胸廓内血管距胸骨边缘距离与心内注射的关系

目的观测胸廓内血管与胸骨边缘的距离,探讨其与心室穿刺的关系。方法解剖20具成年尸体胸前壁,在左、右各肋间,用游标卡尺分别测量胸骨边缘最凹点距胸廓内血管内侧缘、胸廓内血管外侧缘、胸廓内动脉内侧缘、胸廓内动脉外侧缘的水平距离,观察胸廓内动脉与胸廓内静脉排列关系。结果在左侧第四肋间,胸骨左缘距胸廓内血管内侧缘、胸廓内血管外侧缘、胸廓内动脉内侧缘、胸廓内动脉外侧缘平均水平距离分别是0.9500cm、1.5643cm、1.1570cm、1.3857cm;在左侧第五肋间,相应距离分别是0.9071cm、1.6214cm、1.1917cm、1.4333cm。结论心前区右心室注射,为了避免损伤胸廓内血管,应紧贴胸骨左缘进针。     

肋间动脉和肋(骨)的血液供应

肋(骨)的血液供应与临床的带血管游离肋移植术有关。为提供临床参考和累积国人资料。本文研究了100侧成人肋(骨)的血供。肋(骨)的血供来源有发自胸主动脉的肋间动脉(肋间后动脉);发自胸廓内动脉的肋间支(肋前动脉);发自肋颈干的最上肋间动脉发出的第1、2肋间动脉和发自腋动脉的胸最上动脉等。肋(骨)的血供主要来自肋间动脉。本文着重观察了由胸主动脉发出的肋间动脉及其     

胸壁复合组织瓣用于心脏外科小切口的解剖学研究

目的 研究以胸壁带蒂复合组织瓣修复心脏手术后胸壁缺损的可行性，并在此基础上设计出新的心脏手术小切口。方法 观察１０具尸体前胸壁深层结构的血供规律，测量胸骨外侧缘与胸廓内动脉之间的距离。结果 前胸壁学层各结构均由胸廓内动脉及在分支供血，胸廓内动脉距胸骨外侧缘的距离为１ｃｍ左右，紧挨胸骨外侧缘切开肋软骨，可以避免胸廓内动脉的损伤。以该动脉为蒂，可以保证多种前胸壁复合组织瓣有良好的血供。结论 用以胸廓内     

双侧胸廓内动脉起点异位一例

在局部解剖学实验教学过程中,发现1例40岁女尸存在多处变异.其中右侧胸廓内动脉起于锁骨下动脉第3段,左侧胸廓内动脉起于腋动脉第1段(图1).为丰富解剖学资料和临床数据,现报道如下. 右侧:胸廓内动脉起于锁骨下动脉第3段下缘(靠近第1肋内侧缘),起点处的血管外径为3.6 mm、与锁骨下动脉的夹角为49°38′,起点距前斜角肌止点外侧缘的直线距离15.5 mm,发出后斜向左内下,越过前斜角肌止点下方,在距第1胸肋关节上缘26.1 mm处入胸廓,入胸点距前斜角肌止点最下点直线距离11.9 mm,动脉入胸处的血管外径为 3.5 mm,水平夹角46°30′,动脉发出点至入胸点长度35.2 mm(图1).     

冠状动脉旁路术中动脉供体的研究进展

临床冠状动脉旁路术(ｃｏｒｏｎａｒｙａｒｔｅｒｙｂｙｐａｓｓ,ＣＡＢ)始于1962年,当时使用的血管供体为大隐静脉(ｓａｐｈｅｎｏｕｓｖｅｉｎ,ＳＶ)[1]。到1968年,胸廓内动脉(ｉｎｔｅｒｎａｌｔｈｏｒａｃｉｃａｒｔｅｒｙ,ＩＴＡ)开始用于ＣＡＢ,并很快得到推广[2,3]。在随访过程中,不少作者发现,术后ＩＴＡ的通畅率明显高于ＳＶ,并认为其根本原因在于:ＩＴＡ具有与冠状动脉相似的结构和生理特性,而ＳＶ却不具备这些动脉特性,这为动脉供体的应用提供了依据[3,4]。此后,不少自体动脉被用于ＣＡＢ,使ＣＡＢ有了更多的动脉供体来源。对于…     

经皮穿刺心室腔内注射术的研究进展

经皮穿刺心室腔内注射术,在临床抢救病人或人体解剖学专业灌注尸体常用。不宜损伤胸廓内血管、胸膜、肺及左冠状动脉前降支。心前区注射点在左侧第4或第5肋间间隙,距胸骨左缘旁开0.5-1.0cm处沿肋骨上缘刺入左心室腔。剑突下区点位于剑突左侧肋弓下1.0cm处,针尖朝心底方向,穿刺针与腹前壁成45℃角,刺入左或右心室腔内。本文就经皮穿刺心室腔内注射术的进展作一综述。     

胸腔镜辅助下冠状动脉旁路移植术--附12例报告

目的 探讨胸腔镜辅助下胸壁小切口非体外循环下冠状动脉旁路移植术(video-assisted coronary artery by-pass grafting，VACAB)的应用及效果。方法 自2001年11月～2003年7月，12例冠心病病人，男8例，女4例，均在胸腔镜-电视系统监测下沿左或右乳内动脉外侧切开壁层胸膜，游离乳内动脉，上方越过第1肋，下至第6肋，肋间分支用电烙或钛夹止血，游离足够长度的乳内动脉，离断乳内动脉远端前使用小剂量肝素(1mg／kg)，保持部分激活凝血酶原时间(ACT)在250s以上。经第4肋间的小切口直观下切开心包，显露左前降支或右冠状动脉，进行胸壁小切口非体外循环下冠状动脉旁路移植术(MIDCAB)。结果 行左乳内动脉至左前降支搭桥8例，其中6例两支冠状动脉病变者术前行PTCA(Hybrid技术)治疗右冠状动脉病变。行右乳内动脉至右冠状动脉搭桥4例。游离乳内动脉的时间平均为60min(40～110min)，手术均顺利完成，术后气管插管时间均少于5h。无围手术期心肌梗死及手术死亡。均于术后7～10天出院。随访所有患者均无心绞痛症状，生活质量良好。结论 胸腔镜-电视系统监测下游离乳内动脉，在非体外循环冠状动脉搭桥中具有较好的应用效果，术后近期疗效满意。     

女性乳房的血管构筑研究及其临床意义

目的：研究女性乳房的血管构筑模式，为设计安全的乳房缩小整形术式提供形态学基础。方法：采用血管铸型、乳房组织血管透明方法对11具成年女性尸体22个乳房标本血管进行解剖学观察。结果：乳房皮肤层血供主要来自胸廓内动脉的穿支和胸外侧动脉的分支，血管走行朝乳头方向集中。胸廓内动脉穿支中以第2肋间穿支为最粗大，胸外侧动脉分支中以乳头外上方分支为最粗大。乳腺主要血供来自深部穿支：上半部来自胸大肌表面的穿支较细小，下半部来自肋间隙的穿支较粗大。这些穿支血管垂直走向皮肤表面与皮肤层血管形成吻合。结论：(1)乳头乳晕的血供主要来自皮肤层，皮肤血管以胸廓内动脉的第2肋间穿支和胸外侧动脉的起始部分支最为粗大；(2)来自深部乳腺的血供较少，为胸壁穿支的细小终末支；(3)在乳房缩小整形术中，以内上或外上真皮蒂或真皮腺体蒂携带乳头乳晕较单纯腺体蒂更为安全。     

女性乳房的应用解剖

目的研究女性乳房动脉和神经分布特征,为女性乳腺手术和乳房整形美容手术提供解剖学依据。方法对15具成年女性尸体30个乳房标本进行解剖,观测其动脉和神经的分支分布。结果①女性乳房血供由胸外侧动脉、胸廓内动脉、胸肩峰动脉和肋间动脉穿支提供。②第2～6肋间神经的外侧皮支和前皮支均支配女性乳房,分支走向呈"立体发散"模式达乳房腺体及皮肤。乳头和乳晕的神经以第4肋间神经为主。结论女性乳房手术应注意保护其动脉和神经。     

旋股外侧动脉降支用于冠状动脉旁路术的可行性研究

目的 为旋股外侧动脉降支用于冠状动脉旁路术提供解剖学依据,并对其手术切取方法进行初步设计。方法 对19具福尔马林保存成年尸体38侧旋股外侧动脉起始部及其降支的走行、分支及周围结构进行详细的观察,测定旋股外侧动脉降支主干的长度、起点和止点处的外径,以及髂前上棘至髌骨中点连线的中点到股外侧肌与股直肌间沟的水平距离。结果 旋股外侧动脉降支位置较为恒定,位于股中间肌、股直肌、股外侧肌之间的肌间隙内。主干长度为12.0±2.36cm,起点处外径为2.7±0.35mm,止点处外径为2.2±0.28mm,髂前上棘至髌骨中点连线的中点到股外侧肌、股直肌间隙前外侧缘的水平距离为0.4±0.18cm。结论 旋股外侧动脉降支的解剖特点符合冠状动脉旁路术的要求,可以用于该手术,经股直肌和股外侧肌间隙可方便切取该动脉。     

Lateral costal artery: accessory thoracic vessel of clinical interest

The lateral costal artery (LCA), a supernumerary branch of the internal thoracic artery (ITA), occurs in several ethnic groups on one side of the thorax or on both, in 15-30% of cases. It has been considered responsible for the "steal-syndrome" of the coronary blood after coronary artery bypass grafting and it used occasionally for myocardial revascularization. To clarify its functional significance, an interpretation based on our findings and human and comparative anatomy and embryology has been attempted. We report on a case where a right LCA of about 2 mm in caliber, rising from the ITA 2.5 cm below the subclavian, coursed as far as the 4th intercostal space for a distance of 13 cm after the anterior axillary line. Anastomosing with the intercostal arteries, it can act as a blood derivative circuit of the thoracic wall. Embryologically, this artery, like the normal parietal arteries of the trunk, might form a longitudinal channel connecting the intersegmental arteries. In mammals having a thoracic cage transversely restricted (quadrupeds), the ITA is more lateral than in primates having a circular thorax, and gives off a ventral branch toward the sternum. It might be hypothesized that the sternal branch occurring in quadrupeds, undergoing adaptation to the thoracic shape of primates, may become the main trunk of the ITA, whereas the LCA may be the remnant of the ITA of quadrupeds. Because the LCA ran partly along the "milk line" of humans, it might be regarded as a supernumerary mammary artery.     

犬不停跳冠状动脉搭桥模型的构建

目的比较两种不同方法构建不停跳冠状动脉搭桥动物模型,探讨模型构建方法的可行性和优劣性。方法家犬20只随机分为头臂干组和降主动脉组,以小口径异种血管为桥血管。左侧第4肋间切口入胸,先行头臂干动脉或降主动脉端血管吻合,再行冠状动脉端血管吻合,术毕结扎左冠状动脉前降支近端。结果 2组犬均无术中死亡。头臂干组和降主动脉组主动脉端血管吻合用时分别为(33.9±4.8)min和(29.6±3.5)min(P0.05),冠状动脉端血管吻合用时分别为(28.5±3.0)min和(28.1±2.3)min(P0.05),2组术中出血量分别为(77.5±16.2)mL和(66.5±12.3)mL(P0.05)。降主动脉组术中侧壁钳夹降主动脉后股动脉血压明显降低,术后2只犬出现黑便。结论将小口径异种血管吻合在头臂干动脉或降主动脉均可成功构建犬不停跳冠状动脉搭桥模型;降主动脉组股动脉血压波动大,存在腹腔脏器缺血再灌注损伤;头臂干组血管吻合用时稍长,但术中股动脉血压波动小,模型构建相对更安全。     

Bilateral origin of the internal thoracic artery from the third part of the subclavian artery a case report

The routine use of the internal thoracic artery (ITA) as a conduit in coronary artery bypass grafting surgery has highlighted the need to appreciate this vessel’s anatomic variations. The usual origin of this vessel is from the first part of the subclavian artery, occasionally from the second and rarely from the third. Henriques-Pino and Prates described a unilateral origin from the third part on the left and Vorster et al on the right. Our cadaveric case report presents an unusual bilateral origin of the ITA arising from the third part of the subclavian artery in a 25-year-old Black South African female. The ITA arose from the ventral aspect, 7.3 cm on the right side and 8.5 cm on the left side from the origin of the subclavian artery, and inclined acutely inferiorly and medially, anterior to the distal attachment of the scalenus anterior m., followed the inner border of the first rib for a short distance and, thereafter, continued its usual course in the thorax. This appears to be the first case report presenting a bilateral origin of the ITA from the third part of the subclavian artery.     

左侧肋间后动脉用于冠状动脉搭桥术的应用解剖

目的：为左侧肋间后动脉冠状动脉搭桥术提供解剖学基础。方法：在３０具成人尸体标本上,对左侧肋间后动脉及心脏冠状动脉的后降支和左缘支进行了观察。结果：左侧第８、９、１０肋间动脉到后降支（房窒交点下方１ｃｍ处＿平均外径分别为２．５、２．６、２．８ｍｍ,与冠状动脉后降支此点处外径（２．５ｍｍ）较为接近;到左缘支点处的平均外径为２．７、２．８、２．６ｍｍ,与左缘地此点处外径（２．１ｍｍ）较为接近;到后降支中     

Posterior right diagonal artery

Background: There is general confusion about a branch of the posterior segment of the right coronary artery that has been referred to as 1) the lower trunk of a divided right coronary artery; 2) a posterior reflection of the right marginal artery; 3) the ramus lateralis; and 4) a posterolateral branch or a posterior descending artery. Materials: Three hundred human hearts were studied by direct observation, X-ray films, and corrosion casting. Results: This branch of the right coronary artery arises either after the right marginal artery (in 84% of hearts) or it constitutes the continuation of this artery in the remaining 16%. We named it the posterior right diagonal artery (PRDA). It was found in 14% of 266 hearts of right dominant type. It was present in 39% when the length of the posterior descending artery (PDA) was shorter than half of the length of the posterior interventricular sulcus (PIS) and in 6% when it was longer. When the PRDA originated directly from the RCA, the RMA appeared underdeveloped; the PRDA always occupied the inferior part of the PIS and appears either as continuation of a short PDA or as a replacement for a long PDA from the point where this artery leaves the PIS to enter the posterior wall of the left ventricle. The PDRA when present serves as a bridge between the RCA and the left anterior descending artery. Conclusions: These findings are of practical importance for the correct interpretation of coronary arteriographies and in the field of coronary artery surgery. © 1994 Wiley-Liss, Inc.     

Coronary artery bypass grafting with concomitant resection for carcinoma of lung

A 69-year-old woman with angina had a lesion in the left lower lobe on chest film. Angiography revealed coronary artery disease in three vessels. Combined off pump coronary artery bypass grafting (CABG) and left lower lobectomy were performed through median sternotomy. This approach avoids complications due to staged operations and cardiopulmonary bypass (CPB). This report shows that simultaneous off pump CABG and pulmonary operations can be performed safely in patients with coronary artery disease (CAD) associated with lung cancer.     

Dual anterior interventricular arteries

A patient with dual left anterior descending (R. interventricularis anterior of the left coronary artery) coronary artery is presented. A normally arising left anterior descending was hypoplastic, and an anomalous left anterior descending, which arose from the right sinus aorticus had a normal caliber. The anomalous left anterior descending artery traversed between the aorta and the pulmonary artery supplying most of the anterior myocardial wall of the left ventricle. This rare coronary anomaly can potentially have implications on percutaneous coronary interventions or on surgical revascularization procedures. Clin. Anat. 12:153‐158, 1999. © 1999 Wiley‐Liss, Inc.     

Variations in collateral contributions to the blood supply to the sternum

The blood supply of the sternum plays a major role in healing of the sternum after sternotomy. The sternal blood supply is derived mainly from the medial horizontal branches of the internal thoracic artery (ITA). The ITA is usually described as giving off sternal, anterior intercostal and perforating branches supplying their respective areas. The aim of the present study was to describe variations in the arterial branching pattern of collateral contributions to the sternum. The study was conducted on 30 fresh specimens of anterior thoracic wall in which cellulose acetate butyrate was injected into the ITA. The branches of the ITA in the first to sixth intercostal spaces were dissected and any additional artery supplying the sternum in each intercostal space was observed. In the present study, the ITA gave off non-collateral branches - sternal, anterior intercostal and perforating. The ITA was also found to have branches which divided into two to supply two destinations which could establish collateral flow to the sternum: (1). A sterno-intercostal branch (1-12 mm in length) divided and diverged in a Y or T shape. The medial limb supplied the sternum and the lateral limb supplied the adjoining thoracic wall, anastomosing with the terminal part of the posterior intercostal artery. (2). A sterno-perforating branch supplied the sternum either anteriorly or posteriorly before perforating and supplying the pectoral region and anastomosing with the thoracoacromial artery. This study reinforces the practice of ligating branches of the ITA close to its trunk as they have the potential to develop collateral blood supply. In the present study the posterior intercostal artery was at times found to supply the sternum directly or via its collateral branch and was named the persistent posterior intercostal artery.     

肋间动脉与冠状动脉搭桥的应用解剖

为肋间动脉与冠状动脉搭桥术提供解剖学资料,在40侧成年尸体上对第七、八对肋间动脉进行了观察.左侧第七肋间动脉至液后线长平均为19.5cm.至锁骨中线为26cm;左侧第八肋间动脉长分别为19.7cm和27.5cm;右侧第七肋间动脉长分别为20.7cm和27.5cm;右侧第八肋间动脉长分别为21.2cm和28cm.     

人冠状动脉壁组织结构增龄性变化的研究

目的：探讨人冠状动脉壁随年龄变化的形态学改变，为心血管病临床提供形态学资料。方法：33例经福尔马林固定后的正常男性尸体，在左冠状动脉前室间支（以下简称冠状动脉）起始部横断取材，常规石蜡包埋切片，HE和Verhoeff氏铁苏木精染色，光镜观察及图像定量分析。结果：随年龄增长，冠状动脉内膜面积与中膜面积均逐渐增大。各年龄组，心肌侧内膜厚度均大于胸壁侧。内膜面积与内弹力膜周长等价圆面积的百分数与腔面积／截面积值之间呈线性负相关。结论：冠状动态壁最重要的年龄变化是内膜增厚，这种增厚是不均匀的，其中心肌侧内膜厚度大于胸壁侧。评价冠状动脉狭窄程度，内膜面积占内弹力膜周长等价圆面积的百分数是一良好指标。