星状神经节阻滞麻醉的应用解剖

目的:为气管旁入路星状神经节阻滞麻醉提供解剖学依据。方法:对17具(34侧)成人尸体标本进行解剖,对星状神经节的形态、位置及其毗邻结构进行观测。结果:星状神经节出现率为82.35%,其位置位于第7颈椎横突基部和第1肋骨颈之间前方;从颈前皮肤至星状神经节的垂直距离为(31.86±0.72)mm。结论:气管旁入路星状神经节阻滞麻醉选择第6颈椎横突前结节为进针部位是较为安全的方法。     

星状神经节的应用解剖及其与Horner综合征关系的探讨

目的:探讨星状神经节局部解剖及其损伤与Horner综合征的关系。方法:在31具成人尸体标本上,观测了60侧星状神经节的大小、形态、分支及其与肋骨的毗邻关系。结果:星状神经节长径(20.8±3.1)mm,宽径(8.5±1.9)mm,完全融合的出现率是60.0%(36/60)。神经节下缘低于第2肋骨上缘的出现率是33.3%(20/60),星状神经节与第1脊神经的交通纤维进出神经链的位置点均高于2肋上缘,两者距离为2.3～7.8mm。结论:第2肋骨上缘水平损伤交感神经链可能伤及部分星状神经节,但不会引起Horner综合征中的眼部症状。     

颈椎椎间孔与脊神经的形态观察

对30例成年男性颈椎颈2到胸1间的348个椎间孔和相应神经根形态位置进行了观察,对其径线进行了测量。测量结果:椎间孔平均值:前后径5.17±0.81mm,上下径为7.58±1.15mm。神经根平均值:前后径为4.01±0.65mm,上下径为5.60±0.93mm。颈4到颈7间榷间孔与相应神经根之间的间隙较小。本文结合临床和有关文献进行了讨论。     

侧胸部小切的应用解剖

目的为侧胸部小切口手术方法提供应用解剖学基础.方法解剖观测23例(46侧)常规防腐尸体标本的胸前外侧区内胸背神经、胸背血管、胸长神经及胸外侧血管的走行、分支及分布和体表定位.结果侧胸部背阔肌和胸大肌之间的三角形间隙内,胸背神经横径(2.6±0.5)mm;暴露长度(进入背阔肌前)(4.7±0.7)cm;均于第4或5肋间隙进入背阔肌;与其伴行的胸背动脉压径(3.0±0.6)mm.胸长神经横径(2.4±0.6)mm;暴露长度(4.6±0.7)cm;均于第4或第5肋间隙入前锯肌.面胸外侧动、静脉于胸小肌下缘中部第3、4肋间隙穿出胸小肌后也暴露于此三角内,其压径(2.7±0.4)mm;暴露长度(3.9±0.7)cm.结论胸背神经、胸背血管、胸长神经、胸外侧血管在背阔肌与胸大肌之间的三角形间隙内有固定行径,进行侧胸部小切口时,应避免上述结构损伤.     

星状神经节阻滞的应用解剖

目的为临床成功实施星状神经节阻滞提供形态学依据。方法对19具成人尸体标本进行解剖．对星状神经节的形态、位置、大小及其与周围结构毗邻关系进行观测。结果星状神经节的形态主要为星形（左侧占66．67％,右侧占50．0％）;其主要位于颈根部第七颈椎横突至第一肋颈处。星状神经节至颈前正中线的距离及至皮肤的深度在左右侧星状神经节的数值均比较相近,无明显差异（P〉0．05）。结论临床应用中不必考虑侧别等问题。     

肌间沟臂丛神经阻滞相关结构的观测

目的为肌间沟臂丛神经阻滞入路和预防并发症的发生提供解剖学基础。方法对50侧尸体颈部与肌间沟臂丛神经阻滞入路相关结构及其毗邻关系进行了解剖观测。结果肌间沟臂丛神经穿刺进针深度(即皮肤至第6颈椎横突距离。从环状软骨向后引一直线与胸锁乳突肌后缘相交点处的皮肤进针)为(18±1.4,12～22)mm。获得了与臂丛穿刺相关结构的观测结果。结论为肌间沟臂丛神经阻滞入路和预防并发症的发生提供了解剖学依据。     

颈丛麻醉的应用解剖

目的为临床麻醉医师提供有关颈丛麻醉的解剖学基础。方法解剖观察成人尸体28侧(男18侧女10侧)颈前外侧区,以胸锁乳突肌锁骨头起点为A点,颞骨乳突的最低点为B点,颈丛浅支穿出胸锁乳突肌后缘范围中点定为O点,第4颈椎横突肋结节定为C4,测量有关临床颈丛麻醉的6项数据。结果AB线的长度为(12·6±1·1)cm,OB的距离为(6·8±0·6)cm,C4B的距离为(6·5±0·8)cm,SO的最短距离为(0·8±0·1)cm,SC4的最短距离为(2·0±0·2)cm。结论临床颈丛阻滞麻醉,进针部位应在胸锁乳突肌后缘距乳突最低点(6·8±0·6)cm处,进针的深度,颈丛浅支阻滞麻醉应为(0·8±0·1)cm,颈丛深支阻滞麻醉应为(2·0±0·2)cm。     

胸内、外侧神经与肌皮神经吻接的应用解剖

在专供研究用的18具(男9,女9)成人尸体上解剖,观察了36侧胸内、外侧神经和肌皮神经。胸内、外侧神经主干长度分别为42.81±4.18mm和40、55±3.12mm,主干入肌处的宽度分别为1.29±0.09mm和1.57±0.09mm,厚度分别为0.63±0.04mm和0.68±0.05mm。胸内侧神经中有28侧(77.8%)发出1-3支分支入肌,其上支长度为30.69±2.61mm;胸外侧神经中有26侧(72.2%)发出1-3支分支入肌,其上支长度为35.97±3.22mm。肌皮神经的自然长度为43.87±3.41mm,无损伤分离出的长度为22.94±2.17mm,起始处的宽、厚度分别为2.90±0.11mm和1.76±0.07mm。肌皮神经起点与胸内、外侧神经起点之间的距离分别为43.14±3.81mm和50.57±3.71mm。     

颈部血管和神经与颈椎的关系及应用解剖

目的观测颈部血管、神经与颈椎的关系,为颈椎手术提供帮助。方法在40侧成人标本上,观测颈部血管、神经的长度及起止点与相邻颈椎间的距离。结果面动脉与舌神经伴行,起点距相邻C3椎体为(18.5±7.2)mm。舌动脉与舌下神经伴行,起点距相邻C2～3椎体为(19.7±8.4)mm。甲状腺上动脉与喉上神经外支伴行,起点距相邻C3椎体为(17.0±5.7)mm,止点距相邻C5椎体为(18.2±2.5)mm。喉上动脉与喉上神经内支伴行,起点距相邻C3椎体为(15.7±6.7)mm,止点距相邻C3椎体为(19.7±5.8)mm。甲状腺下动脉起点距相邻C7椎体为(17.3±5.5)mm,止点距相邻C7椎体为(11.3±3.4)mm。结论颈上部有数支动脉起至C2～3高度,此处显露喉上神经尤为重要。颈中部尽量减少对颈内脏鞘和颈动脉鞘的牵拉。颈下部则熟悉喉返神经与甲状腺下动脉的关系。手术途径选右侧为宜,以避免胸导管的损伤。     

交感干臂丛间灰、白交通支的解剖学特点及其临床意义

目的:探讨交感干臂丛间交通支的分布特点及其临床意义.方法:选用33具成年防腐尸体,解剖并观测交感干与臂从交通支的走行分布特点.结果:1.颈中神经节或节间支与臂丛交通支多对称分布,至第5、6颈神经的42条交通支在第5、6颈椎横突水平内行自头长肌、颈长肌间沟后行入神经.2.星状神经节(或颈下神经节及胸l神经节)发出向内上方加入第7、8颈神经的交通支除1例外均对称分布.至C8神经的交通支与C8神经结合前51侧发出分支与C7,神经相交通,其中45侧穿过第7颈椎横突孔.至C7神经的交通支与C7神经结合前41侧发出分支与C6神经相交通,分支伴椎动脉经第6颈椎横突孔上行,29侧分支沿途发出许多细小纤维支至椎动脉及周围椎间、横突间关节.结论:1、交感干与臂丛间的交通支具有典型的分布特点,可为研究交感神经对臂从神经功能支配及颈椎前路扩大减压术时减少损伤提供解剖学资料.2、至C7神经的交通支分布特点可为临床上通过椎神经阻滞治疗顽固性颈痛提供解剖学依据.     

Functional anatomy of the major cardiac nerves in cats

In recognition of the extensive use of the cat as an experimental model of cardiac innervation, the effects of electrical stimulation of stellate ganglia, thoracic vagosympathetic complexes, and individual feline cardiopulmonary nerves on heart rate, blood pressure, and contractility in all four cardiac chambers were analysed and correlated with the anatomy of the thoracic autonomic nervous system. The right and left stellate ganglia in cats are relatively large and globular. Distinct dorsal and ventral ansae subclavia arise from these ganglia, connecting with the relatively small, spindle-shaped middle cervical ganglia situated in the apices of the thoracic cage bilaterally. A cranial pole nerve arises from each of the middle cervical ganglia and courses cranially to unite with the ipsilateral superior cervical ganglia. On each side, the major cardiopulmonary nerves arise from the middle cervical ganglion, the relatively large vagosympathetic trunk, and the stellate ganglion. On the right side these nerves consist of a very small right stellate cardiac nerve, a recurrent cardiac nerve, a group of craniovagal nerves and a group of caudovagal cardiopulmonary nerves. On the left side are the left stellate cardiac, ventrolateral, ventromedial, and innominate cardiopulmonary nerves. All of these nerves contain efferent parasympathetic and/or sympathetic fibers which modify cardiac chronotropism and/or inotropism. Some contain afferent fibers. These results indicate that specific cardiopulmonary nerves exist in cats, which when stimulated, modify the cardiovascular system in specific fashions.     

The paraventricular nucleus of the hypothalamus sends efferents to the spinal cord of the rat that closely appose sympathetic preganglionic neurones projecting to the stellate ganglion

Using a combination of anterograde and retrograde neuronal tract-tracing techniques, the descending projections from the paraventricular nucleus of the hypothalamus (PVN) to the brain/spinal cord and in particular those axonal projections that appear to be contiguous with sympathetic preganglionic neurones (SPN) projecting to the stellate ganglion have been studied. Descending PVN pathways were located by the anterograde transport of biotinylated dextran amine (BDA), whilst SPN were retrogradely labelled with cholera B toxin subunit conjugated to horseradish peroxidase (CB-HRP). BDA-labelled PVN axons terminated in both hypothalamic and extrahypothalamic (including the midbrain, medulla and spinal cord) brain nuclei, with dense terminal labelling observed particularly in the arcuate hypothalamic nucleus and adjacent median eminence, in the solitary tract, vagal nuclei and in the intermediolateral region of the spinal cord (IML). Varicose descending PVN fibres in the IML were often observed to closely appose both the cell soma and dendrites of retrogradely labelled SPN (projecting to the stellate ganglion) in the spinal cord. In addition, it was shown that PVN descending axons crossing to the contralateral side of the spinal cord were closely associated with retrogradely labelled SPN projecting to the superior cervical ganglion. Such findings suggest that descending pathways from the PVN may exhibit a direct influence on cardiac sympathetic outflow and may also influence the behaviour of the contralateral population of SPN projecting to the superior cervical ganglion. Received: 7 May 1997 / Accepted: 17 October 1997     

Stellate ganglion block may relieve hot flashes by interrupting the sympathetic nervous system

Stellate ganglion block is routinely used in pain clinics. The mechanism of action of the stellate ganglion block is uncertain; the most common explanation is that it produces peripheral vasodilation, resulting in neural inhibition in the ganglion's sphere of innervation. However, the wide range of conditions that have been reported to respond favorably to stellate ganglion block suggest that its effectiveness may not be solely the result of increased blood flow nor restricted just to its sphere of innervation. We have found that stellate ganglion block is effective in the treatment of hot flashes in postmenopausal women, as well as those with estrogen depletion resulting from breast cancer treatment. Based on evidence that hot flashes may be centrally mediated and that the stellate ganglion has links with the central nervous system nuclei that modulate body temperature, we hypothesize that the stellate ganglion block provides relief of hot flashes by interrupting the central nervous system connections with the sympathetic nervous system, allowing the body's temperature-regulating mechanisms to reset. If this mechanism can be confirmed, this would provide women with intractable hot flashes with an effective, potentially long-lasting means of relieving their symptoms, and potentially widen the range of indications for stellate ganglion block to include other centrally mediated syndromes.     

星状神经节毗邻关系的解剖学研究

目的：观察星状神经节形状、大小、位置及其与周围组织结构的毗邻关系,为临床进行星状神经节阻滞术提供确切的数据支持。方法：用新鲜成人尸体17具,逐层解剖星状神经节周围结构,暴露星状神经节,测量其大小及与周围结构的距离。结果：星状神经节长为（12．3±3．3）mm,宽为（3．9±1．1）mm,厚为（2．1±0．5）mm,神经节下缘距胸膜顶垂直距离为（55．1±1．5）mm,内侧缘距离颈正中线直线距离为（27．1±5．6）mm,星状神经节和椎动脉在冠状面上的最近距离为（7．6±4．8）mm,星状神经节和椎动脉在矢状面上的最近距离为（1．8±2．0）mm。结论：星状神经节周围组织结构复杂,星状神经节阻滞术易误伤周围结构产生并发症。     

星状神经节阻滞术及其相关应用解剖研究进展

目的：研究星状神经节阻滞术及其相关应用解剖,从而更好地指导临床工作。方法：查阅国内外相关文献,阐述星状神经节及其毗邻结构的解剖关系,分析星状神经节阻滞术式的发展过程及其并发症。结果：星状神经节毗邻众多重要结构,星状神经节阻滞术有一些比较严重的并发症。结论：术者需熟悉星状神经节周围结构以减少并发症,解剖学研究是一个必需的基础。     

Ultrastructural localization of neurotensin immunoreactivity in the stellate ganglion of the cat

Summary The morphological features and cellular relationships of neurotensin-containing axon terminals were studied at light and electron microscopic levels in the cat stellate ganglion using peroxidase and immunogold immunocytochemistry. By light microscopy, neurotensin immunoreactivity was detected within thin varicose fibres distributed throughout the ganglion. Immunoreactive fibres were no longer apparent following chronic deafferentation of the ganglion indicating that they were of extrinsic origin. Ultrastructural analysis of peroxidase immunostained material confirmed the presence of neurotensin immunoreactivity within a subpopulation of axonal varicosities which made synaptic contacts with the dendrites of ganglion cells. Within labelled varicosities neurotensin immunoreactivity was found by both immunoperoxidase and immunogold methods to be concentrated within large dense core vesicles 80–120 nm in diameter. These large dense core vesicles were characteristically distant from the active zone, in keeping with a possible extrasynaptic release of the peptide.     

Brain-derived neurotrophic factor and Glial cell line-derived neurotrophic factor expressions in the trigeminal root entry zone and trigeminal ganglion neurons of a trigeminal neuralgia rat model

Microvascular compression on the trigeminal root entry zone (TREZ) is the main etiology of trigeminal neuralgia (TN) patients. To investigate brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) in the trigeminal ganglion (TG) and TREZ, immunofluorescence staining and Western blot were used in a rat TN model. Both BDNF and GDNF were observed in the TG neurons and TREZ. The expression of the BDNF dimer in the TG was increased in the TN group, while GDNF expression was decreased after compression injury. The BDNF dimer/pro-BDNF ratio in the TREZ of the TN group was higher than that in the sham group, but the GDNF expression in the TREZ was significantly lower than that in the sham group. These results suggested that compression injury in the TREZ of rats induced dynamic changes in BDNF and GDNF in both the TG and TREZ, and these changes are involved in the nociceptive transmission of the TN animal model.     

Light and electron microscopic autoradiographic study of the dorsal root projections to the cat dorsal horn

The distribution of terminals arising from dorsal root primary afferents was examined in the lumbar spinal cord of cats using light- and electron-microscopic autoradiography. Tritiated proline or leucine was injected into either the L6 or L7 dorsal root ganglion. The light-microscopic spinal cord distribution of radioactivity in the ganglia was independent of the type of amino acid used. Likewise, the length of the survival time after injection had no effect. The projections to the substantia gelatinosa and the marginal zone were consistently the densest. However, the topography of the dorsal horn distribution, relative the the segment of entry, varied significantly especially in the gelatinosa, depending upon the ganglia injected. Those to the substantia gelatinosa were largely limited to the segment of entry; those to the marginal zone and nucleus proprius extended many segments beyond the level of entry. At all levels the projection was exclusively ipsilateral to the side of injection.At the electron-microscopic level the distribution of radioactivity was determined in each of the three easily recognizable areas of the dorsal horn: the marginal zone, the substantia gelatinosa and the nucleus proprius. In each dorsal horn area the total terminal population was divided into four basic categories. Each of these areas was found to contain a characteristic distribution of these four terminal categories. The difference between areas arose, primarily, as a consequence of the dorsal to ventral decreasing frequency gradient of two types of terminal: those containing large, dense-cored vesicles and the increasing gradient of those containing flattened vesicles. The terminals with small pleomorphic vesicles and those with large round vesicles were frequently encountered in all three areas without a detectable frequency gradient.Similarly, the primary afferent terminal population, that is the subset of the total terminal population labelled after dorsal root ganglion injection, was also characteristic of the area, and each area was dominated by a different terminal type. In the marginal zone the terminals containing large dense-cored vesicles dominated. In the substantia gelatinosa the terminals with pleomorphic vesicles (which included the so-called ‘C’ type terminals) dominated. And the terminals containing large round vesicles dominated the primary afferent population in the nucleus proprius. The terminals containing flattened vesicles were never found to be specifically labeled in any of the areas examined.     

The spinal sensory component of the ganglia of the sympathetic nervous system

Summary The author studied the sources of the spinal sensory fibers of the celiac, stellate and superior cervical sympathetic ganglia.These ganglia were removed in cats and in 8–19 days all the cervical thoracic and lumbar spinal ganglia were studied in serial sections to reveal retrograde changes in the neurones.It was established that the neuron processes of the spinal ganglia C₅ and L₁ of the ipsilateral side pass through the celiac ganglion. The bulk of these neuroneslies in the spinal ganglia D₇-L₃. The neurone processes of the spinal ganglia C₂-L₄ pass through the stellate ganglion, but mainly-C₇-D₅; the neurone processes of the spinal ganglia C₂-D₄ pass through the superior cervical sympathetic ganglion.The neurone processes of the spinal ganglia of the contralateral side pass through all the sympathetic ganglia mentioned.(Presented by Active Member AMN SSSR V. N. Chernigovskii) Translated from Byulleten' eksperimental'noi biologii i meditsiny Vol. 49, No. 1, pp. 122–125, January, 1960