI-PPEI绝对值为(25±5)ms;RVS起搏为(13±4)ms,LVS为(11±3)ms,差异有统计学意义(P＜0.01).心室起搏后,LVPLWRVALW差值变化与APEI-PPEI绝对值增加呈正相关(r=0.993,P＜0.01).LVS起搏后主动脉压[(127±23)mm Hg]和左室收缩末压[(142±22)mm Hg]明显增加(P＜0.05),左室舒张压显著降低[(9±3)mm Hg,P＜0.05].结论 LVS起搏对心室间电机械同步性影响小,更符合生理性的起搏,心室间电激动与机械收缩同步相一致.

Abstract：

Objective To compare the different impacts of right ventricular apex, right ventricular outflow tract septum and left ventricular outflow tract septum region on interventricular electro-mechanical synchronization and assess the ideal pacing sites for maintaining the interventricular electro-mechanical synchronization. Methods A total of 30 patients without organic heart disease were operated with radiofrequency ablation at our hospital. The mapping electrodes were implanted post-operatively on the left ventricular posterior wall (LVPLW) and right ventricular anterior lateral wall (RVALW) respectively. And the ablation electrodes were placed subsequently in right ventricular apex, right ventricular outflow tract septum region and left ventricular outflow tract septum. The difference values were measured between transmission time from pacemaker to LVPLW, from pacemaker to RVALW and between aortic pre-ejection interval (APEI) and pulmonary artery pre-ejection interval (PPEI). Then their correlations were compared. Results When pacing at right ventricular apex, the difference value between transmission time from pacemaker to LNPLW and from pacemaker to RVALW was (34±7)ms. And it was (18 ±4)ms while pacing at right ventricular outflow tract septum region and ( 12 ± 4)ms at left ventricular outflow tract septum region. There was significant difference (P＜0.01). The absolute value of APEI-PPEI was (25 ±5) ms at right ventricular apex, (13±4) ms at right ventricular outflow tract septum region and (11±3) ms at left ventricular outflow tract septum region. And there was significant difference (P ＜0. 01 ). The absolute value of APEI-PPEI was positively correlated with the change of LNPLW-RVALW (r= 0. 993, P ＜ 0. 01 ). Left ventricular outflow tract septum pacing showed ABp and left ventricle end-systolic pressure significantly increased [(127±23) mm Hg, (142±22) mm Hg,P ＜0.05], left ventricular end-diastolic pressure was significantly lower [(9±3) mm Hg, P ＜ 0. 05]. Conclusion Compared with right ventricular apical pacing and right ventricular outflow tract ventricular septal pacing, left ventricular outflow tract septum has a smaller impact on the electro-mechanical synchronization. It conforms more closely to the physiological pacing so that there is a higher synchronization of electrical and mechanical ventricular contractions.     

三点连线法指导床边经左锁骨下静脉快速心脏起搏

将78例患者分为2组,A组40例床边经左锁骨下静脉临时心脏起搏,应用“三点连线法”指导床边经左锁骨下静脉快速心脏起搏;B组38例在X线透视下穿刺左或右侧锁骨下静脉进行临时起搏。结果示2组患者手术成功率均为100％,电极操作时间及起搏阈值无差异（P〉0．05）,总抢救时间A组明显短于B组（P〈0．01）。成功后电极平均深度为“三点间连线长度＋9．0cm”。提示利用三点连线法指导床边经左锁骨下静脉快速心脏起搏时能有效缩短手术时间,适用于不同年龄、身高和体形的患者,对无自主心律和有自主心律的严重缓慢性心律失常同样有效。     

Left atrial wall thickness: anatomic aspects relevant to catheter ablation of atrial fibrillation

Background  The success and complication rates of atrial fibrillation (AF) ablation may be related to regional differences in left atrial (LA) wall thickness. The purpose of this study was to investigate the transmural LA wall thickness in various regions.

Methods  We measured LA wall thickness in 36 human heart specimens using calipers at three planes including left pulmonary veins (PVs) vestibule plane, right PVs vestibule plane and the middle plane between the two. In each plane, eight points were selected, including superior, middle and inferior levels at anterior and posterior wall, roof and bottom.

Results  The anterior and posterior wall thickness displayed gradient from superior to inferior level (anterior wall: (2.73±1.01) mm, (2.08±0.91) mm and (1.54±0.69) mm; posterior wall: (1.74±0.68) mm, (1.48±0.39) mm and (1.27±0.42) mm). At the roof, LA wall thickness was thickest in middle plane ((2.01±1.02) mm) and was thinnest in left PVs vestibule plane ((1.29±0.41) mm). The posterior wall thickness in left PVs vestibule plane was thinner than in the other two planes (P <0.05–0.001), and was thinner in right PVs vestibule plane than in middle plane (P <0.01–0.001). Whereas in anterior wall, the wall thickness in left PVs vestibule plane was thicker than in middle and right PVs vestibule plane.

Conclusions  Significant variations exist for mean LA wall thickness at different regions which are often targeted during circumferential pulmonary venous ablation (CPVA). Appreciating these differences may have significant implications in catheter ablation of AF.

     

DDD起搏器的心房电极放置体会

总结１３例ＤＤＤ起搏器植入术中心房电极放置的体会，认为应先放置心室电极，后放置右房电极，操作过程要缓慢、细心观察电极头在右心耳的左右摆头现象，并维持导管一定弯度，保持适当的张力，以防止电极脱位，同时，术后的卧床休息亦有益于心房电极的固定