急性胰腺炎活体肾筋膜向下附着的CT解剖学研究

以多层螺旋CT(MDCT)扫描及三维重建为研究手段,探讨急性胰腺炎成人肾筋膜向下的附着关系、肾周间隙向下的通连关系,以及CT对其的诊断价值。收集2012年5月~7月于我院行全腹CT增强扫描检查的急性胰腺炎82例的CT资料,采用三维重建,观察肾筋膜向下的附着情况及肾周间隙向下的通连关系。结果发现:(1)肾筋膜前后层在髂窝平面附近融合:左侧占71.95%(59/82),右侧占75.61%(62/82),左右肾周间隙、肾旁前后间隙在下方均不通连。(2)肾筋膜前后层在肾脏下方不融合:左侧占28.05%(23/82),右侧占24.39%(20/82),左右肾周间隙向下可延伸至盆腔腹膜后间隙及腹股沟深面,肾旁前后间隙在下方仍不通连。研究显示MDCT增强扫描三维重建能判断肾筋膜向下的附着情况,以及肾周间隙向下的通连关系。     

降结肠与左肾位置关系的CT解剖学研究

目的　运用多层螺旋CT探讨降结肠相对左侧肾脏的位置分区与同侧肾筋膜外侧附着类型的相关性。 方法　收集121例行上腹部CT扫描的成人病例的影像学资料并进行回顾性分析,着重观察和记录降结肠相对左侧肾脏的位置分区以及同侧肾筋膜外侧附着类型,并分析二者之间的相关性。 结果　（1）72例的左侧肾筋膜外侧附着类型属于I型,49例的左侧肾筋膜外侧附着类型为II型;（2）降结肠整体走行呈现自左肾前方至左肾侧后方的趋势;（3）左侧肾门水平,降结肠相对左肾的位置分区与左侧肾筋膜外侧附着类型具有相关性（χ2=6.254, P<0.05）。 结论　降结肠相对左侧肾脏的位置分区与同侧肾筋膜外侧附着类型存在相关性。     

16 腹膜后间隙向内侧通连的应用解剖

<正>在30具成人尸体制成的腹部连续横断面标本上(其中8具为肾周间隙灌注后制成的,6具为肾周间隙灌注并作CT扫描后制成的断面标本,断面厚约1.00cm),观察了腹膜后间隙向内侧通连的情况,结果如下:1.肾旁后间隙向内侧的延伸随肾后筋膜内侧端附着位置的变化而变化,肾后筋膜内侧端附着点变化在腰方肌稍外侧的腹横筋膜和腰大肌后外侧部的筋膜之间,但集中附着在腰方肌外侧3/4的筋膜上,在肾门和肾下极平面分别占80%和90%左右.2.两侧肾周间隙完全不通者占30%左右,而通连者约70%,前者的肾前筋膜向内侧与腹部大血管及其周围结缔组织紧密连接,后者的肾前筋膜向内侧经肾血管和腹部大血管的前方与对侧同名筋膜延续,与血管间为疏松结缔组织所填充.在70%的连通中,肾门平面连通的为100%,L_3～5单面的占16%,另有8%可在Th_(11～12)平面,主动脉裂孔的前上方经膈前方通连,而腹腔动脉和肠系膜上动脉起始部之间的区域由于有大量致密结缔组织、神经丛和节的存在以及肾前筋膜与此的紧密连接,为不能通连区.3.肾旁前间隙在胰平面因胰在腹后壁的横垮可两侧通连,但间隙灌注显示灌注剂多局限在灌注侧.在联平面以下,两侧间隙由于肠系膜根在腹后壁的附着而被阻隔.熟悉腹膜后间隙的内侧延伸和通连情况,对腹膜后间隙疾患尤其积液的诊治具有?     

肾与升降结肠及后腹膜隐窝位置关系的应用解剖

在３０具成年男性尸体制成的腹部横断面标本上，观察和统计了肾与升、降结肠及与后腹膜隐窝在肾上、下极和肾门平面的位置关系，主要结果如下：①肾后外侧位和肾后位结肠出现在肾门及其以下平面，左侧出现率高于右侧；肾门平面仅在左侧出现，分别为３．３％和６．７％；肾下极平面左侧为６．７％和１０．０％，右侧均为３．３％。②后腹膜隐窝肾后伸延在肾门及其以上平面出现，肾门平面左、右侧分别为１０．０％和６．７％，肾上极平面仅见于右侧为６．７％。本文还对上述结果结合临床进行了讨论。     

成人肾及其血管的CT影像解剖

目的:为影像学诊断及临床诊治提供解剖学影像资料.方法:对160例成人进行64排螺旋CT平扫加增强扫描,统计测量肾的体积、肾动静脉、副肾动脉.所得数值按年龄、性别、侧别进行分组统计处理并进行相关性分析.结果:肾平均体积左侧(148.88±26.397)cm3,右侧(141.25±29.09)cm3,左右侧别无差异,男性组大于女性组.两侧肾动脉起点右侧高于左侧占优.左肾动脉与腹主动脉夹角平均79.39°,右肾动脉与腹主动脉夹角平均71.14°.肾动脉长度:左侧43.08 mm,右侧52.56mm,左右侧差异有统计学意义.左右肾静脉与下腔静脉之间的夹角分别为69.93°、67.23°.肾静脉长度左侧长于右侧.副肾动脉出现率为28.75%,入肾上极者多于入肾下极和肾门;副肾动脉起始于腹主动脉者占26.27%,起源于同侧肾动脉者占73.73%.结论:肾体积大小男性略大于女性,左右侧无差异;肾动、静脉长度、内径左、右侧存在差异性,但无性别差异.     

甲状腺病变累及至上纵隔的MDCT表现特征及其解剖、病理学基础

为了明确甲状腺病变累及至上纵隔的多层螺旋CT(MDCT)影像表现特点及其解剖、病理学基础,回顾性收集经临床病理证实的累及至上纵隔的甲状腺病变49例(其中结节性甲状腺肿22例,甲状腺瘤13例,甲状腺癌14例),结合其解剖、病理学基础,分析其MDCT表现特征及优势解剖分布。结果发现甲状病变向下位于前上纵隔约占67.3%(33/49)、后上纵隔14.3%(7/49)、跨前后纵隔18.4%(9/49);不同性质病变有各自特征性的MDCT表现:结节性甲状腺肿以局限多发结节、肿块为主,约占77.3%(17/22);甲状腺腺瘤以单发肿块为主,约占92.3%(12/13);甲状腺癌以单发肿块为主,约占57.1%(8/14),9例合并有颈部和(或)纵隔淋巴结转移。因此,甲状腺病变累及至上纵隔,位于前上纵隔多见,后纵隔少见,其影像学表现及优势解剖分布与其解剖、病理基础密切相关。     

输尿管与生殖股神经的应用解剖及临床意义

目的:为临床输尿管手术中避免损伤生殖股神经提供应用解剖学资料。方法:在21具42侧经甲醛固定的成人尸体标本上,对生殖股神经腰大肌穿出点的位置关系、在髂嵴最高点平面和髂总血管分叉平面生殖股神经与输尿管的位置关系、生殖股神经与输尿管交叉点的位置关系等进行了解剖观测。结果:①生殖股神经腰大肌穿出点距髂嵴最高点平面上方的垂直距离,左侧(2.93±0.14)cm、右侧(3.61±0.19)cm;距腰大肌外侧缘的水平距离,左侧(2.14±0.83)cm、右侧(1.87±0.85)cm;生殖股神经穿出点位于输尿管内侧占80.95%。②在髂嵴最高点平面,生殖股神经位于输尿管外侧占71.43%,其平均距离在左侧为(1.09±0.71)cm、右侧(1.36±0.62)cm。③在髂总血管分叉水平面,生殖股神经全部行于输尿管的外侧。④生殖股神经与输尿管80.95%发生交叉,交叉点距髂嵴最高点平面上方的垂直距离在左侧为(0.73±0.21)cm、右侧(0.56±0.16)cm;交叉点距腰大肌外侧缘的水平距离在左侧为(1.66±0.42cm)、右侧(1.65±0.38cm)。结论:在输尿管起始段手术应从其后外侧分离较安全;在输尿管第2狭窄附近的手术应从后内侧分离较安全。     

基于灰度差分法的7.0 T及3.0 T MRI测量正常大鼠海马容积的对比研究

目的 评价7.0 T MRI对正常大鼠海马结构及亚区容积的检测能力。方法 40只正常Wistar大鼠分别行7.0 T 和3.0 T MRI T₂WI扫描,图像导入IMAGE J软件,利用灰度差分法辨识海马及亚区的解剖点,测得两种场强MRI海马及亚区层面积、容积并进行比较。结果 7.0 T MRI中,侧脑室、环池辨认率达100%(40/40),腹侧海马裂与下托辨认率达95%(38/40),丘脑外侧核、外侧膝状体背侧核辨认率达90%(36/40)。3.0 T MRI上只能清晰辨认双侧侧脑室及环池,不能分辨大鼠海马亚区结构。3.0 T MRI所测海马层面积左侧 (2.81±0.86) mm²、右侧 (2.77±0.80)mm²,容积左侧(56.36±5.98) mm³、右侧(55.61±6.03 )mm³;7.0 T MRI所测海马层面积左侧(3.25±0.92) mm²、右侧 (3.14±0.81)mm²,容积左侧(64.29±7.13)mm³、右侧(65.34±7.74)mm³;两者比较差异均有统计学意义(P值均<0.05)。7.0 T MRI所测海马CA1区层面积左侧为 (2.81±0.98) mm²、右侧 (2.88±0.92) mm²,容积左侧为(27.02±4.62)mm³、右侧(27.64±4.13) mm³;CA3和DG区合并计为CA3-DG区,其层面积左侧为 (4.21±1.21) mm²、右侧 (4.19±1.40)mm²,容积左侧为(38.73±4.17) mm³、右侧(38.11±5.09) mm³。结论 依据灰度差分法,大鼠海马7.0 T MRI能够准确辨认海马结构、亚区边界标志点,获得其较为可靠的容积大小,其相关数据可为此类研究提供参照和依据。     

多层螺旋CT增强扫描显示肝静脉正常解剖及变异

目的采用多层螺旋CT增强扫描显示肝静脉正常解剖及变异情况,为活体肝移植及肝叶切除提供解剖学数据.方法100例行CT增强扫描,用肝静脉期(70s)采集数据,应用薄层横断面(1～2 mm)行多平面重组(MPR)、最大密度投影(MIP)法重建.对肝静脉的解剖和变异进行分型,并测量其直径,同时测量右后下肝静脉的直径和肝外段长度.结果100例中3大支肝静脉单独汇入下腔静脉占71%;肝左静脉和肝中静脉共干占29%.肝左静脉直径(6.8±1.8)mm;肝中静脉直径(6.7 1.7)mm;肝右静脉直径(7.9±2.5)mm;右后下肝静脉显示率83%(83/100),右后下肝静脉直径(4.1±1.5)mm;右后下肝静脉肝外段显示率59%(49/83),右后下肝静脉肝外段长度(4.0±1.8)mm.结论多层螺旋CT增强扫描MPR及MIP图像能很好地显示肝静脉正常解剖及变异情况.     

辽宁汉族成人外鼻不对称性的欧几里德几何距离矩阵分析

目的:利用欧几里德几何距离矩阵分析(EDMA)对辽宁汉族成人外鼻形态进行不对称性分析。方法:将101例辽宁汉族成人分为男性组与女性组,其中男性组41人,女性组60人。使用VG Studio 2.2 MAX软件对两组MRI扫描数据进行三维面部重建及外鼻三维坐标测量,最后对两组受试者左右侧外鼻测量数据进行EDMA分析。结果:EDMA结果显示,男性组与女性组左、右侧外鼻均有显著形态学差异,形状差异矩阵(FDM)比值(左侧比右侧)小于0.95和大于1.05的部分男性组有2个,占13.3%(2/15),女性组有4个,占26.7%(4/15)。结论:辽宁汉族成人外鼻左右不对称,右侧外鼻整体轮廓大于左侧,女性外鼻不对称性高于男性。     

腹膜后间隙纵向联系的应用解剖

运用矢状断面解剖。整体层次解剖和光镜观察方法,在34具尸体标本上研究了肾筋膜和腹膜后间隙在纵向上的延伸,附着和通连,结果显示,(1)肾前筋膜其上下在不同部位与后腹壁腹膜愈合,肾后筋膜向上与膈下筋膜愈合,向下愈着髂腰筋膜,外侧与腹膜愈合;(2)肾周间隙向上伸入肝裸区,肾旁前、后间隙向上受阻于肾前、后筋膜与后腹壁腹膜和膈下筋膜的愈合处,(3)肾周间隙向下开放,延续盆部腹膜外间隙,腹股沟深面及腹前外侧壁,肾旁前、后间隙在下方互不通连。     

腹膜后间隙横向联系的应用解剖

目的　探讨肾筋膜的横向延伸、附着情况及其对腹膜后间隙划分及腹膜后各间隙横向连通的影响 ,为腹膜后间隙内疾病的诊治提供形态学资料。方法　进行应用断层解剖、间隙灌注等方法 ,对 36例成人尸体观察、分型和统计肾筋膜的横向延伸和附着及腹膜后间隙横向连通的变化情况。结果　肾筋膜外侧延伸和附着在肾门及其以下平面有四种类型 ,肾门以上平面为另一种类型 ,它们影响着腹膜后各间隙的外侧通连 ;两侧肾周间隙存在越中线连通与不连通两种类型 ,连通类型中又有不同平面出现率的变化 ;肾旁后间隙向内侧可延伸至腰大肌的后外侧缘。结论　肾筋膜横向延伸和附着的各种类型影响着腹膜后各间隙横向的连通 ;过去对肾筋膜和腹膜后间隙横向延伸、附着及连通的结论不够全面 ;掌握腹膜后间隙横向联系的应用解剖 ,有助于腹膜后间隙疾病的诊治。     

腹腔镜下腹膜后筋膜间隙外科平面的解剖观察

目的 探讨在腹腔镜下升、降结肠或肾切除术相关的腹膜后筋膜和筋膜间隙的解剖学特点及毗邻关系,以便正确地寻找、识别和选择安全的筋膜间隙外科平面. 方法在腹腔镜下对5具成人新鲜腹部标本,30例腹腔镜下升、降结肠切除术和95例肾切除术中的腹膜后筋膜和筋膜间隙的位置、沟通和毗邻关系进行了观察.结果升、降结肠外侧缘的脏腹膜与壁腹膜之间有一条黄白交界线,沿此线切开腹膜、腹膜外组织,即可显露深面的融合筋膜.融合筋膜与肾前筋膜之间的潜在间隙为融合筋膜间隙.切开融合筋膜,沿此间隙向内分离,可将升结肠或降结肠及原始结肠系膜向内翻起,完成结肠游离;或显露后方的肾前筋膜.肾前筋膜、融合筋膜外侧部与侧锥筋膜之间的间隙为肾旁前筋膜间隙;肾后筋膜、侧锥筋膜与腰方肌筋膜之间的间隙为肾旁后筋膜间隙.肾旁前筋膜间隙与融合筋膜间隙和肾旁后筋膜间隙沟通,通过这些间隙分离,可将肾安全游离. 结论 黄白交界线为进入融合筋膜间隙的标志,融合筋膜间隙及肾旁前、后筋膜间隙内无重要血管,易于辨认和分离,为腹腔镜下升、降结肠或肾游离的理想外科平面.     

肾后筋膜内侧附着的CT解剖及其意义

目的：研究肾后筋膜的内侧附着点和肾旁后间隙的内侧边界。方法：回顾性分析64例CT扫描资料和临床资料完整的腹膜后间隙炎性病变的连续性病例，其中经手术病理证实29例；经临床综合指标及抗炎治疗随访显效而诊断者35例。着重观察肾后筋膜的内侧附着和肾旁后间隙的内侧边界。结果：（1）在肾上极以上水平，双侧肾后筋膜内侧均附着于腰方肌筋膜；（2）90．62％（58例）显示左侧肾后筋膜内侧在肾下极水平或锥下间隙水平附着于腰大肌筋膜外后方；（3）95.31％（61例）显示右侧肾后筋膜内侧在肾下极水平或锥下间隙水平附着于腰大肌筋膜外后方；（4）双侧肾后筋膜内侧附着点并不总是一致；（5）双侧肾旁后间隙内侧界主要分成两部分，为腰方肌或腰方肌和部分腰大肌。结论：（1）肾后筋膜的内侧附着点不是固定不变的，两侧肾后筋膜内侧附着情况也不一致；（2）肾旁后间隙内侧边界随肾后筋膜内侧附着点的改变而发生变化。     

Retropancreatic fascia is absent along the pancreas facing the superior mesenteric artery: a histological study using elderly donated cadavers

To determine the fascial configuration between the superior mesenteric artery and vein and the posterior aspect of the pancreas, we examined histological sections of 10 elderly donated cadavers without pathology in the abdomen. The retropancreatic fascia was absent along the pancreatic parenchyma facing the artery and vein. Abundant nerves along the artery were separated from the pancreas by loose tissue almost 10 mm in thickness. In addition, anterior renal fasciae facing the pancreatic body were not evident in these specimens, possibly due to the degeneration of the left adrenal gland with age. Thus, a definite renal fascia was restricted on the lateral and posterior sides of the left kidney. These findings suggest that interactions between a pancreatic tumor and nerves would require migration of cancer cells over a long distance. Conversely, attachment of the enlarged tumor mass to the nerves may be necessary for the invasion. The anterior renal fascia may fuse with the retropancreatic fascia.     

Development of the human hypogastric nerve sheath with special reference to the topohistology between the nerve sheath and other prevertebral fascial structures

Semi-serial sections from the lumbosacral region of nine fetuses (8-25 weeks gestation) were examined to clarify the lumbar prevertebral fascial arrangement. The prevertebral fasciae became evident after 12 weeks of age. After 20 weeks of age, the hypogastric nerve (HGN) was sandwiched by two fascial structures; the ventral fascia which seemed to correspond to the mesorectal fascia, whereas the dorsal fascia corresponded to the presacral fascia. These fasciae or the HGN sheaths extended laterally along the ventral aspects of the great vessels and associated lymph follicles. The ventral fascia is, to some extent, fused with the mesocolon descendens on the left side of the body. Notably, the lateral continuation of these two fasciae also sandwiches the left ureter, but not the right ureter, presumably due to modifications by the left-sided fusion fascia. A hypothetical common sheath for the HGN and ureter (i.e., the ureterohypogastric or vesicohypogastric fascia) might thus be an oversimplification. Before retroperitoneal fixation, the morphology of the peritoneal recess along the mesocolon descendens and mesosigmoid suggested interindividual differences in location, shape, and size. Therefore, in adults the ease of surgical separation of the rectum and left-sided colon from the HGN seems to depend on interindividual differences in the development of the embryonic peritoneal recess. On the caudal side of the second sacral segment, fascial structures were restricted along and around the HGN, pelvic splanchnic nerve, and pelvic plexus. The rectal lateral ligament thus seems to represent a kind of migration fascia formed by mechanical stress.     

Reaction Time in a Visual 4-Choice Reaction Time Task: ERP Effects of Motor Preparation and Hemispheric Involvement

Reaction time (RT), the most common measure of CNS efficiency, shows intra- and inter-individual variability. This may be accounted for by hemispheric specialization, individual neuroanatomy, and transient functional fluctuations between trials. To explore RT on these three levels, ERPs were measured in a visual 4-choice RT task with lateralized stimuli (left lateral, left middle, right middle, and right lateral) in 28 healthy right-handed subjects. We analyzed behavioral data, ERP microstates (MS), N1 and P3 components, and trial-by-trial variance. Across subjects, the N1 component was contralateral to the stimulation side. N1-MSs were stronger over the left hemisphere, and middle stimulation evoked stronger activation than lateral stimulation in both hemispheres. The P3 was larger for the right visual field stimulation. RTs were shorter for the right visual hemifield stimulation/right hand responses. Within subjects, covariance analysis of single trial ERPs with RTs showed consistent lateralized predictors of RT over the motor cortex (MC) in the 112–248 ms interval. Decreased RTs were related to negativity over the MC contralateral to the stimulation side, an effect that could be interpreted as the lateralized readiness potential (LRP), and which was strongest for right side stimulation. The covariance analysis linking individual mean RTs and individual mean ERPs showed a frontal negativity and an occipital positivity correlating with decreased RTs in the 212–232 ms interval. We concluded that a particular RT is a composite measure that depends on the appropriateness of the motor preparation to a particular response and on stimulus lateralization that selectively involves a particular hemisphere.     

Systematization,Description, and Territory of the Middle Cerebral,Rostral, and Cerebroethmoidal Arteries on the Surface of the Brain of the Ostrich (Struthio camelus)

Thirty ostrich specimens were injected with red-dyed latex via the internal carotid arteries (Aa.) The middle cerebral and cerebroethmoidal arteries and their branches were systematized. The middle cerebral artery (a.) was always a single large vessel. On the right side, it had two, three, or one developed medial hemispheric branches in 46.6%, 26.7%, and 26.7% of cases, respectively. On the left side, one (36.7%), two (33.3%), and three (30%) developed medial hemispheric branches were observed. The middle cerebral artery had eight (40%), nine (20%), seven (16.7%), eleven (6.7%) ten (6.7%), twelve (3.3%), six (3.3%), and five (3.3%) developed lateral hemispheric branches on the right side and seven (46.7%), nine (13.3%), eight (13.3%), six (10%), five (10%), and ten (6.7%) on the left. Two (33.3%), four (20%), three (20%), one (16.7%), and five (10%) direct perforating branches of the middle cerebral artery were present on the right, and three (33.3%), two (30%), one (13.4%), six (10%), four (10%), and five (3.3%) were present on the left. The cerebroethmoidal artery, always present as a natural continuation of the rostral terminal branch of the brain's carotid artery and originating from the middle cerebral artery, was a large vessel that projected rostromedially, giving off the rostral cerebral artery shortly after its formation and continuing as the ethmoidal artery. The rostral cerebral artery was a single (90%) and double (10%) vessel on the right and a single (96.7%) and double vessel (3.3%) on the left. The ethmoidal artery was always a medium to large single vessel and was the natural continuation of the cerebroethmoidal artery, immediately after giving off the rostral cerebral artery. Anat Rec, 302:1187–1194, 2019. © 2018 Wiley Periodicals, Inc.     

直肠癌患者及健康人群直肠及周围解剖结构的高分辨MRI观察

目的 应用高分辨MRI观察直肠肠壁及其周围解剖细节,为直肠癌的临床诊断和治疗提供解剖参数和依据。 方法 收集60名健康人及20例直肠癌患者的盆腔多序列参数MRI;两位高年资医师行双盲法阅片,对20例直肠癌患者行术前T分期并与术后病理对照,分析准确率;统计分析60名正常人直肠固有筋膜前、后、左、右侧的MRI显示率,以及所有研究对象的骶前筋膜、骶骨筋膜、腹膜返折、直肠侧韧带、下腹下丛的MRI显示率。结果 高分辨MRI可以清楚地显示直肠壁的黏膜层、黏膜下层和固有肌层,直肠癌术前T分期的总准确率为80%（16/20）。健康人直肠固有筋膜前、后、左、右侧的MRI显示率分别为71.7% （43/60）、96.7%（58/60）、90.0%（54/60）和83.3%（56/60）。Denonvillier′s筋膜、骶前筋膜、直肠骶骨筋膜、腹膜返折及下腹下丛的MRI显示率分别为68.8%（55/80）、65.0%（52/80）、87.8%（69/80）、86.3%（69/80）和90.0%（72/80）;直肠侧韧带的显示率较低,左侧为53.8%（43/80）,右侧为47.6%（38/80）。结论 高分辨MRI可以辨识直肠肠壁及其周围解剖细节,帮助直肠癌术前T分期及制定临床治疗方案,判断全直肠系膜切除手术的侧切缘是否浸润,提高微转移癌灶的手术切除率,减少手术并发症。