喉返神经的应用解剖研究

目的为甲状腺手术术中对喉返神经的定位和保护提供解剖学基础。方法采用经福尔马林固定的60具成人标本(男40,女20)共120侧,用解剖学方法对喉返神经及其分支进行定位观测,以及观测甲状腺下动脉、甲状软骨下角和甲状腺下极等3种解剖标志与喉返神经的毗邻关系。结果(1)喉返神经的分支有喉支和喉外支,前者在喉前多分为前、后支。(2)喉返神经与甲状腺下动脉的关系分5种类型。(3)91.7%(110侧)喉返神经的喉支多在距甲状腺下角尖端(16.9±7.2)mm处分前、后支,喉外支多在其下(10.4~70.3)mm范围内发出。(4)59.2%的喉返神经分支发出部位在甲状腺下极平面以上,距甲状腺下极平面距离(11.25±7.1)mm。结论在甲状腺手术中应注意喉返神经的变异,通过暴露和辨认喉返神经及其分支防止其损伤。     

喉、甲状腺手术的应用解剖

目的:为颈前部手术提供相关血管、神经的形态学依据.方法:在16具32侧成人头颈部标本上解剖观测喉和甲状腺的血管和神经的走行及分布.结果:甲状腺左、右叶平均长度分别为(49.5±8.2)、 (50.1±7.8) mm,有锥形叶者7例,占43.7%;16例中有1例甲状腺最下动脉(出现率为6.3%);甲状腺上动脉与喉上神经伴行,甲状腺下动脉与喉返神经相交叉.喉上动脉入喉处在甲状软骨上角的前下方左侧为(13.91±2.83) mm,右侧为(14.96±2.56) mm,两侧差异有统计学意义;喉上神经喉内支入喉处在甲状软骨上角前下方左侧为(11.80±3.42) mm,右侧为(12.24±2.68) mm;喉下神经在甲状软骨下角后下方入喉,距离甲状软骨下角左侧(5.38±1.56) mm,右侧(5.69±1.77) mm,两侧差异有统计学意义.结论:熟悉喉、甲状腺血管、神经的应用解剖学是有效预防甲状腺手术并发症的基础     

喉后外侧进路杓状软骨定位的应用解剖

目的 :为临床喉后外侧手术进路杓状软骨的定位提供解剖依据。方法 :观察 3 0例 60侧 (男 19例 ,女 11例 )喉软骨架标本杓状软骨肌突与甲状软骨板的位置关系。结果 :(1)杓状软骨肌突距甲状软骨下角下端距离 :男 (12 .5± 1.8)mm ,女 (10 .5± 1.8)mm ;距甲状软骨板后缘间距 :男 (8.0± 1.7)mm ,女 (6.7± 1.8)mm ;距甲状软骨板内面间距 :男 (3 .4± 1.7)mm ,女 (3 .5± 1.1)mm。 (2 )杓状软骨肌突投影点位于甲状软骨板斜线后区下部 ,该投影点距甲状软骨下缘距离 :男 (6.6± 0 .1)mm ,女 (4 .9± 0 .4)mm ;距后缘距离 :男 (6.8± 1.8)mm ,女 (5 .5± 1.3 )mm。结论 :经喉后外侧进路手术可从甲状软骨后缘、下缘、环甲关节下缘或去除部分甲状软骨板来定位肌突。肌突距甲状软骨板内面最近 ,若从甲状软骨板斜线后区开窗寻找肌突可以缩短手术进路距离。     

喉返神经的应用解剖

目的:为颈部手术特别是甲状腺手术中避免喉返神经损伤提供解剖学基础.方法:采用甲醛固定的50具成人标本(男30,女20)共100侧,对喉返神经的走行、分支及其与甲状腺下动脉、甲状软骨下角的位置关系进行解剖观测.结果:喉返神经按其分布分为喉支和喉外支,前者90%在距甲状软骨下角尖(16.7±7.5)mm处分为前、后两支,后者多在其下10.2～ 70.5 mm 范围内发出.左侧喉返神经82.0%走在甲状腺下动脉的后面,右侧76.0%走在动脉的前面,侧别差异有统计学意义(P＜0.005).结论:查明喉返神经的行径及其毗邻关系,有助于防止术中损伤喉返神经.     

喉上神经外支变异1例

笔者对41例标本,共82侧喉上神经外支进行解剖时发现1例成年男性尸体左侧喉上神经外支变异,现报道如下:左侧喉上神经位于第2颈椎横突,发自迷走神经,在舌骨大角处分为较大的内支和细小的外支.内支与喉上动脉伴行,经甲状软骨上缘和舌骨之间穿甲状舌骨膜入喉;外支沿甲状软骨下缘行走,伴行甲状腺上动脉,并分出3支:第1支位于甲状软骨上缘发出进入甲状舌骨肌;第2支由甲状软骨下缘发出,进入咽缩肌;第3支在甲状腺侧叶与咽缩肌和气管之间下行,于环状软骨下缘与喉返神经一起进入环甲关节后缘,沿途喉上神经外支与甲状腺侧叶实质紧贴,肉眼不易与甲状腺周围的筋膜区别(图1).     

杓状软骨的定位研究及其意义

目的为杓状软骨相关手术的术中定位提供解剖数据。方法观测30例60侧正常成人喉标本杓状软骨声带突和肌突形态及其与甲状软骨板的位置关系。结果 (1)测量了顶底间距等10项杓状软骨形态指标,除了甲杓肌附着深度外,其余指标具有性别差异(P0.05)(;2)肌突距甲状软骨下角下端距离:男(13.05±1.92)mm,女(11.76±1.79)mm;距甲状软骨板后缘间距:男(8.11±1.17)mm,女(6.95±1.26)mm;距甲状软骨板内膜间距:男(3.71±1.31)mm,女(3.65±1.23)mm。(3)杓状软骨肌突投影点位于甲状软骨板斜线后下区域,该投影点距甲状软骨下缘距离:男(7.12±1.43)mm,女(5.92±1.26)mm;距后缘距离:男(7.27±1.52)mm,女(5.81±1.47)mm。结论杓状软骨相关手术可根据甲状软骨后缘、下缘、环甲关节下缘来定位肌突。肌突距甲状软骨板内面最近,若从甲状软骨板斜线后区开窗寻找肌突可以缩短手术进路距离。     

喉切除发音管重建术中环咽肌与喉下神经的应用解剖

目的：为提高全喉切除术后用发音管发音重建的成功率提供解剖学基础。方法：对４０具（男３０，女１０）成人标本环咽肌进行解剖，观测左右侧喉下神经入喉处与甲状软骨下角的距离、喉下神经和环咽肌的关系。结果：喉下神经入喉点距甲状软骨下角的距离，左侧（５．５±１．４） ｍｍ；右侧（５．３±１．３） ｍｍ。７５％（６０侧）喉下神经在环咽肌的下方穿入喉部；２５％（２０侧）喉下神经在环咽肌纤维之间穿入喉部。结论：本研究对于指导环咽肌切断术，诊治环咽肌失驰缓症，探讨喉下神经和环咽肌的关系等有重要的临床意义。     

与颈部手术相关的喉返神经的应用解剖

目的 :为颈部手术中喉返神经的定位和保护提供形态学和局部解剖学基础。方法 :解剖 5 0具 (10 0侧 )成人颈部尸体标本 ,对喉返神经及其分支进行定位观测。结果 :(1)喉返神经的分支有喉支和喉外支 ,前者在入喉前多分为前支、后支。 87%的喉返神经分支呈树枝状 ,13 %的喉返神经分支之间或分支与颈交感干之间相互吻合呈袢状。 (2 )有 2 %的双喉返神经和 1%的非返喉下神经。 (3 ) 94%的喉返神经的喉支多在距甲状腺下角尖端 (16.9± 7.6)mm处分为前、后支 ,喉外支多在其下 10 .4～ 70 .4mm范围内发出。 (4 )喉返神经与甲状腺下动脉的关系分为 5种类型。 (5 )喉返神经与颈部食管及颈动脉鞘的位置关系复杂。结论 :在颈部相关手术中应注意喉返神经的变异 ,通过显露和辨认喉返神经防止其损伤。     

喉切除术相关血管神经的解剖学研究

目的:为喉切除手术提供相关血管神经的形态学依据。方法:在20具(40侧)成人头颈部标本上解剖观测喉的血管和神经的走行及分布。结果:喉上动脉的入喉处在甲状软骨上角前下方左侧(14.91±3.83)mm、右侧(15.96±3.56)mm;喉上神经喉内支的入喉处在甲状软骨上角前下方左侧(12.80±4.42)mm、右侧(13.24±3.68)mm;喉下神经入喉处距离甲状软骨下角左侧(5.38±1.57)mm、右侧(5.69±1.78)mm。进行左右比较时,表现为右侧优势。结论:本研究对喉切除手术以及其他颈前区手术具有一定的参考意义。     

喉上神经外支在环甲间隙的应用解剖学研究

目的为甲状腺手术中保护喉上神经外支提供解剖学基础。方法成人尸体32具(64侧),解剖观察喉上神经外支在环甲间隙的解剖学特点,观察该神经与间隙内其他解剖结构的关系。结果3侧喉上神经存在袢状结构;发现所有标本中均存在环甲肌支,71.8%(46侧)存在咽支;按Friedman分型方法进行分型:Ⅰ型占28.1%(18侧)、Ⅱ型占54.7%(35侧)、Ⅲ型占17.2%(11侧)。喉上神经外支入咽下缩肌点位置均位于胸骨甲状肌深面,斜线下方。喉上神经外支入咽下缩肌点至斜线的垂直距离为(3.60±0.30)mm,距胸骨甲状肌内侧缘的垂直距离(8.27±1.72)mm,距环状软骨中点的距离是(27.09±1.46)mm。结论甲状腺手术中,从环甲间隙入路多数情况下可以显露保护喉上神经外支环甲肌支;大于17.2%的情况下不能显露,但也不会损伤。     

颈前区器官的应用解剖研究

目的观察颈前区器官与血管和神经的毗邻关系,为临床手术提供解剖学依据。方法在18例36侧成人头颈标本上解剖观测喉、气管颈部和甲状腺的血管和神经的走行及分布。结果甲状腺左、右叶平均长度为48．9±8．8mm和49．9±7．9mm．锥状叶者8例,占44．4％;1例出现甲状腺最下动脉（出现率5．6％）．2例出现甲状腺最下静脉（出现率11．1％）;喉上动脉人喉处在甲状软骨上角的前下方左侧为13．94±2．79mm,右侧为14．93±2．58mm,差异有统计学意义;喉上神经内支人喉处在甲状软骨上角前下方左侧为11．78±3．44mm,右侧为12．26±2．66mm;喉下神经在甲状软骨下角后下人喉,距离甲状软骨下角左侧5．34±1．61mm,右侧5．72±1．74mm,差异有统计学意义。结论手术时应注意这一区域血管神经走行情况,防止并发症的发生。     

喉返神经的应用解剖学

本文解剖115例喉返神经,从临床应用角度出发。对喉返神经的横径,终未分支;喉返神经与甲状软骨下角,甲状腺下动脉,气管食管沟,甲状腺,喉返神经三角的局部关系进行了研究。提出甲状软骨下角,气管食管沟,喉返神经三角是识别喉返神经的简便,可靠、实用的标志和手术中避免损伤喉返神经的解剖学依据。     

An anatomical study of the recurrent laryngeal nerve: its branching patterns and relationship to the inferior thyroid artery

Abstract: The aim of this study was to provide information about the morphology and topography of the recurrent laryngeal nerve (RLN), its external features and branches, as well as its relationship to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland. The RLNs in 50 adult cadavers (100 sides) were dissected and analyzed. A communicating loop connecting one branch of the RLN to another or a twig originating from the cervical sympathetic trunk was present in 13 of 100 sides. A double left RLN appeared in 2 sides; a right non-recurrent inferior laryngeal nerve appeared in one side. All of the RLNs, including looped ones, bifurcated into laryngeal branches and extralaryngeal branches, with most of the former further dividing into the anterior and posterior branches entering the larynx. The relations of the RLN to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland were inconstant. The information gained from this study will be of value in thyroid surgery.     

An anatomical study of the recurrent laryngeal nerve: its branching patterns and relationship to the inferior thyroid artery

The aim of this study was to provide information about the morphology and topography of the recurrent laryngeal nerve (RLN), its external features and branches, as well as its relationship to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland. The RLNs in 50 adult cadavers (100 sides) were dissected and analyzed. A communicating loop connecting one branch of the RLN to another or a twig originating from the cervical sympathetic trunk was present in 13 of 100 sides. A double left RLN appeared in 2 sides; a right non-recurrent inferior laryngeal nerve appeared in one side. All of the RLNs, including looped ones, bifurcated into laryngeal branches and extralaryngeal branches, with most of the former further dividing into the anterior and posterior branches entering the larynx. The relations of the RLN to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland were inconstant. The information gained from this study will be of value in thyroid surgery.     

Laryngeal branching pattern of the inferior laryngeal nerve, before entering the larynx

The objective of the present work was to investigate the laryngeal branching pattern of the inferior laryngeal nerve (ILN) in detail before the branches entered the larynx. In 49 specimens 96 sides were examined for this project, including 27 males and 22 female cadavers. In 7 sides (7.3%, 5 on the left and 2 on the right) the ILN passed as a single trunk into the larynx below the inferior constrictor muscle. In 82 sides (85.4%, 40 on the left and 42 on the right) two laryngeal branches originated from the nerve. The nerve divided either just before entering the larynx (58.3%, 24 on the left and 32 on the right) or 15–32 mm below the inferior constrictor muscle (27.1%, 16 on the left and 10 on the right). In 69 sides (71.8%), the anterior and/or posterior laryngeal branches subdivided into one or two sub-branches. The anterior (observed in 49 sides, 51%) and posterior laryngeal branches supplied all intrinsic laryngeal muscles except the cricothyroid muscle and the mucosa below the vocal cords, respectively, while their sub-branches reached the cricopharyngeal part of the inferior constrictor muscle, esophagus and/or the thyroid gland. In 7 sides (7.3%, 4 on the left and 3 on the right) the nerve divided into three laryngeal branches. In conclusion, the branching pattern of the nerve may be important pitfalls of the thyroidal and laryngeal surgery. Owing to this the surgeon should keep in mind the risk of extra laryngeal division of the nerve and not confuse laryngeal and extra laryngeal branches.     

喉部动脉影像解剖学的应用研究

目的研究喉部动脉的影像解剖学为临床提供解剖学依据和资料。方法取36例喉部结构完整的尸体标本,8例尸体标本做动脉铸型,12例尸体标本用MR扫描仪进行水平面和矢状面的扫描,8例尸体标本进行1mm/片冰冻磨铣,8例尸体标本进行大体及显微解剖,并对5种不同的形态学研究方法关于喉部动脉的观测结果进行统计学分析和定性、定量研究。结果左、右甲状腺上动脉的长度分别为(42.30±0.20)mm和(40.50±0.20)mm,起点处的管径分别为(1.80±0.30)mm和(1.65±0.30)mm;左、右甲状腺下动脉的长度分别为(23.60±0.27)mm和(22.40±0.24)mm,起始点的管径为分别为(1.40±0.25)mm和(1.35±0.30)mm。喉上动脉起点处的管径(1.50±0.20)mm,入喉处管径为(1.32±0.15)mm,长度为(18.60±2.45)mm;其入喉处在甲状软骨的前下方,距甲状软骨上角尖的距离,左侧为(6.80～25.50)mm,平均(14.60±2.45)mm;右侧为(7.60～28.60)mm,平均(15.58±2.58)mm,两侧差异有统计学意义(<0.05)。喉下动脉起点处的管径(1.70±0.30)mm,长度为(15.50±1.80)mm。结论喉部动脉的影像解剖学研究,为耳鼻喉头颈科特别是喉部病变的临床诊断和治疗提供更为科学和全面的影像解剖学依据及血供形态学资料。     

与喉手术有关血管神经显微解剖及其临床意义

目的：为减少喉切除等术中的出血、保留正常组织和缩短术后的创面愈合及功能恢复的时间。方法：在手术显微镜下对４０具（８０侧）成人头颈部标本进行解剖测量，着重测量与喉有关的血管和神经。结果：左右侧甲状腺上动脉的长度平均值分别为４２．３，３９．９ｍｍ，起始点的口径平均值均为２．４ｍｍ。左右侧喉上动脉的长度平均值分别为２３．１，２１．６ｍｍ，起始点的口径平均值分别为１．６，１．５ｍｍ，入喉点的口径平均值分别为１．４，１．３ｍｍ。左右侧喉上神经的喉内支入喉点处平均值的宽度和厚度大于左右侧喉返神经入喉点处的宽度和厚度。结论：结果对喉麻痹恢复手术，将来行喉移植手术，以及其他颈部手术均有指导意义。     

喉返神经及其分支的变异与临床意义

目的：为甲状腺手术中对喉返神经的定位和保护提供解剖学基础.方法：解剖50具（100侧）人颈部尸体标本.在甲状腺手术区对喉返神经及其分支进行定位观测.结果：（1）86.0%的喉返神经分支呈树枝状,称树枝型（多支型）;14.0%喉返神经分支与分支或分支与交感神经链、喉上神经间吻合成袢状,称喉返神经袢.（2）根据不同的交通形式,可分为3型：A型,喉返神经分支与分支相交通者3侧（3%）;B型,其分支与交感链之间相交通者2侧（2%）;C型,分支与喉上神经交通者2侧（2%）;D型,分支与分支、分支与交感链、喉上神经之间相交通者7%（7侧）.结论：在甲状腺及颈部手术中,应仔细分离、注意喉返神经的各种变异,以免损伤喉返神经和（或）其分支.     

The morphology and topography of the superior laryngeal artery

The aim of this study was to investigate and correlate the anatomical parameters of the superior laryngeal artery (SLA). For the study, 50 adult, human specimens were used; laryngeal pieces were drawn from 16 cadavers and the arteries were dissected intralaryngeally. In 68%, the SLA originated from the superior thyroid artery and in 32%, directly from the external carotid artery. In five sides, an aberrant superior laryngeal artery (ASLA) was entering the larynx through a foramen thyroideum. The normal superior laryngeal artery (NSLA) had a short extralaryngeal part and continued intralaryngeally, with two segments and a point of inflexion; the first segment ran along the superior border of the thyroid cartilage, the point of inflexion of the NSLA was at a minimal distance of 1.1 cm anterior to the superior horn of the thyroid cartilage and from this point the NSLA continued in the paraglottic space. The ASLA had a constant origin from the superior thyroid artery; it then traversed the foramen thyroideum and reached the paraglottic space–at the superior border of the lateral cricoarytenoid muscle, it ended in two terminal branches. We constantly evidenced the following collateral branches of the NSLA: superior, anterior and postero-medial. The terminal branches are the antero-inferior branches that constantly anastomose with the cricothyroid artery and the postero-inferior branch anastomosed with the inferior laryngeal artery. Occasionally, additional branches of the NSLA were found. In conclusion, the intralaryngeal branching patterns of the NSLA and the ASLA are similar, the differences being given by the entry point into the larynx that will make the superior and anterior branches of the ASLA longer, will eliminate the transversal segment of the NSLA, and will shorten the descending segment in the paraglottic space in the case of ASLA. The base of the upper horn of the thyroid cartilage, the oblique line and its tubercles, the cricothyroid membrane and the cricothyroid joint are constant landmarks that allow a precise intralaryngeal identification of the SLA. These findings can improve performances during surgical manipulations of the larynx and laryngeal transplants.