预防大隐静脉术中股静脉损伤的应用解剖

目的 :探讨大隐静脉术中可能造成股静脉损伤的解剖学因素 ,并提出相应的预防措施。方法 :对 5 2条患肢和 40条下肢标本的隐静脉裂孔及大隐静脉根部的局部解剖结构进行观察与测量。结果 :隐静脉裂孔形态以卵圆形和盾形者为主 ,其纵径 (40 .0± 12 .0 )mm ,横径 (2 8.0± 9.0 )mm ,大隐静脉根部属支以 3或 4支为多见。结论 :根据隐静脉裂孔特点及属支解剖情况 ,作者认为 :①切口要足够大 ;②正确识别解剖层次 ;③掌握正确的高位结扎部位。是防止术中股静脉损伤的关键。     

下肢主要静脉的应用解剖

用35侧成人(男性21侧,女性14侧)下肢新鲜标本经乳胶灌注后,对浅、深静脉的长度、外径、穿通支及瓣膜进行解剖观察。大隐静脉长度为70.57±0.94cm(变动范围52～80cm)。共属支以3～5文为多数.穿通支可分为三类:直穿支、穿肌支和混合支。瓣膜数为6～9个(8.21±0.56)。管径在内踝尖处均值为2.31±0.25mm。小隐静脉以单支注入腘静脉占42.86+9.35%。长度平均为41.17±1.81cm。管径在A线处为2.22±0.17mm;在D线处为2.37±0.39mm。瓣膜数为2～10个(6.75±0.44)。大、小隐静脉瓣膜位于不同部位山现率亦不同。结果提示为临床手术剥脱法治疗静脉曲张、血管外科修补和移植提供形态学资料。     

大隐静脉与股静脉交汇点解剖变异1例报道

我们在行右下肢单纯性大隐静脉高位结扎＋分段抽剥术时,发现大隐静脉与股静脉交会点变异,特报道如下。     

健侧大隐静脉与股深静脉吻合治疗下肢深静脉栓塞的应用解剖

ObjectiveTo provide anatomical basis for treatment of the deep venous thrombosis of lower limb with deep femoral vein shunting to contralateral great saphenous vein.MethodsThe course,tributaries,valve,anastomosis,length and diameter of the deep femoral vein were observed and measured on 30 sides of adult cadavers.ResultsThe deep formal vein,formed by the perforating venous trunk and tributaries of gracilis muscle,converged into the femoral vein 8.6±0.9 cm below the midpoint of inguinal ligament.Its truck was 2.6±0.5 cm long and 6.9±1.1 mm in diameter.In 29 cases,there was 1 valve proximal to the abouchement of the first perforating vein.The deep femoral vein collected the venous blood of the thigh and the knee,the superficial venous blood of the shank.ConclusionsThe deep femoral vein anastomosis with the contralateral great saphenous vein can remit the swelling and the venous high pressure of the lower limb by shunting the deep femoral venous blood to the contralateral great saphenous vein.     

下肢深静脉瓣膜的应用解剖

在30具成人尸体上,对60侧股静脉,胸静脉、股深静脉、胫前静脉,56侧胫后静脉,58侧腓静脉的瓣膜进行了观察,深入研究了各段静脉瓣膜的出现率、数目、形态、分布和位置。单侧下肢深静脉瓣膜总数平均值为48.61个。绝大多数瓣膜为双叶瓣(99.34%±0.14%),极少数为单叶瓣(0.61±0.14%),三叶瓣罕见(0.03±0.03%)。双叶瓣大部分位于静脉的前、后壁(88.78±0.58%),少部分位于静脉的左、右壁(11.21±0.58%);单叶瓣位于静脉的后壁;三叶瓣位于静脉的右、后、右壁。     

股外侧浅静脉与大隐静脉汇成静脉窦变异1例

《局部解剖学》所述,大隐静脉及其5条属支常发生变异,它们汇人大隐静脉的形式有不同的类型,较常见为腹壁浅静脉起自旋髂浅静脉为25．6％。     

腘静脉的组成及其瓣膜的观测

对100侧成人尸体各23侧童尸下肢小腿深静脉的观察和测量,结果表明:腘静脉的支数以2支型最多(65.85%);腘静脉的组成分2个主型和10个亚型,以Ⅰ a 型最多(26.39%);腘静脉外径(成人86侧)1支型平均值为6.03mm、2支型大支为6.35mm,小腿诸深静脉外径均较细小。102侧腘静脉中平均每条腘静脉有2.26个瓣,一条腘静脉内有2个瓣者最多(53.92%);腘静脉第1段第1瓣位置平均在膝关节线以上12.06cm,胭静脉第2段第1瓣位置在膝关节线以下2.08cm。92侧小隐静脉的回流分3型,正常型最多见(占78.26%)。     

足背浅静脉及其瓣膜的应用解剖

在专供研究用的21具(42侧)成人足标本上,解剖观测了足背浅静脉及其瓣膜,发现大、小隐静脉足背段瓣膜数分别为2.8个和1.4个;在第一～四跖背静脉汇入口处瓣膜出现率分别为70.0%,53.3%,85.3%,77.8%,在共干型的跖背静脉内瓣膜出现率达100%;在直径小于2mm的跖背静脉也观测到瓣膜。本文认为足背静脉(弓)作为移植体(静脉动脉化)来修复掌浅弓缺损可以减少临床修复掌浅弓手术的复杂性。但应充分重视足背静脉(弓)内及跖背静脉汇入口处的静脉瓣。     

大隐静脉剥脱术误扎股动、静脉的治疗体会

目的 探讨大隐静脉剥脱中高位结扎大隐静脉时误扎股静脉或/和股动脉的治疗方法及其临床效果。方法 回顾性分析 2011 年9月—2015 年10月徐州仁慈医院收治外院转诊的7例大隐静脉剥脱术中高位结扎大隐静脉时误扎股静脉或/和股动脉患者的临床资料,其中男4例、女3例,年龄39～61岁;股静脉破裂1例,股静脉切断结扎4例,股动脉切断结扎1例,股动、静脉切断结扎1例。7例患者中,股静脉破裂修补1例,屈髋屈膝位吻合血管3例,对侧大隐静脉移植桥接修复2例,人工血管移植桥接修复1例。结果 本组7例患者术后血管造影示术侧股动、静脉通畅。术后随访6个月~ 3年,所有患者患肢功能满意,行走正常。结论 实施大隐静脉高位结扎手术时,应熟练掌握解剖基础;术中误扎股动、静脉后,应根据缺损程度及时采取适当的术式进行修复重建,可获得满意疗效。     

大隐静脉瓣膜的形态特点及其意义

目的:为临床诊断和治疗大隐静脉曲张、构建组织工程静脉瓣提供形态学基础。方法:34侧大隐静脉股段标本按自身比例均分为近、中和远3段,手术显微镜下解剖、观察瓣膜的形态,测量相关数值,分析瓣膜与静脉属支的关系。对新鲜瓣膜行Masson三色改良染色和H-E染色。结果:大隐静脉股段瓣膜数为(3.18±0.94)个,瓣膜以半月形双叶瓣为主,瓣膜方位无显著性差异,隐-股点主要位于属支汇入处的远心端(Ⅲ型)。瓣膜的窦面和腔面均覆着一层内皮细胞,在管腔面内皮下层覆着数层网状的弹力纤维,瓣膜主要由胶原纤维构成。结论:通过对大隐静脉瓣膜形态学研究,获取了其基本形态学特点及数据,为进一步临床研究及组织工程构建人工瓣膜提供形态学参考。     

Anatomical basis of an original pedal approach to the great saphenous vein for surgery

Varicose vein repair often necessitates a distal approach to the great saphenous vein (GSV). The classic method involves a medial pre-malleolar approach. We propose a more distal approach via the medial surface of the foot where there is a cutaneous landmark, which can be used to locate the GSV in a simple, reliable and reproducible fashion. In 20 cadaveric feet, we dissected out the GSV exploiting the above-mentioned cutaneous landmark. We then extended the dissection up as far as the medial pre-malleolar region (from where the GSV is classically approached) in order to be able to compare the diameter of the vein at the two different points (in the foot and in the pre-malleolar region). We also compared the cutaneous landmark with ultrasonographic location of the GSV in 22 feet of healthy subjects. Both dissections and ultrasound examinations demonstrated the reliability of the cutaneous landmark. Moreover, no significant difference was detected in the diameter of the GSV at the two different approach points. This original distal approach to the GSV requires only minor modifications of current practice for varicose veins surgical treatment.     

股神经周围筋膜及其毗邻结构的解剖

目的 探讨股神经周围是否存在完整的筋膜鞘以及股神经与周围筋膜的解剖学关系,为下肢外周神经阻滞麻醉的选择提供形态学依据。方
法选择5具10%福尔马林固定的两侧第1腰椎至大腿中段保存完整的标本进行研究,共10侧;其中8侧由远端向近端逐步注射乳胶后局部解剖观察,
1具标本即2侧经-35℃冷冻1周后制成横断面连续断层切片,行断层解剖观察。结果 本实验未发现股神经周围存在完整筋膜鞘。股神经周围有筋膜
样结构包绕,从近端向远端主要包括腰丛筋膜、腰大肌肌间隔、髂筋膜及疏松的脂肪组织。结论 大体解剖学观察股神经周围并不存在完整筋膜
鞘。     

肘部动静脉内瘘手术解剖学基础及临床应用

目的　探讨肘部动静脉内瘘的手术方法及在血液透析中的应用。 方法　2006年5月至　2012年5月完成肘部动静脉内瘘术22例。采用肘关节横纹下2～3 cm横切口,其中桡动脉与肘正中静脉端侧吻合17例,侧侧吻合2例,2例采用头静脉与肱动脉进行侧侧吻合,1例采用贵要静脉与肱动脉进行侧侧吻合。所有患者围手术期均采用彩色多普勒进行动态观察评估。 结果 平均手术时间为(120±16.15) min。在手术中无外科并发症。术后内瘘均立即通畅,前臂可触及动脉搏动。平均内瘘成熟时间为(41±8.15) d。术后早期1例因动脉搏动欠佳出现血栓阻塞。2例出现短暂性前臂局部水肿。其余患者未出现盗血综合征,动脉瘤,栓塞,感染,出血等并发症。 结论　肘部动静脉内瘘是维持血液透析患者一个理想和安全的选择。手术方法应根据患者肘部血管的解剖学特点进行选择。     

甲状腺假被膜的形态特点及临床意义

目的　研究甲状腺假被膜的解剖学形态特点,探讨其临床意义。 方法 在95例单侧甲状腺叶切除术中,观察甲状腺假被膜的解剖学形态,甲状腺假被膜与真被膜、甲状腺血管、甲状旁腺和喉返神经的关系。 结果 在甲状腺下静脉、中静脉和上血管附着于腺体的部位,甲状腺假被膜呈“系膜”样结构附着在腺体上,切除腺叶后观察“系膜”呈“C”型的延续平面,甲状腺下静脉、中静脉和上血管分别自系膜缘穿出,喉返神经、甲状腺下动脉、甲状旁腺位于“系膜”的“C”型圈内。 结论 对甲状腺假被膜的解剖新认识,有助于术者安全的完成甲状腺手术,特别是被膜解剖技术的应用。     

Number and location of venous valves within the popliteal and femoral veins: a review of the literature

Although deep venous insufficiency is common and important, the anatomy of deep vein valves is poorly understood. The aim of this study was to investigate the location, number and consistency of venous valves in the femoral and popliteal veins in normal subjects. A detailed literature search of PubMed was performed. Abstracts and selected full text articles were scrutinised and relevant studies published between 1949 and 2010 reporting anatomical details of deep vein valves were included. From 7470 articles identified by the initial search strategy, nine studies with a total of 476 legs were included in this review. All studies were cadaveric and subjects ranged from stillborn fetuses to 103 years of age. Studies suggested that femoral veins contain between one and six valves, and popliteal veins contain between zero and four valves. Deep vein valves were consistently located in the common femoral vein (within 5 cm of the inguinal ligament), the femoral vein (within 3 cm of the deep femoral vein tributary) and in the popliteal vein near the adductor hiatus. Valves are consistently located at specific locations in the deep veins of the leg, although there is often significant variability between subjects. Further anatomical and functional studies using new imaging modalities available should target these areas to identify whether certain valves play a more important role in venous disease. This may guide us in the development of new treatment options for patients with deep venous disease.     

经股静脉行肝内门-体静脉分流插管术的回归方程及临床意义

目的　为临床经股静脉肝内门 体静脉分流插管术提供解剖学依据。方法　在 4 5具成人尸体上观测了双侧股静脉穿刺点至肝中静脉的长度 ,与胸骨颈静脉切迹到耻骨联合上缘的距离作相关回归分析。结果　从左侧股静脉穿刺点至肝中静脉的长度为 (3 9 83± 3 87)cm ,直线回归方程为 ^y =3 0 9± 0 71x;P <0 0 2 5 ;从右侧股静脉穿刺点至肝中静脉的长度为(3 8 4 9± 3 60 )cm ,直线回归方程为 ^y =3 0 3± 0 67x ;P <0 0 1;左、右侧股静脉与髂外、髂总静脉的夹角分别为 163 2 2°± 5 5 7°和 166 0 0°± 5 10° ,左、右侧髂外、髂总静脉与下腔静脉的夹角分别为 14 6 4 4°± 9 0 7°和 15 8 0 0°± 5 2 3°。结论　经右侧股静脉插管较左侧更为有利 ,可根据方程计算出从股静脉穿刺点到肝中静脉的长度