心冠状窦的应用解剖研究

本观测了30例成人和6个年龄组180例小儿心脏的冠状窦。结果显示：冠状窦口均朝向右前上方；冠状窦瓣膜不明显或呈半月形合计占74．7％，瓣膜呈袋状、网状、筛状、条索状合计占25．3％；瓣膜大多数位于窦口后下部，少数位于前下部；冠状窦口直径及冠状窦瓣宽度和高度随年龄的增长而增大，而且窦口直径与心最大宽径呈正相关，本根据观测结果，求出了回归方程，提供临床参考。     

有关冠状窦心导管术的应用解剖

对３０例成人心标本进行解剖，测得冠状窦口的纵径为１７．７９±４．６６ｍｍ，横径为８．７５±３．３９ｍｍ。发现冠状窦口朝向上或水平方向者占７０．００％；向下者占３０．００％，冠状窦瓣有新月状、半月状、网状、筛状和嵴状等五种形态。瓣高５．３１±４．１８ｍｍ，宽８．６２±２．４４ｍｍ。冠状窦的长度为３１．３３±１０．２２ｍｍ，最窄径为５．６０±１．０５ｍｍ；并有成角、缩窄和发育不良现象。其属支中有７３．３３％的心中静脉和１０．００％的心小静脉开口于冠状窦口处。本文并就冠状窦心导管术插管的成败因素进行了讨论。     

山羊和家猪冠状窦和Marshall静脉肌桥的解剖学特征

目的：报道山羊和家猪心脏冠状窦和Marshall静脉肌桥的形态特征。方法：用大体解剖方法，观测山羊和家猪冠状窦和Marshall静脉肌桥的形态，起止点、走行及出现率，结果：两种动物冠状窦和Marshall静脉肌桥的出现率大于90%，其形态可分环形、纵形和斜形3种，它们均来源于右心房后壁，止于左心房。结论：山羊和家猪冠状窦和Marshall静脉表面覆盖有心肌纤维，是左右心房的异常通道之一这两种动物具备制作局灶性心房颤动物模型的解剖学基础。     

海绵窦外侧壁的冠状断层解剖及临床意义

目的通过对海绵窦外侧壁冠状断层观察,了解海绵窦外侧壁的毗邻关系。方法选择30个成人尸颅,采用火棉胶包埋技术制作海绵窦冠状薄层切片,利用数码相机获取数字资料,观察其内部结构和毗邻结构。结果①海绵窦外侧壁为两层结构,外层是硬脑膜,内层是动眼神经、滑车神经和三叉神经分支的神经鞘膜;②56%海绵窦外侧壁的内层不完整,发生在Parkinson三角后部或Mullan三角前部。结论冠状断面能清晰显示海绵窦外侧壁的毗邻结构,对该区域的神经外科手术和影像诊断具有重要意义。     

海绵窦的巨微冠状断层解剖及其临床意义

目的:为海绵窦的影像诊断学和神经外科学提供解剖学资料。方法:采用火棉胶包埋技术制作海绵窦冠状薄层切片并进行观察和测量。结果:两侧海绵窦间距为(12.90±1.28)mm;海绵窦外侧壁为两层结构,外层是硬脑膜,内层是动眼神经、滑车神经和三叉神经分支的神经鞘膜;海绵窦内侧壁为薄层的结缔组织,与颈内动脉之间有纤维小梁连接;海绵窦的静脉间隙出现率表现各异。结论:冠状断面能清晰显示海绵窦的详细解剖,对该区域的神经外科手术和影像诊断具有重要意义。     

上矢状窦起始段及其桥静脉属支的解剖学研究

目的:探讨上矢状窦血栓形成的原因及上矢状窦与其它硬脑膜静脉窦之间吻合的意义。方法:观察3例新鲜胎儿及婴儿尸体头部制作ABS铸型标本,15例湿性成人尸头标本的上矢状窦起始段形态及注入该部位桥静脉的支数、管径及其与周围其它硬脑膜静脉窦之间的吻合情况。结果:上矢状窦起始段的前端均为闭锁端,起始段长度为(10.9±1.0)cm,由前向后逐渐变宽,注入上矢状窦起始段的桥静脉多位于大脑半球的外侧面,左侧和右侧分别为(6.4±4.2)支和(5.6±3.4)支。上矢状窦通过大脑中浅静脉与海绵窦的吻合。结论:上矢状窦管腔内横穿小梁和纤维索以及桥静脉的锐角逆行注入是血栓形成的形态学和血液流变学基础;上矢状窦借大脑中浅静脉与海绵窦的吻合是保证上矢状窦的静脉血回流的形态学基础之一。     

心冠状窦的年龄解剖学研究

目的　为临床应用提供心冠状窦的年龄解剖学资料。方法　 30例成人心脏和 180例分成 6个年龄组的儿童心脏 ,观察冠状窦口的朝向和瓣膜形态 ,测量窦口直径 ,并将其与心最大宽径作直线回归分析。结果　冠状窦口全部朝向右前上方 ,窦口平面与水平面之夹角为 49°± 6°。冠状窦瓣缺失或不明显者占 15 .2 % ;瓣膜形状以半月形为多见 (6 0 .5 % ) ,其他呈袋状、网状、筛状或条索状者占 2 4.3%。冠状窦口直径与心脏最大宽径呈正相关 ,直线回归方程成人为 ^Y =4.2 5 +0 .0 7X ,儿童为 ^Y =1.0 3 +0 .0 9X。 结论　根据冠状窦口的朝向和冠状窦瓣的观察结果 ,利用所提供的回归方程和心脏最大宽径可推算出冠状窦口的直径 ,为心导管型号的选择及手术入路提供解剖学资料 ,并为临床心导管术中部分难或无法进入冠状窦提供形态学资料。     

上矢状窦旁桥静脉的显微外科解剖

目的：为手术中保护和重建桥静脉提供解剖学基础。方法：通过手术显微镜和组织学切片，对４０例脑标本的桥静脉和上矢状窦进行观测。结果：桥静脉平均每半球１０．２支，长度４．２±２．７ｍｍ，直径２．１ｍｍ以上占３６．９％，直径２．１ｍｍ以上、长度７．５ｍｍ以上共３９支，引流中央沟静脉的桥静脉距额极１４．６±１．５ｃｍ，桥静脉贴段大多数距中线１．５ｃｍ以内，桥静脉壁厚度约０．３ｍｍ。结论：平均每例标本约有１支桥静脉达到直接重建的条件，应用桥静脉保护技术可以增加重建的可能性。     

The anatomy of the coronary sinus and its tributaries

The coronary sinus and its tributaries were studied by anatomical dissection in 37 adult human cadaveric hearts, which had been fixed in formalin solution. An anastomosis of approximately 1.0mm in calibre was observed between the anterior and posterior interventricular veins in 19% of specimens. Myocardial bridges were detected above the anterior interventricular vein or its tributaries in 8% of specimens. The great cardiac vein formed the base of the arteriovenous trigone of Brocq and Mouchet with the bifurcating branches of the left coronary artery in 89% of specimens and formed an angle accompanying these arterial branches in 11%. In the trigone the anterior interventricular and great cardiac veins were superficial to the arteries in 73% of specimens. The left marginal vein was present in 97% of specimens, emptying into the great cardiac vein in 81% of cases and into the coronary sinus in the remaining 19%. The small cardiac vein was present in 54% of specimens. In the coronary sulcus the great cardiac vein was adjacent to the circumflex branch of the left coronary artery in 76% of specimens and to the right coronary artery in 5% in 19% there was no relationship with either artery. The coronary sinus maintained a relationship with the right coronary artery in 46% of specimens and with the left coronary artery in 32% in 22% it had no relationship with these vessels.     

海绵窦上壁的应用解剖学研究

目的为经海绵窦(CS)上壁的手术提供解剖学资料。方法解剖观测15例(30侧)成人头颅标本CS上壁的解剖三角、脑膜及相关结构。结果①CS上壁为不规则的四边形,可分出3个解剖三角:颈动脉三角、动眼神经三角及前内侧三角;②动眼神经门的长径为(5.67±0.87)mm,短径为(1.09±0.35)mm;动眼神经鞘膜袋前深(4.69±1.31)mm,后深(6.50±1.58)mm;③上壁的脑膜结构有镰状韧带、前岩床皱襞、后岩床皱襞、床突间韧带,颈动脉床突韧带、颈动脉穴及颈动脉领、动眼神经鞘膜袋、远环及近环等,膜结构在前床突(ACP)尖形成复杂的膜复合体。结论CS上壁的解剖三角可作为CS的手术入路,其脑膜结构对于手术也具有重要意义。     

心前静脉系统的应用解剖

目的：研究心前静脉系统属支的形态特征，为临床提供解剖学基础。方法：经10％福尔马林固定后的58例成人尸体心脏标本，在肉眼或低倍放大镜下直接解剖、观察心前静脉的各属支。结果：在58例心脏中发现有缘静脉、有心室前静脉、动脉圆锥静脉、动脉圆锥后静脉和主动脉壁静脉通过各种组合形式构成心前静脉系统，最后经壁内静脉窦注入有心房。结论：了解心前静脉系统是除了冠状窦以外心脏静脉血回流的一个正常的重要通道，对临床心血管疾病的诊治有一定帮助。     

冠脉CT与冠脉造影诊断心肌桥的临床价值比较

目的:比较冠脉CT与冠脉造影诊断心肌桥的临床价值。方法:收集2015年7月~2020年7月苏州大学第二附属医院心内科收治的107例疑似冠心病患者临床资料。依次进行冠脉CT和冠脉造影检查,计算壁冠状动脉（MCA）狭窄程度,观察前降支、对角支、钝缘支、后降支和回旋支冠脉分布走行以及与心肌的关系,测量心肌桥长度和厚度。比较两种检查方法图像质量优良率、心肌桥检出率以及心肌桥测量指标。分析两种检查方法显示MCA狭窄程度和诊断心肌桥的一致性。以冠脉造影为金标准,计算敏感度、特异度、准确度、阳性预测值、阴性预测值,评估冠脉CT判断MCA中重度狭窄和诊断心肌桥的价值。结果:两种检查方法图像质量优良率均较好,冠脉CT心肌桥检出率显著高于冠脉造影（25.23% vs 14.02%, P<0.05）;冠脉CT测得心肌桥长度大于冠脉造影,MCA狭窄程度低于冠脉造影,差异具有统计学意义（P<0.05）;冠脉CT和冠脉造影显示MCA狭窄程度的一致性较好（Kappa=0.832, P<0.05）;与冠脉造影比较,冠脉CT判断MCA中重度狭窄的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为90.63%、86.67%、74.36%、95.59%、87.85%;冠脉CT和冠脉造影诊断心肌桥的一致性较好（Kappa=0.815, P<0.05）;与冠脉造影比较,冠脉CT诊断心肌桥的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为64.29%、73.33%、69.23%、68.75%、68.97%。结论:冠脉CT与冠脉造影对心肌桥诊断均具有一定价值,而冠脉CT具有无创性、图像质量优良率高,且对心肌桥位置及分布显示佳,并对MCA狭窄具有较高敏感度和特异度,更具临床应用优势。     

内窥镜鼻窦手术相关解剖结构测量及临床意义

目的：为功能性鼻内窥镜术中确定手术部位，减少并发症提供解剖学基础。方法：２０具（４０例）头部标本，以鼻小柱基部为基点，分别测量各解剖结构与基点间的距离的该连线与鼻底的夹角。结果：鼻小柱基点及基线与各解剖结构的平均距离和夹角分别为：泪囊３．９±０．４ｃｍ，５２°±７．０°；中甲前缘３．９±０．３ｃｍ，４５．０°±５．０°；额窦开口５．１±０．４ｃｍ，５８．０°±４．０°；额隐窝４．９±０．５ｃｍ，５６．０°±５．０°；钩突前缘４．４±０．４ｃｍ，４９．０°±６．０°；上颌窦开口４．３±０．２ｃｍ，４５．０°±４．０°；筛前动脉５．６±０．４ｃｍ，５０．０°±５．０°；视神经６．９±０．５ｃｍ，４１．０°±６．０°；蝶窦开口６．６±０．４ｃｍ，４５．０°±４．０°。结论：①鼻小柱是一直观的参照标志，以其为基点测出各解剖数据，对ＦＥＳＳ具有实用意义；②尸体标本所测数据与正常人基本一致     

选择性冠状动脉造影术解剖结构的计算机数字化图像研究

为配合选择性冠状动脉造影术,利用IMG_2型计算机数字化图像处理系统(Digtal Image Processing DIP)的功能,根据物体的图像灰度,采用C语言编程,测算了50例成人心脏左、右冠状动脉口的内径、位置、平面角、夹角、开口方向、数目及左冠状动脉主干的长度,以探讨造影术成败的解剖学因素.     

Myocardial coverage of the coronary sinus and related veins

The incidence and distribution of landmarks relating to the coronary sinus (c.s.) were evaluated in 240 human hearts. Special attention was directed to the myocardial coat of the c.s., the distribution and pattern of the cardiac veins, and their dimensions. In all specimens the myocardial coat of the c.s. also covered the adjacent 2 to 11 mm of the great cardiac vein. In 15% of cases this myocardial layer was thickened in a sphincter-like fashion, the edge of which was formed obliquely, in a crescent-like manner, or diffusely without a sharp border. In 3% of the hearts the myocardial cover of the c.s. extended over the terminal 10 mm of the middle cardiac vein as a strong fiber cord. In 9%, single isolated belts of fibers fixated the terminal parts of the adjoining cardiac veins to the posterior wall of the left atrium, and in 8% two or three myocardial cords, embedded in the fatty tissue of the left coronary sulcus, did the same. Because the myocardial cover extended leftwards to variable distances over the c.s., the left edge of the myocardial covering cannot serve to define the beginning of the coronary sinus. The location of the ostial valve of the great cardiac vein (valve of Vieussens) was variable as well, being found on the average 2.5 mm proximal to the opening of the oblique vein of the left atrium. Moreover, the valve of the great cardiac vein was found in only 87% of cases; therefore it is inappropriate for defining the beginning of the coronary sinus. Finally, the dot-like ostium of the oblique vein was most constant, and from the viewpoint of embryologic development, it is the logical landmark for determining the beginning of the coronary sinus, a necessary presupposition for cardiologic procedures like reperfusion of cardiac veins.     

上矢状窦旁桥静脉的显微解剖与影像学观察

目的:通过对上矢状窦(SSS)旁大脑桥静脉的显微解剖、影像学观察及其对照研究,为各种纵裂间手术入路中桥静脉的保护提供基础。方法:分别对30例(60侧)上矢状窦和颈内静脉内灌注蓝色乳胶的成人头颅湿标本、40侧DSA静脉相和16侧CTV进行显微解剖和影像学观察。结果:上矢状窦前部和后部分别有一缺乏桥静脉注入段,显微解剖、DSA和CTV观察上矢状窦旁桥静脉的数量分别为11.2支、8.9支和7.0支,DSA和CTV观察发现桥静脉注入上矢状窦处常显示不清。结论:熟悉和比较上矢状窦旁桥静脉的解剖学和影像学特征有利于各种纵裂间手术入路和手术过程中桥静脉的保护。     

The Thebesian valve: Gatekeeper to the coronary sinus

Clinical cardiac procedures such as electrophysiology studies, catheter ablation of arrhythmias, retrograde cardioplegia delivery, cardiac resynchronization therapy and, more recently, percutaneous mitral annuloplasty, involve cannulation of the coronary sinus (CS). The presence of a membrane closing the orifice of the CS may cause difficulties during these interventions. Thus, detailed knowledge of the variations and anomalies of the valve of the CS, or the Thebesian valve, now has practical significance. To improve our understanding of this structure, classic anatomical dissection of 50 hearts from dissection room cadavers was performed. A Thebesian valve was present in the overwhelming majority (88%) of cases. Its morphology varied widely, from a few small strands of tissue, to a membrane covering more than half the CS ostium. A significant number (20%) of valves occluded >65% of the ostium, making them "potential complicating factors" in cannulation of the CS. An understanding of these anatomical variations may help in identifying and overcoming potential difficulties during clinical cardiac interventions.