舌的淋巴系

在80具小儿尸体上,用器官内淋巴管注射方法,观察了舌器官内淋巴管及其淋巴流向。舌前及舌后背侧粘膜只有单层毛细淋巴管网,舌体背侧和舌下面粘膜存有浅、深两层毛细淋巴管网。舌前部淋巴管多半注入颏下淋巴结和下颌下淋巴结,舌中央部淋巴管多是注入平对舌动脉起点高度的颈深上淋巴结及下颌下淋巴结,舌侧部淋巴管主要注入下颌淋巴结和颈静脉二腹肌淋巴结,舌后部淋巴管全部注入颈静脉二腹肌淋巴结。     

鼻咽部的淋巴系

1.在70例胎儿及婴儿尸体上用器官内淋巴管注射的方法,观察了鼻咽部的淋巴管及其局部淋巴结。 2.在鼻咽部粘膜层具有一层毛细淋巴管网,于咽鼓管扁桃体及咽扁桃体处最为密集。粘膜层毛细淋巴管注入粘膜下淋巴管,后者汇成数条输出管。 3.从鼻咽部后壁走出的输出管注入咽后内、外侧淋巴结,或是经过颈内动、静脉的后方,注入乳突尖部深处的颈上深淋巴结。 4.从鼻咽部侧壁走出的输出管,注入颈内动、静脉出入颅底处前方的淋巴结,或向下入颈静脉二腹肌淋巴结及在舌动脉起点至颈总动脉分岐处之间的颈上深淋巴结。 5.咽后外侧淋巴结位于寰椎侧块高度,有1～2个;咽后内侧淋巴结紧贴咽腱膜,仅有1个。充色的颈静脉二腹肌淋巴结仅有一个,形体较大。     

甲状腺侧叶淋巴引流到颈淋巴结的观察及临床意义

目的：为治疗甲状腺癌手术清除淋巴结和放射治疗范围提供解剖学基础。方法：在５０例新生儿及婴儿尸体上，用普鲁士兰氯仿溶液向甲状腺侧叶的实质内注射，观察其淋巴引流及颈淋巴结。结果：①甲状腺侧叶的淋巴引流主要注入同侧颈深上、中、下淋巴结，气管旁、气管前淋巴结，喉前淋巴结和锁骨上淋巴结；②此外，有些淋巴管经颈深淋巴结后注入同侧的副神经淋巴结和下颌下淋巴结；③还有部分淋巴管越过中线注入对侧的颈深中、下淋巴结，气管旁淋巴结和锁骨上淋巴结。结论：患甲状腺癌时，不仅要清除同侧的颈深淋巴结，下颌下淋巴结和锁骨上淋巴结，还要注意对侧的颈深中、下淋巴结，气管旁淋巴结和锁骨上淋巴结的清除和放射治疗。     

下颌下淋巴结的解剖学研究

目的 :研究下颌下淋巴结的分布状况 ,为临床颈淋巴结清扫术提供解剖学依据。方法 :对 57侧成人头颈部标本进行观测分析 ,并对 6侧新生儿下颌下腺进行序列切片 ,组织学检查。结果 :成人及新生儿标本中均未见腺内淋巴结。下颌下淋巴结数目多为 3个 ,其中腺上、腺前、腺后和腺深群淋巴结数目分别占标本淋巴结总数的 59.4 %、2 4 .2 %、1 5 .2 %、1 .2 % ;从分布区域看 ,腺上群淋巴结出现率最高(1 0 0 % ) ,其次依次为腺前群 (61 .4 % )、腺后群 (38.6 % )和腺深群 (3 .5 % )。结论 :对下颌下淋巴结进行分群研究 ,为临床颈淋巴结清扫术提供了解剖学依据 ,并对此术式是否一定要摘除下颌下腺提出了建议。由于腺内淋巴结存在的机率极小 ,在较早期的口腔癌行选择性颈淋巴结清扫术时 ,可考虑保留下颌下腺及其功能 ,但需注意清扫干净腺周各群淋巴结     

自体下颌下腺部分移植治疗干眼病的应用解剖学

目的:为血管化自体下颌下腺部分游离移植治疗重症干眼病微创手术提供形态学依据.方法:在30侧经红色乳胶灌注的成人标本上,对下颌下腺腺体的体积、下颌下腺导管的长度及腺体周围动静脉腺支血管的走行、分布、毗邻关系等显微解剖特点进行了较为详细的观测.结果:下颌下腺分为浅部和深部.浅部体积约为(1.77±0.53)cm3;深部体积约为(1.08±0.84)cm3.下颌下腺导管由下颌下腺浅部的深面发出,长约5 cm.营养下颌下腺的最丰要血供来源为面动脉和颏下动脉.下颌下腺的主要同流静脉是面静脉.结论:根据下颌下腺导管、下颌下腺及周围动静脉腺支的解剖点,提示在采用血管化自体下颌下腺游离移植治疗重症干眼病的手术时,可以将带血管的下颌下腺浅部及导管移植至颞部.术式经标本模拟具有可行性.     

下颌骨磨牙区淋巴流向的应用解剖

用普鲁士蓝氯仿液对３０具胎儿及５具新生儿的新鲜尸体作下颌骨磨牙区内淋巴管间接注射，观察下颀骨磨牙区集合淋巴管的主要行程：①经下颌磨牙区的牙槽窝沿下颌骨内、外面骨膜的浅面，下行至下颌下淋巴结及角淋巴结；②伴下牙槽神经、血管经下颌孔至翼颌间隙，再行至下颌下淋巴结及角淋巴结；③穿颏孔伴面血管至下颌下淋巴结。以上各淋巴结的输出淋巴管至颈外侧深淋巴结上群。在解剖显微镜下见到淋巴管主要行于肌间隔内。本研究为下颌骨恶性肿瘤病灶切除范围及改良性或功能性颈清扫术，提供解剖学依据。     

新生儿和婴儿肝淋巴流向的研究

用淋巴管间接注射法，观察了１３２具新生儿和婴儿的肝淋巴流向。结果表明肝浅部淋巴管主要形成９条集合淋巴管离开肝脏，注入局部淋巴结。而肝深部淋巴管集合成２组经肝门离开肝脏，肝左叶实质内数条淋巴管组成左前组，右叶实质内的深淋巴管组成右后组。两组深淋巴管分别注入肝总淋巴结和门静脉后淋巴结。肝浅、深部淋巴管间有交通支相互吻合。     

耳后发际入路内镜辅助下颌下腺切除术的解剖研究

目的　为耳后发际入路内镜辅助下颌下腺切除术提供解剖学依据,并评价其可行性和安全性。 方法　新鲜尸体15具（30侧）,观测耳后发际区和颌下区的解剖层次及重要结构。新鲜尸体5具（10侧）,模拟内镜手术,术后解剖标本,观察有无神经、血管损伤。 结果　耳后发际区的分离层面在表浅肌肉腱膜系统与颈深筋膜浅层之间。胸锁乳突肌上部浅面,由后上至前下依次为枕小神经、耳大神经、颈外静脉。颌下区的分离层面在颈阔肌深面与下颌下腺鞘膜之间。下颌缘支出腮腺后：①66.7%行于下颌骨下缘之上（7.21±0.50）mm;②23.3%平行下颌骨下缘;③10％行于下颌骨下缘以下（9.43±0.32）mm。在咬肌前下角处,面神经下颌缘支均与面动脉和面静脉交叉,交叉点至下颌角距离分别为（29.86±2.77）mm和（25.71±3.32）mm。舌下神经经茎突舌骨肌和二腹肌后腹深面进入颌下区。舌骨舌肌浅面,自上而下分别是舌神经、下颌下腺导管、舌下神经。10侧模拟手术顺利完成,术中无重要结构损伤,无需中转切口。 结论　熟悉耳后发际区和颌下区的解剖层次、标志及参数,耳后发际入路内镜辅助下颌下腺切除术安全、可行。     

膀胱的淋巴流向

在６５具童尸上，用３０％普鲁士兰氯仿溶液进行器人洲射，观察了膀胱各区域的淋巴流向，来自膀胱前壁的淋巴管行向外上方，直接或经膀胱外侧淋巴前淋巴结后间接注入髂外淋巴结，髂内淋巴结，髂总淋巴结及闭孔淋巴结。来自膀胱后壁的淋这向后上方，直接或经膀胱外侧淋巴结后间接注入髂外淋巴结，髂内淋巴结，髂总淋巴结，骶淋巴及主动脉下淋巴结。     

下颌下腺移位预防放疗口干燥症的应用解剖

目的　为下颌下腺移位于颏下间隙预防头颈部放疗后口干燥症提供解剖学基础。 方法　30侧经颈外动脉灌注红色乳胶的正常成人头颈部标本,在2.0~3.0倍的便携式手术显微镜下对下颌下腺及血管进行显微解剖,观测下颌下腺腺体的体积、下颌下腺导管的长度及腺体周围动静脉腺支血管的走行、分布、毗邻关系等显微解剖特点。 结果　下颌下腺以下颌舌骨肌后缘为界分为较大的浅部和小的深部。浅部体积为（1.7±0.5）cm3;深部为下颌下腺的延长部分,体积为（1.0±0.8）cm3。下颌下腺导管由下颌下腺浅部的深面发出,长约5cm,开口于舌系带旁的舌下肉阜。 结论　下颌下腺移位于颏下间隙预防头颈部放疗后口干燥症的手术具有可行性。     

Metastatic tumors to the parotid and submandibular glands--analysis and differential diagnosis of 108 cases

The distinction between primary salivary gland tumors and metastases of other primary tumors in salivary glands is of special importance for therapy and prognosis. In the files of the Salivary Gland Register, 10,944 cases were collected during 1965 and 1985. Among these cases, there were 108 cases of metastatic tumors to the parotid and submandibular gland. The pathohistological analysis of these tumors revealed the following data: 47 cases (43%) of metastatic tumors were localized in the parenchyma of the parotid gland (37 cases) or of the submandibular gland (10 cases). 61 cases (57%) displayed metastases in the lymph nodes of the parotid gland (38 cases) or of the submandibular gland (23 cases). The sublingual gland was free of metastatic tumors. 65 metastatic tumors originated from primary tumors in the neighborhood (head and neck). 32 tumors were carcinomas of the skin, 17 tumors were melanomas, and 13 tumors were nasopharyngeal cancers. Metastases of thyroid cancers were found in 3 cases. The relative frequency of metastases in the lymph nodes of the salivary glands is due to the intense drainage with lymph vessels and the presence of many lymph nodes which are localized especially in the gland parenchyma or around the parotid gland. 21 metastatic tumors originated from primary tumors distant from the head and neck region. There were metastases of lung cancers (7 cases), renal cancers (6 cases), mammary cancers (6 cases), colonic cancer (1 case) and uterus cancer (1 case). Clear cell carcinomas in salivary gland tissue should always be checked for a metastasis of a primary renal cancer.(ABSTRACT TRUNCATED AT 250 WORDS)     

The anatomical features and surgical usage of the submental artery

The skin characteristics make the submental region an available flap site for facial and intraoral reconstructions. For this reason, the anatomy of the submental region and the submental artery (SA) has gained in importance recently. The SA branches out from the facial artery at the level of superior edge of the submandibular gland. The SA runs anteromedially below the mandible and superficial to the mylohyoid muscle. It gives off some perforating branches to the overlying platysma and underlying mylohyoid muscle during its course. The terminal branches continue toward the midline, crossing the anterior belly of digastric muscle either superficially or deep, and end at the mental region in general. Some perforating arteries from the terminal branches supply the anterior belly of digastric muscle. This study aimed to describe the anatomical features of the SA and its branches to help in the preparation of submental arterial flaps.     

Evidence of antibody production in the rat cervical lymph nodes after antigen administration into the cerebrospinal fluid

We previously showed histologically that, in the rat, the cerebrospinal fluid drains from the subarachnoid space along the olfactory nerves to the nasal lymphatics and empties into the superficial and deep cervical lymph nodes. The present study was performed to investigate whether these lymph nodes play a role in the immune response of the central nervous system. For this purpose, keyhole limpet hemocyanin conjugated with fluorescein isothiocyanate (KLH-FITC) was administered into the subarachnoid space of the rat brain, and the time-kinetics and location of FITC and anti-FITC antibody forming cells in the cervical lymph nodes were studied histologically and immunohistochemically. FITC fluorescence was detected in superficial and deep cervical lymph nodes as well as the subarachnoid space and the nasal mucosa 2 h after FITC-KLH injection into the subarachnoid space. The specific antibody-forming cells first appeared in both the superficial and deep cervical lymph nodes on the 4th day after antigen administration although the reaction was more intense in the deep than in the superficial cervical lymph nodes. These cells were located in the medullary cords of the cervical lymph nodes. The number of antibody forming cells increased thereafter, reached a peak around the day 6, and then declined on day 10. These findings indicate that antigens introduced in the cerebrospinal fluid are drained into the cervical lymph nodes through the nasal lymphatics and initiate the antigen-specific immune response there. Thus, the cervical lymph nodes probably act as a monitoring site for cerebrospinal fluid and play a major role in the central nervous system immune response.     

Plunging ranula

Saliva extravasation from the sublingual gland causes ductal lesion or obstruction and results in the formation of a ranula. It spreads through or behind the mylohyoid muscle situated on the neck. Most frequently it is located in the submandibular or submental region. The diagnosis of plunging ranula is simple if the signs of ranula are present in the intraoral cavity, whereas in case of a ranula localized on the neck definite diagnosis is made by histologic analysis of the pseudocyst that has been surgically excised in toto. Cases are presented of both types of plunging ranula treated by various surgical approaches. Plunging ranula in the submental region was treated by transoral approach, marsupialization and aspiration of the content, whereas the ranula in the submandibular region was treated by exterior cervical approach. In both cases, sublingual gland was removed. During the 3.5-year follow-up, neither recurrence of the disease in the neck area nor the occurrence of simple ranula in the intraoral region was observed.     

Immune Response in Deep Cervical Lymph Nodes and Spleen in the Mouse after Antigen Deposition in Different Intracerebral Sites

Brain interstitial and cerebrospinal fluid drainage into the lymphatics was studied by injections of 5 microliters of packed sheep red blood cells (SRBC) injected into the caudate nucleus, the occipital lobe, and the lateral ventricle of the brain in mice. The number of plaque-forming cells (PFC) was determined in the deep cervical lymph nodes, the axillary lymph nodes, and the spleen, and the number of PFC was compared with the response in the same tissues after intravenous immunization with 0.1 ml 10% SRBC. The weight of the deep cervical lymph nodes increased 3.0 times on day 3 after injection in the brain parenchyma compared with the weight of these nodes after intravenous immunization. The antigen-specific response peaked on day 5, 392 +/- 37 PFC/10(6) for IgG in the deep cervical lymph nodes after antigen deposition in the caudate nucleus, whereas only a minor peak in the antigen-specific response was obtained after intraventricular antigen deposition, 127 +/- 79 PFC x 10(6) for IgG on day 6. There were no increased PFC in any of the lymph nodes after intravenous immunization. The experiments show an antigen-specific response in the deep cervical lymph nodes after intracerebral antigen deposition, whereas antigens deposited in the lateral ventricles drain preferentially to the blood, with a high response in the spleen.     

家兔甲状腺的淋巴流向

用活体淋巴管注射法，研究了４０只家兔甲状腺的淋巴流向。甲状腺的集合淋巴管多是注入颈深淋巴结，一部分汇入喉腹侧淋巴结及气管旁淋巴结。在６例有一条集合淋巴管直入颈内静脉或静脉角。     

Pattern of nodal involvement in papillary thyroid cancer: a challenge of quantitative analysis

Introduction: Backgrounds of this study were to examine and analyse the relationship among the number of lymph nodes with metastases harvested in central and lateral compartments, the characteristics of tumours and patients, and the recurrences rate. Methods: A retrospective review of 118 patients treated for a papillary thyroid cancer and underwent to neck dissection, including in all cases both central and lateral compartment, was realised. A quantitative analysis, on this homogeneous cohort of patients, was performed to hypothesize the minimum number of cervical lymph nodes to be necessarily excised in order to obtain an adequate management of these patients. Results: The mean follow-up time was 75.9 months. Five-year overall survival was 96.6%. The correlation among the metastatic lymph node number of the ipsilateral central compartment, isolated or pooled with those of the ipsilateral lateral compartment, age of patient and tumour size revealed a statistical significance (P=0.01); both parameters, tumour size and age, may be considered as dependent predictor variables. Conclusion: We suppose, notwithstanding the limited number of patients, that the number of lymph nodes harvested to achieve an optimal cervical dissection may be superior to 8 and 11 in central and lateral compartments, and 6 and 10 in contralateral ones, respectively. Moreover we recommend the bilateral dissection of central nodes compartment in presence of tumour localised in the isthmus.     

The problem of direct lymph drainage of the bronchopulmonary segments into the mediastinal and hilar lymph nodes

The phenomenon of skip metastases depends on the occurrence of direct metastases of non‐small cell lung cancer into mediastinal lymph nodes without the involvement of hilar lymph nodes. The medical literature suggests that this prevalence ranges between 13 and 37.8% of cases. The goal of our study was to evaluate the prevalence of subpleural superficial lymphatic vessels carrying the lymph from the bronchopulmonary segments directly to the mediastinal nodes thus skipping the hilar nodes and determine whether there is a tendency towards differentiation in lymph drainage between males and females. During autopsy, 27 left and 27 right lungs were removed from 19 male and eight female cadavers. The lymphatic vessels were visualized at the mediastinal and interlobar surface of the lung by visual inspection. These vessels were then cannulated and injected with drawing ink. The first lymph node to become ink‐colored via injection was dissected and histologically examined. The lymph flowed into hilar lymph nodes in 79.5% of the cases and into the mediastinal nodes in 20.5% of all the 83 vessels injected; of these 13.2% were from the right lung and in 7.2% from the left lung. The upper right lobe (5/14 vessels) and its anterior segment (3/14 vessels) were the most common source of the direct lymph drainage to the mediastinum. Vessels of 15.4% in female cadavers (4/26) and 22.8% vessels in male cadavers (13/57) traveled directly to mediastinal nodes skipping the hilar nodes. This difference was not statistically significant. Clin. Anat. 22:509–516, 2009. © 2009 Wiley‐Liss, Inc.     

成人IgG4相关性颌下腺疾病的超声表现

目的 分析及归纳IgG4相关性颌下腺疾病的超声影像特征.方法 回顾性分析19例22灶IgG4相关性颌下腺疾病的超声表现,包括颌下腺尺寸、形态、病变范围、内部回声、血流、周围淋巴结.结果 19例22灶IgG4相关性颌下腺疾病的超声表现可分为局限性结节样改变、弥漫性结节样改变、类肿瘤样改变3种类型.局限性结节样改变(2例2灶),病侧腺体的浅侧、被膜下显示不均匀增粗的低回声区,内见条状强回声,血流偏多.弥漫性结节样改变(11例12灶),病侧腺体呈网格状或蜂窝状,具体表现为腺体回声增强、增粗、不均匀、血流丰富,内见弥漫、散在、大小不一的结节样低回声,其周围显示条状强回声.类肿瘤样改变(7例8灶),病侧腺体表现为回声不均匀减低、增粗,内夹杂多发条状强回声,并显示放射状丰富血流.结论 超声检查可作为IgG4相关性颌下腺疾病首选的影像学检查方法.该病超声影像呈局限性结节样改变、弥漫性结节样改变、类肿瘤样改变3种类型.当怀疑患IgG4相关性颌下腺疾病时,应进一步检查IgG4相关性疾病常累及的组织和器官,同时进行超声引导下穿刺活检明确诊断.