胎儿直肠黏膜下层微血管构筑的研究

目的研究胎儿直肠黏膜下层器官内微血管的分布特点。为临床直肠相关疾病病机的分析及术式改进提供血供方面的基础资料。方法胎儿尸体20例,墨汁灌注,组织切片及组织揭层透明蒲片,光镜下观察直肠黏膜下层微血管的构筑情况,测量黏膜下层毛细血管分部密度。结果上半直肠黏膜下层微动脉多呈环状分布,下半直肠黏膜下层微血管多呈纵行的丛状分布。在上半直肠前壁及直肠颈后壁中线部位存在毛细血管"相对低密度区"。结论直肠黏膜下层的微血管网、丛在整个直肠血供中起核心作用,在上半直肠前壁及直肠颈后壁中线部位存在毛细血管"相对低密度区"。     

直肠表面动脉的形态学观测

目的观察直肠表面动脉的分支分布特点。方法随机选取成人尸体20具,婴幼儿尸体15具,行巨微解剖观察。结果上段直肠主要由乙状结肠直肠动脉的横支供血,在器官表面的分支形式多为环绕型;直肠壶腹主要由直肠上动脉的终支供血,其在器官表面的分支形式多呈主根须样;直肠颈主要由直肠下动脉和肛动脉供血,其在器官表面的分支形式可有鸦爪型、单支型、二叉型、三又型及“K”型等;上半直肠多为横行的环状分布,下半直肠多为纵行分布;各支间可存在吻合,方式为网型、直接及不规则型吻合。结论在上半直肠前壁和直肠颈后壁,存在无血管吻合区;直肠动脉在器官表面存在区域性配布的特点。     

新生儿直肠的动脉和神经分布

观察了90例新生儿直肠的动脉和神经分布。盆膈以下的肛管由肛门血管和神经供应,盆膈上方的肠管由直肠上、下动脉分布,但仅42.2%的例子存在直肠下动脉。直肠上动脉终支进入直肠壁的位置相当于3个主痔所在的线上,距肛门约为2cm。直肠壶腹两侧的下腹下丛的下端约距肛门2.5cm,它与肠壁之间隔有直肠筋膜,如沿筋膜内面游离直肠,可避免损伤此丛。     

乙状结肠直肠动脉直肠部的形态观测

目的　观察乙状结肠直肠动脉在上段直肠的分支分布特点。方法　随机选取成人尸体 2 0具 ,婴幼儿尸体 15具 ,行巨微解剖观察。结果　上段直肠主要由直肠上动脉的分支乙状结肠直肠动脉供血 ;动脉在器官外根据走行可分为降支型、吻合弓型及并列型 ;动脉在器官表面分支多呈环绕型和“鸦爪”型 ,前者主要分布于上段直肠 (壶腹以上 ) ,后者主要分布于直肠壶腹的上半 ;在直肠上段前壁中线部位 ,存在“无血管吻合区”。结论　吻合弓型乙状结肠直肠动脉优于其它两型 ;上段直肠前壁中线表面部位可能存在“相对供血贫乏区”。     

大脑皮质微血管构筑

本实验用铸型扫描电镜法观察大鼠和豚鼠大脑皮质内微血管构筑。两者基本相似,均存在以皮质微静脉为中轴的、周围由6支皮质微动脉形成的6边棱柱状的微循环单位。大鼠皮质微动脉长约800～1000μm,直径约18～20μm,两相邻微动脉间距约200μm。皮质微静脉长约1100～1500μm,直径约40～45μm,两相邻皮质微静脉间距约530μm。每支皮质微静脉引流范围约0.2～0.3mm~2。皮质毛细血管的直径约5.0～5.5μm,长约80～200μm。有些区域毛细血管较密集,吻合形态复杂。直径大于8μm的微动脉管壁有完整的平滑肌,毛细血管前括约肌明显。     

国人直肠上动脉的X线解剖

本文用X线观察成人35具尸体的直肠上动脉,其中直肠乙状结肠动脉间有吻合的占22.9％、与左右支有吻合的占42.9％、既有动脉间的吻合又有与左右支吻合的占11.4％;左、右支的分支分布呈三种形式:在同侧形成丛有吻合的左支22.9％、右支31.4％;在同侧呈纵行分布左支48.6％;右支51.4％;分支越过中线到对侧左支28.6％、右支17.1％。讨论分支分布的临床应用。     

国人直肠上动脉的介入解剖研究

目的观察直肠上动脉的形态、分布并测量相关数据,为临床经直肠上动脉的介入诊疗提供基础资料。方法随机选取成人尸体20具,婴幼儿尸体15具,行巨微解剖观测。结果直肠上动脉供应整个直肠及部分肛管的血液,向上参与乙状结肠末段的血供;直肠上动脉本干及左、右、背侧支起点的内管径均值均大于0.8mm,各分支与本干间下夹角均值均小于50°。结论直肠上动脉本干及其一级分支的角度及管径等,均可满足临床介入手段的需要;直肠上动脉作为直肠供血动脉中最重要、最恒定的一支,是动脉插管的首选途径。     

利用微血管铸型技术研究肝外胆管动脉的分布特征

目的　统计分析肝外胆管的血供来源和分布以及在十二指肠上段胆管的吻合动脉链之间的多环形血管网,为胆管外科手术提供临床解剖学理论依据。 方法　以丙烯酸树脂为动脉填充剂灌注6例肝外胆管动脉制备铸型标本,使用photoshop测量法测量微小血管内径,观测和分析肝外胆管的血供来源和分布情况。 结果　肝固有动脉左、右支在肝总管上方存在弓型交通支,十二指肠上段胆管左右边缘的吻合动脉链间有丰富的横向动脉,吻合动脉链的供血约53%来自下方,来自上方的约占46%,1%来自中段肝固有动脉。通过对每条横向动脉中部的内径和两侧起始部的内径测量,发现肝总管中段和上段的横向动脉较粗,中部的平均内径分别为（0.26±0.02）mm和（0.24±0.04）mm,与两侧的内径比也比较大,上段比值最大,为1.09,中段其次,为1,下段中部的平均内径为（0.14±0.03）mm;与两侧的内径比值为0.74。 结论　肝外胆管上、下方的血供来源比例相对均衡;肝外胆管手术应尽可能于动脉吻合相对较少的胆总管十二指肠上段和血管相对较细小肝总管下部做纵行小切口,以降低肝外胆管血供的损伤;肝总管段的血供丰富,支持现行原位肝移植离断部位在胆囊管汇合处上方的主张。     

高血压病人阻力动脉重构和微血管功能障碍

目的研究原发性高血压（EH）阻力动脉重构及其微血管整合功能。方法对EH病人30例和正常对照组30例，采用上肢节段性血压、Doppler超声、激光Doppler血流仪等无创性检查方法，评估阻力动脉结构、功能和微循环变化。结果①EH病人阻力动脉段向上延伸（P〈0．05），包括微动脉和小动脉；②阻力动脉重构特征：小动脉管壁增厚（P〈0．01）、壁／腔比值增大（P〈0．01），腔径轻度减少（P〉0．05）；管壁僵硬度增加，脉波传导速度增快（P〈0．001）；血流介导内皮依赖性血管扩张障碍和收缩作用减弱。③同时，皮肤毛细血管压升高（P〈0．01），这与阻力动脉重构引起微循环“调节机制储备”受损和上游高血压跨壁传输作用的两种机制有关。结论高血压病人阻力动脉段向上延伸，伴存动脉结构、机械特性和血管舒缩运动异常，并导致微血管系统整合功能障碍。测定这些改变的相关指标．有助于评估微血管病变程度和降压治疗的外周效应。     

Radial artery running beneath the biceps tendon and its interrelation between the radial recurrent arteries

A radial artery running beneath the biceps tendon was found in the cadaver of a Japanese woman during a student dissection course at Kumamoto University School of Medicine in 2006. The brachial artery bifurcated into the radial artery and the ulnar artery in the cubital fossa, and the radial artery twisted laterally running beneath the biceps tendon, and when it was situated laterally to the tendon, twisted distally at the level of the radial tuberosity, and then twisted medially again. After the radial artery passed over the biceps tendon, it turned distally and continued as a normal radial artery. The superficial brachial artery, which coexisted with the brachial artery, was given off from the axillary artery and it continued to the final twist of the radial artery. The course of this radial artery is similar to the arterial rings surrounding the biceps tendon, found during the same dissection course. The arterial rings were formed between the brachial artery and the radial artery, and their proximal origins ran beneath the biceps tendon, while the distal origins were superficial. The present arterial variation is thought to have occurred when the normal part of the radial artery in the cubital fossa was substituted by the arterial ring, coexisting with the superficial brachial artery, which usually disappears during normal development. Furthermore, it is suggested that a part of the arterial ring always remains as a radial recurrent artery.     

Bilateral accessory renal arteries associated with some anomalies of the ovarian arteries: A case study

Accessory renal arteries are found frequently—more often on the left side and occurring in as high as 30–35% of cases in some series. These arteries usually enter the upper or lower poles of the kidney. The main clinical significance of such arteries entering the lower pole is that they may obstruct the ureter and lead to hydronephrosis. We report the presence of accessory renal arteries found during routine dissection in an elderly female cadaver. The uniqueness in the variations noted in our cadaver included (1) a dual relationship of the ureters to the accessory renal arteries and (2) both the right and left ovarian arteries originating from their respective accessory arteries. Anomalous renal vessels arise as a result of the complicated development of the kidneys. Similarly, the aberrant origins of both the ovarian arteries observed here could be explained on an embryological basis. Clin. Anat. 11:417–420, 1998. © 1998 Wiley-Liss, Inc.     

The relationship between parotid and superfical fasciae

Summary The paper reports a study conducted on serial sections of subcutaneous neck and facial tissues taken from ten human fetuses with a craniocaudal distance of between 7 and 30 cms for the purpose of establishing the age at which various anatomical structures develop and interact. In particular, the study was aimed at investigating the relationship between the parotid and superficial fasciae. Findings, supported also by direct observations on humans, demonstrated that a parotid fascia proper does not exist. The study was also aimed at confirming or invalidating the contrasting opinions refported in recent literature. On the basis of our observations on the parotid gland, no parotid fascia as such seems to be present, but rather a superficial thickening of the connective tissue with muscle fibres which can be identified with the superficial fascia of the region and as a continuation of the platysma m., and with the septa subdividing the gland. Moreover, only a thin connective layer was detected in the deep surface of the fascia. These findings are in line with those reported by Jost [10] who, like ourselves, conducted his research on both primates and humans. The anatomical and surgical implications of these findings are considerable as they entail a redefinition of the existence of a parotid fascia. In particular, this implies abandoning the expression introduced by Mitz [12] who defines this structure as representing a superficial muscular and aponeurotic system (SMAS) which in fact can be considered to correspond to the superficial fascia as correctly described by Sterzi [17] and subsequently confirmed by Bertelli [2]. The surgical dissection commonly called sub-SMAS can therefore be properly defined as a mere detachment of the superficial fascia. As reported by Jost [10], during anatomical dissection full removal of the superfical fascia can only be achieved by working down to the level of the parotid gland. It is in fact sufficient to dissect the superficial fascia as far as the anterior edge of the gland and then proceed under the full thickness of the superficial fascia including the platysma m. These observations are also confirmed by comparative anatomical studies which demonstrate that all mammals except insectivores and marine mammals present a similar configuration in the relationship between the mimic muscles and the superficial fascia.

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Rapports entre aponévrose parotidienne (FP) et aponévrose superficielle (FS)

Resumé Nous avons étudié sur des coupes en série, le tissu sous-cutané du cou et de la face chez 10 foetus humains présentant une longueur crânio-caudale comprise entre 7 et 30 cms, dans le but de déterminer à quel âge apparaissent et commencent à interagir les différentes structures anatomiques. Nous avons examiné en particulier le rapport entre le fascia parotidine (FP) et le fascia superficiel (FS). Cette étude nous a permis d'arriver à la conclusion, qu'étayent également des observations directes sur l'homme, qu'il n'existe pas à proprement parler de FP. Le but de ce travail est de soumettre à vérification les résultats formulés récemment encore par différents auteurs, dont certains sont en désaccord. En effet, selon les observations que nous avons pu faire, il n'existe pas de FP au niveau de la parotide, mais un épaississement superficiel du tissu conjonctif, avec des fibres musculaires, qui n'est autre que le FS de cette région, lequel prolonge le m. platyoma; la glande est subdivisée par des cloisons et à l'arrière l'on observe uniquement une fine couche de tissu conjonctif. Ces observations viennent s'ajouter à celles qui ont été faites par Jost [10] lequel a mené des recherches sur les primates et, comme nous, sur l'homme. Les conséquences anatomiques et chirurgicales sont d'envergure. En effet, c'est l'existence même du FP qui est remise en question. Il faudrait par conséquent abandonner l'expression de superficial muscular and aponeurotic system (SMAS) introduite par Mitz [12], puisqu'il ne s'agit en fait de rien d'autre que du FS, si bien décrit par Sterzi [17], puis par Bertelli [2]. La dissection chirurgicale que l'on désigne sous le nom de sub-SMAS n'est rien d'autre que le décollement du FS ; lors de la dissection anatomique, pour soulever entièrement le FS, il est nécessaire, comme l'a montré Jost [10] de partir de la surface de la parotide. Au point de vue chirurgical, il suffit de disséquer la partie antérieure de la glande puis de continuer sous toute l'épaisseur du FS comprenant le m. platyoma. L'anatomie comparée elle-aussi confirme ces observations: tous les mammiféres à l'exception des insectivores et des mammifères marins, présentent cette même disposition des muscles mimiques et du FS.

     

Deep and superficial circumflex iliac arteries and their relationship to the ultrasound‐guided femoral nerve block procedure: A cadaver study

The in‐plane lateral to medial approach is a standard technique for ultrasound‐guided femoral nerve block (USG‐FNB). The first bifurcation of the femoral artery, which consists of the deep artery of the thigh (DAT) or occasionally the lateral circumflex femoral artery (LCFA), is regarded as the distal border for this procedure. We sometimes detect arteries along the estimated needle trajectory for USG‐FNB. The superficial (SCIA) and deep (DCIA) circumflex iliac arteries run laterally parallel to the inguinal ligament from the femoral or external iliac artery. The relationship between the SCIA and DCIA and other anatomical structures related to USG‐FNB around the femoral triangle region was studied by gross anatomical examination of 100 formalin‐fixed adult cadavers. At least one SCIA and one DCIA were identified around each femoral triangle; 81.8% of SCIA and 58% of DCIA originated from the femoral artery. All DCIA coursed between the fascia lata and fascia iliaca and 80% of SCIA penetrated the fascia lata. In 94% of femoral triangles, at least one arterial branch heading towards the lateral part of the thigh originated from the femoral artery from the level of the inguinal ligament to the first bifurcation of the femoral artery. The presence of SCIA and DCIA should be considered during USG‐FNB using the in‐plane lateral to medial approach to avoid inadvertently injuring them, as they are occasionally located along the presumed needle trajectory superficial to the fascia iliaca. Clin. Anat. 30:413–420, 2017. © 2017 Wiley Periodicals, Inc.     

Three-dimensional reconstruction of abnormal intramural coronary arteries in human cardiac allograft biopsies

A novel abnormality of intramural coronary arteries has been recently described in allograft cardiac biopsies. Three-dimensional (3-D) models of these abnormal arteries have now been constructed from serial histological sections of diagnostic post-transplant endomyocardial biopsies. These revealed that there was an interlacing meshwork of longitudinal smooth muscle bundles in abnormal arteries. In addition, the lumen and external surface of these arteries were irregular. This contrasted with reconstructions of normal control arteries in the same sections, which were smooth and straight. This elucidation of an unusual abnormality suggests that 3-D reconstruction of arteries in forceps biopsies may be a useful technique. © 1997 John Wiley & Sons, Ltd.     

内毒素血症所致脑血管痉挛与体液及神经内皮素-1表达的关系

目的探讨内毒素血症大鼠内皮素-1与脑血管痉挛发生与发展的关系。方法 96只Wistar大鼠随机分为对照组、内毒素血症组(注射内毒素第3、6、12、24、48h),以放射免疫检测血浆内皮素-1水平的变化,免疫组织化学ABC法对大鼠大脑中动脉内皮素-1能神经纤维进行染色观察。结果内毒素血症后3、6、12h大鼠血浆内皮素-1水平较对照组明显升高(P0.05),内毒素血症后24和48h已趋于正常(P0.05)。对照组和内毒素血症大鼠大脑中动脉可见棕褐色、呈细线状内皮素-1能免疫反应阳性纤维,以内毒素血症后第6、12h大鼠大脑中动脉内皮素-1免疫反应最为显著(P0.05)。结论内毒素血症后,大鼠内皮素-1合成和释放入血水平升高,脑血管神经纤维内皮素-1的表达水平上调,这两种因素可能同时参与了脑血管痉挛的发生与发展。     

An investigation of the origin, location and variations of the renal arteries in human fetuses and their clinical relevance

We investigated the origin, localizations and anatomic variations of the renal artery (RA) in human fetuses with the aim of determining the distribution of these variations according to lateralization and gender. In total, 90 fetuses of spontaneous abortion (45 males, 45 females) with no congenital malformations were included to the study. The abdominal aorta and its branches were dissected after latex solution colored with red ink had been injected into the vessels from the thoracic aorta. In all, 180 RA dissections were performed bilaterally in 90 cases and the anatomic variations were photographed. Right and left RAs were found to originate from the following levels according to the columna vertebralis, respectively: 3.8% and 1.9% lower T12, 67.3% and 25.0% upper L1, 9.6% and 28.8% mid L1, 15.3% and 40.3 lower L1, 3.8% and 3.8% upper 1/3 part of L2 vertebra. The right RA originated from the lateral part and anterolateral wall of the abdominal aorta in 73.0% and 26.9% of cases while the lateral and anterolateral wall origin percentages of left RA were 90.3% and 9.6%, respectively. The origin site of the right RA from the abdominal aorta was superior to, at the same level with, and inferior to that of the left RA in 53.8%, 34.6% and 11.5% of the cases, respectively. There were no variations in 75% of the cases whereas the remaining 25% had several variation patterns. The presented morphological results are as follows: A single hilar artery in 75% of the cases, double hilar arteries in 11.1%, an inferior polar artery in 10.5%, and a superior polar artery in 3.3% of specimens studied. Anatomical variations were observed more frequently among male fetuses and on the right side. Knowledge of RA variations is important for surgeons in performing many procedures and may help to avoid clinical complications, especially, during radiological examination and/or surgical approaches in the abdominal region.     

空回肠入壁动脉走行及表面动脉形态的解剖学观察

目的 探讨人空回肠入壁动脉走行及表面动脉形态，为空回肠的器官移植提供巨微解剖学资料。方法新鲜胎儿尸体30例，新鲜成人尸体3例通过墨汁灌注、组织切片、薄层透明、微血管铸型及扫描电镜观察，进行观测其走行及其表面动脉形态。结果获得人空回肠入壁动脉走行及表面动脉形态的形态学资料。结论空回肠入壁动脉在各层都有分支，表面动脉由直动脉的长支和短支发出。     

Atherosclerotic stenosis of the extramural and intramural coronary arteries of man

Summary Atherosclerotic stenosis of the extramural coronary arteries was quantitated for a series of 223 hearts of adults and found to correlate positively with values for stenosis of the intramural coronary arteries of that series. However, minor grades of extramural coronary stenosis may be associated with advanced stenosis of the intramural coronary arteries and myocardial microinfarction, which may explain symptoms of ischemic heart disease in the absence of demonstrable extramural coronary stenosis. Stenosing lesions of extramural and intramural coronary arteries apparently involve the same process, and develop through reorientation, proliferation and migration of pleomorphic smooth muscle cells of the arterial wall, combined with increased formation of mucopolysaccharides, and elastic and collagen fibers. The process corresponds to that by which coronary arterial stenosis appears to develop in swine and other animals.

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Zusammenfassung Bei 223 Herzen adulter Menschen wurden stenosierende atherosklerotische Veränderungen an extra- und intramuralen Arterien quantitativ ausgewertet. Zwischen beiden Arteriensystemen besteht eine positive Korrelation hinsichtlich Grad der stenosierenden Atherosklerose. Einzelne Herzen mit nur geringgradiger Stenose extramuraler Arterien wiesen jedoch eine hochgradige Stenose intramuraler Arterien und gleichzeitig Mikroinfarkte auf. Solche Befunde können Symptome einer ischämischen Herzkrankheit beim Fehlen nachweisbarer extramuraler Coronarstenosen erklären. Stenosierende Veränderungen an extraund intramuralen Coronararterien haben eine gemeinsame Pathogenese und entwickeln sich durch Reorientierung, Proliferation und Migration von pleomorphen glatten Muskelzellen der Arterienwand, kombiniert mit vermehrter Bildung von Mucopolysacchariden, elastischen und kollagenen Fasern. Diese Genese entspricht derjenigen der stenosierenden Coronarsklerose beim Schwein und anderen Species.

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Supported in part by grant HE 01979, National Heart and Lung Institute, Bethesda, Maryland, and in part by a grant from the World Health Organization.