喉部血液供应的解剖学观察

目的为喉部疾病的诊断和治疗提供血供形态学资料.方法解剖观察成年尸体动脉乳胶注标本16具(32侧),分别观察了喉上、下动脉的起始部位、管径、分支及其吻合.结果喉下动脉的起点恒定,均起于甲状腺下动脉;喉上动脉84.4%起于甲状腺上动脉,12.5%起于颈外动脉,3.2%与舌动脉共干.喉上动脉男性平均外径1.7mm±0.23mm,女性平均外径1.5mm±0.17mm;喉下动脉男性平均外径1.1mm±0.18mm,女性平均外径0.9mm±0.14mm;喉上动脉穿入喉的部位84.4%经甲状舌骨膜,9.4%经甲状软骨板;喉上、下动脉之间及左、右两侧之间有广泛的交通吻合.结论喉属多来源血供器官,血供丰富,有良好的侧支循环系统.     

喉科学

20021207喉部血液供应的解剖学观察/詹必武…//中国耳鼻咽喉颅底外科杂志一2002,8(l)一56~57 目的:为喉部疾病的诊断和治疗提供血供形态学资料。方法:解剖观察成年尸体动脉乳胶注标本16具(32侧),分别观察了喉上、下动脉的起始部位、管径、分支及其吻合。结果:喉下动脉的起点恒定,均起于甲状腺下动脉;喉上动脉84.4%起于甲状腺上动脉,12.5%起于颈外动脉,3.2肠与舌动脉共干。喉上动脉男性平均外径1.7mm士0.23mm,女性平均外径1.smm士0.17mm;喉下动脉男性平均外径1.lmm士0.18mm,女性平均外径0.gmm士0.14;喉上动脉穿入喉的部位84.4%经甲状软骨,9.4…     

舌动脉的解剖特点与舌根中线部分切除术的关系

目的观察舌动脉的走行、比邻及其主干与舌表面各标志的关系,以指导舌根中线手术,提高手术安全性。方法8具（16侧）颌面部发育正常成人尸头标本,颈总动脉灌注红色乳胶。①解剖观察舌动脉的起源、走行;②以舌骨舌肌为界将舌动脉分为3段,对各段的长度及其邻近结构进行观测。③以舌盲孔、舌盲孔前5mm和10mm、舌盲孔后10mm及舌根与会厌谷粘膜分界处为标志,分别测量舌动脉主干距舌中线及舌表面的距离。结果舌动脉全长为(92.88±13.53)mm;其中第1段为(40.44±5.79)mm,第2段为(18.33±3.32)mm,第3段为(38.33±7.74)mm。舌动脉主干在舌盲孔前10mm和5mm、舌盲孔、舌盲孔后10mm、舌根与会厌谷分界处距舌中线的距离分别为(7.78±3.15)mm,(8.56±3.57)mm、(11.00±4.95)mm、(13.00±3.28)mm、(15.22±3.11)mm,距舌表面的距离分别为(22.56±7.81)mm、(22.11±6.74)mm、(21.44±5.59)mm、(16.56±5.57)mm、(2.56±0.73)mm。结论舌骨大角上方10mm范围内为寻找舌动脉的首选位置,在行舌根中线部分切除术时,在舌根与会厌谷粘膜分界处最易伤及舌动脉主干,切除范围在舌中线两侧7mm、舌表面下10mm范围内,可防止舌动脉的损伤。     

喉科学

990866喉血管、神经的应用解剖学研究/彭玉成…//第二军医大学学报一1998,19(4)一373~374 目的:研究喉的血管、神经的走行、分布和变异。方法;在40具(80例)成人头颈部标本上解剖测量喉的血管和神经。结果:喉上动脉的入喉点在甲状软骨上角前下方左侧(14.71士3.92)nlm、右侧(15.86士3.86)mm;喉上神经的入喉点在甲状软骨上角前下方左侧(12.59士4.25)mm、右侧(12.88士3.71)mm;喉下神经入喉点距离甲状软骨下角左侧(5 .50士1.44)mm、右侧(5.31士1.34)rnm。有1具右侧喉上动脉起源于甲状腺上动脉后,在入喉前分为2支入喉。结论:本研究对喉切除手术的…     

胸背动脉穿支皮瓣的解剖学研究及其在头颈修复中的意义

目的探讨胸背动脉穿支皮瓣的解剖学基础及其在头颈修复中的临床意义。方法解剖新鲜成人尸体5具,观察、测量胸背动脉穿支皮瓣供血穿支的数目、类型、管径、蒂长、走行、出筋膜后轴向及源血管外径,并对其定位。结果胸背动脉穿支44支,其中肌皮穿支35支、肌间隔/直接皮穿支9支。胸背动脉内侧支的肌皮穿支数占38.6%。胸背动脉外侧支的皮穿支数占54.5%,大部分位于背阔肌前缘2?cm之内。最粗穿支血管平均蒂长（12.41±2.84）cm。肩胛下动静脉外径（3.59±0.62）、（3.75±0.41）mm,胸背动静脉外径（2.71±0.43）、（2.98±0.18）mm。结论胸背动脉的穿支血管解剖位置较为恒定,穿支皮瓣制作方便,其管径及蒂长均适宜头颈肿瘤术后缺损的修复。     

国人喉软骨测量

本文作者对30个国人成入尸体喉(男性19个;女性11个)按自行设计径线对诸软骨进行较为详细测量,所测数据均经统计学处理。结果如下:1.甲状软骨径线:①外径线;水平上线36.87±9.38mm,水平下线28.83±6.02mm,左右上结节间距42.07±5.79mm,垂直前线25.21±6.59mm,垂直后线22.25     

膈神经替代喉返神经修复治疗双侧声带麻痹的应用解剖

目的　探讨膈神经干与喉返神经喉内段前支吻合治疗双侧声带麻痹的解剖学基础。方法　解剖并观察 12具 (2 4侧 )成年尸体、7只喉全切除术切除的喉体、12例 (2 4侧 )根治性颈淋巴结清扫术和 6例 (6侧 )膈神经替代修复喉返神经患者共 46侧膈神经的起源、走行、血供及毗邻关系 ,测量膈神经干相关的长度 ,图像分析仪观测 30侧膈神经、喉返神经前支相关的组织学参数。结果　颈段膈神经营养动脉均自膈神经根部进入 ,来自于颈升动脉的占 95 6 % (4 4/4 6 )。膈神经干位置较深 ,在颈根部位于颈总动脉、椎静脉外侧 ,颈内静脉及胸导管 (左 )深面 ;在胸腔入口处跨过锁骨下动脉在锁骨下静脉深面下行。膈神经起点至锁骨下静脉上缘平面及至环甲关节的距离平均 ( x±s)分别为(7 2± 1 6 )cm及 (5 5± 1 4)cm ,两者相差至少 1 5cm。膈神经干平均有髓纤维数及神经束截面积分别为喉返神经前支的 2 41及 2 15倍 ,膈神经颈段单个神经束约占 75 0 % (18/2 4)。结论　临床上在胸腔入口解剖膈神经干安全可行 ,在锁骨下静脉上缘平面切断膈神经与喉返神经前支吻合无张力     

颏下岛状皮瓣的解剖学研究

目的:对颏下动脉、静脉及所供皮瓣进行解剖学研究。方法：测量21具成人尸体标本的颏下动脉、静脉及支配皮瓣的面积。结果：颏下动脉起点处外径（1.41±0.32）mm,颏下静脉的最大外径为（2.41±0.91）mm,皮瓣的长度为（78.2±13.9）mm,宽度为（55.6±5.4）mm。结论：颏下动脉是面动脉的一根恒定分支，血管行经长，位置表浅，口径粗，有恒定的伴行静脉，是良好的皮瓣供血动脉。     

鼻科学

20030020下鼻甲动脉的应用解剖/向宇燕…//中国耳鼻咽喉颅底外科杂志一2002,8(2)一123一24 目的:为下鼻甲手术提供局部解剖学数据。方法:在10侧成人头颈部标本上解剖观测了鼻后外侧动脉的来源、走行、分支、分布及吻合情况。结果:蝶愕动脉大多(90%)在蝶愕孔处已分为鼻后外侧动脉和鼻后中隔动脉,二者在蝶愕孔处外径分别为。.84mm和。.98mm。鼻后外侧动脉发出下鼻甲动脉和中鼻甲动脉,其外径分别为。.70mm和o.63mm。下鼻甲动脉在中鼻甲后端附着处下方约3mm处起始后垂直下行,经中鼻道粘膜下进人下鼻甲后方,在下鼻甲近内侧面与上面交界处的粘膜下…     

鼻科学

20050573嗅相关神经的临床解剖学观测/朱杭军…//临床耳鼻咽喉科杂志·2005,19(2)·76~78目的:了解嗅神经的正常走行及其与视神经、鼻窦之间的关系,为临床开展相关手术提供解剖学资料,并为预防鼻窦手术中嗅神经损伤提供解剖学依据。方法:在16例32侧成人尸头上对嗅神经、嗅束、嗅球进行解剖测量,并观察其与视神经、鼻窦之间的关系。结果:嗅束的长度为(29·33±2·11)mm,中点处宽度为(3·36±0·83)mm,嗅束中点内侧距前颅底中线垂直距离为(5·48±1·02)mm,嗅束与矢状线之间夹角为(21·32±3·28)°,嗅球长度为(10·43±2·35)mm,宽度为(5·12…     

Anatomic relation between the external branch of the superior laryngeal nerve and the thyroid gland

AimThis prospective study investigated the anatomic relations between the external branch of the superior laryngeal nerve (EBSLN), the superior thyroid artery (STA) and the thyroid gland in human cadavers.Material and MethodsTwenty-two human cadavers aged over 18 years old, less than 24 hours after death.ResultsThe mean distance between the EBSLN and the superior pole of the thyroid gland was 7.68 ±3.07 mm. A tangent to the inferior edge of the thyroid cartilage between the EBSLN and the STA measured 4.24 ±2.67 mm. A line from the intersection of the EBSLN - related to the STA - to the superior pole of the thyroid gland measured 9.53 ±4.65 mm. A line from the EBSLN to the midline of the most caudal point of the thyroid cartilage measured 19.70 ±2.82 mm. A line from the RENLS to the midline on the most cranial point of the cricoid cartilage was 18.35 ±3.66 mm.ConclusionThere is a variable proximity relation between the EBSLN and the superior pole of the thyroid gland; this distance ranges from 3.25 to 15.75 mm. There was no evidence of significant variation between the measures in the ethnic groups comprising the sample.     

颏下逆行带蒂岛状皮瓣的应用解剖研究

目的 为颏下逆行带蒂岛状皮瓣修复颜面部皮肤软组织缺损的可行性及手术操作提供解剖学依据.方法 解剖20例40侧福尔马林固定、颈总动脉灌注红色乳胶的成人头颈标本及4例灌注汞溴红、2例灌注亚甲蓝的新鲜成人头颈标本,测量相关动脉的外径及相关标志点之间的距离(以-x±s表示);观察两侧面动脉之间、面动脉与颞浅动脉及眼动脉终术之间的吻合情况,观察面动、静脉的行程要点及其与面神经各分支之间的位置关系,观察面静脉与相关静脉之间的吻合情况.结果 颏下动脉、上唇动脉、下唇动脉起点处的外径(-x±s,以下同)分别为(1.42±0.30)mm、(1.34±0.35)mm、(1.34±0.27)mm.下唇动脉起点至颏下动脉起点直线距离为(35.19±9.18)mm,实际距离为(50.13±13.79)mm;上唇动脉起点至颏下动脉起点直线距离为(64.99±5.24)mm,实际距离为(92.09±8.73)mm.双侧面动脉之间、面动脉与颞浅动脉及眼动脉终末之间有丰富的吻合.在下颌缘水平,面动、静脉相贴伴行,面神经下颌缘支跨过其浅面;在下颌缘水平以上,面静脉行于面动脉后外约1 cm处,面神经颊支经面静脉表面于面动、静脉之间人表情肌.面静脉通过内眦静脉与眼静脉、面深静脉与上颌静脉之间有良好的交通.结论 以颏下逆行带蒂岛状皮瓣修复颜面部皮肤软组织缺损在解剖上具有可行性,建议皮瓣的旋转点选择在口角或口角以下平面.     

喉内结构在甲状软骨板上的投影位置关系

Objective：To provide anatomic basis of locations of laryngeal interior structures for laryngeal operating through lateral laryngeal approaches in clinic. Method： Thirty cadavers laryngeal cartilage specimens（ 19 male and 11female）was collected. Using pin pierced method under direct vision to locate the projections of muscle process of arytenoids cartilage and vocal fold on thyroid ala,then to observe their relationships. Result：The projection of vocal fold is the line that connecting a little bit superior of the middle point of anterior commissure of thyroid cartilage and the point on the crosspoint of superior 3/4 and inferior 1/4 of the posterior edge of thyroid cartilage ala. The angle of the line and anterior commissure of thyroid cartilage is sixty-five degrees, The projection of muscle process is locating on the projective line of vocal fold. The projection of pyriform fossa is locating at the posterior superior portion of thyroid cartilage ala. Conclusion： The interior structures of larynx have a intact relationship of projective position on thyroid cartilage ala,which providing anatomic references for clinical surgeries relating to vocal fold through laryngeal framework.     

Ⅰ型甲状成形术相关参数在喉标本和CT测量中的比较研究

目的探讨Ⅰ型甲状成形术相关参数通过喉标本和螺旋CT两种不同方法测量结果是否存在差异。方法对50例喉全切除术患者的喉体标本术后立即进行测量(均为单侧),并与术前通过螺旋CT多平面重建技术所测喉体相关参数结果进行比较研究,观察两种测量结果的差异是否具有统计学意义。结果所设6个参数通过两种方法测量结果差异均无统计学意义(P值均>0.05)。应用螺旋CT和喉标本两种方法测量所设参数的结果(x±s)分别为:甲状切迹至下缘的长度为(20.7±1.7)mm和(20.6±1.7)mm;声带的长度为(17.3±1.8)mm和(17.3±1.8)mm;斜线的长度为(28.6±3.2)mm和(29.1±2.7)mm;假设水平线的长度为(26.2±2.0)mm和(26.2±2.0)mm;声带前端至假设水平线在喉内的垂直距离为(4.5±0.6)mm和(4.5±0.7)mm;声带突至假设水平线在喉内的垂直距离为(10.8±1.1)mm和(10.9±1.1)mm。填入楔形假体在喉体内前、后端的宽度分别以4～5mm和8～9mm为宜。结论通过螺旋CT的多平面重建技术对喉体进行测量是准确可信的,是Ⅰ型甲状成形术术前设计开窗和假体大小的理想方法,解决了术中设计假体大小的滞后性。     

舌动脉的解剖特点与舌根中线部分切除术的关系

OBJECTIVE: To investigate the relationship between anatomic characteristics of lingual artery and midline glossectomy, for the purpose of increasing operative safety. METHODS: (1) 16 extraoral dissections of the submandibular region were performed on 8 human cadavers and to observe the origin and distribution of lingual artery. (3) The lingual artery was divided into three segments, and the length and adjacent organs were observed and measured. RESULTS: The whole length of lingual artery was (92.88 +/- 13.53) mm; At points of foramen cecum of the tongue, 5 mm and 10 mm prior to foramen cecum, 10 mm behind foramen cecum, and at adjacent part between root of the tongue and epiglotic vallecula, the distances between lingual artery and midline of the tongue were separately measured. The distances were (11.00 +/- 4.95) mm, (8.56 +/- 3.51) mm, (7.78 +/- 3.15) mm, (13.00 +/- 3.28) mm, (15.22 +/- 3.11) mm. The distances between lingual artery and the surface of tongue were (21.4 +/- 5.59) mm, (22.11 +/- 6.74) mm, (22.56 +/- 7.81) mm, (16.56 +/- 5.57) mm, (2.56 +/- 0.73) mm respectively. CONCLUSION: During the midline glossectomy, the lingual artery is easier to be damaged at the position where the root of tongue adjoining epiglottic vallecala. The operation should be done within 10 mm below the surface, 7 mm lateral to the midline, to avoid the damage of lingual artery.     

改良会厌喉成形术

目的：探讨声门癌Ｔ３病变在喉大部切除后重建喉支架的手术方法。方法：３６例声门癌Ｔ３病变,在喉大部切除后施行改良会厌喉成形术;１一侧甲状软骨全乇除、会厌软骨侧向下移取代;２对侧甲状软骨部分保留,肌筋膜瓣或肌甲状软骨膜瓣修复声带;３会厌前侧缘与甲状软骨前缘对合成锐角前连合,后侧缘与对侧杓部形成后连合,会厌上缘与对侧声带形成新声门。结果：３３例拨管,３０例发声清晰、宏亮且易懂,３例发声低沉沙哑。３年和５     

Epiglottoplasty for reconstruction of posttraumatic laryngeal stenosis

Laryngeal stenosis secondary to blunt laryngeal trauma is mostly localized at the supraglottic and glottic levels. The epiglottis is ideally suited to reconstruct the defect after excision of supraglottic and glottic scar tissue and anterior thyroid cartilage. It is the conclusion of the authors that epiglottic reconstruction is an effective procedure for repair of laryngeal stenosis at the supracricoid level. Two case reports are given.     

声门型喉癌T3病变喉部分切除术后疗效评价

目的 探讨喉部分切除术对声门型喉癌Ｔ３病变的可行性及修复材料的选择。方法 对１９８６年１月～１９９４年１月７８例行喉部分切除术的声门型喉癌Ｔ３病变患者的术式及修复方法进行了回顾性分析。结果 患者３年、５年生存率分别为８８．５％、７５．６％,局部复发率１５．４％。应用了梨状窝粘膜＋甲状软骨板外侧软骨膜,会厌软骨瓣及带状肌双肌双蒂瓣３种方法修复创面,均获得了较好的喉功能恢复。结论 喉部分切除术是根治声     

声门上水平喉部分切除术应用55例

目的 评价声门上水平部分喉切除术的手术方法及远期疗效。方法 我科１９８６～１９９５年采用声门上水平部分喉切除治疗喉癌声门上型５５型,男３２例,女２３例,平均年龄５６岁,Ｉ期１１例,ＩＩ期２６例,Ⅲ期１１例,Ⅳ期７例。对声门上水平部分喉切除加以改进。用两侧梨状窝内侧壁粘膜缝合,封闭甲状软骨断面的后１／３,用甲状软骨外骨膜同喉室底壁粘膜缝合,封闭甲状软骨断面的前２／３,切除舌骨,将保留的甲状软骨同舌根     

Pathological validation of supracricoid partial laryngectomy in laryngeal cancer

Objectives: To validate pathologically whether supracricoid partial laryngectomy is an oncologically sound procedure in cases with invasion of the thyroid cartilage, paraglottic space, pre‐epiglottic space, anterior commissure, or subglottis. Design: A retrospective review of case notes was performed. Setting: Patients treated at a single institute in the Republic of Korea. Participants: Sixty‐three patients who underwent supracricoid partial laryngectomy for laryngeal squamous cell carcinoma between June 1994 and May 2005 who were followed for at least 2 years. Main outcome measures: Local control and overall survival rates. Pathological invasion of the thyroid cartilage, anterior commissure, pre‐epiglottic space, paraglottic space, or subglottis was also investigated as a cause of recurrence. Prognostic factors for local control and survival were evaluated with univariate and multivariate models. Results: Invasion of the anterior commissure, paraglottic space, thyroid cartilage, pre‐epiglottic space, or subglottis had no significant impact on the recurrence or overall survival rates. The presence of a positive resection margin was significantly associated with recurrence in the univariate and multivariate analyses (P = 0.026, 0.028, respectively). When considering the prognostic factors influencing survival, the univariate analysis showed that N stage, a positive resection margin and recurrence had significant influences on the overall survival rate (P = 0.010, 0.0004 and 0.000 respectively). In the multivariate analysis, only recurrence affected the survival rate (P = 0.002). Conclusion: Supracricoid partial laryngectomy can be used with oncological safety in selected cases of laryngeal cancer with invasion of the anterior commissure, thyroid cartilage, pre‐epiglottic space, paraglottic space, or subglottis.