脉络丛前动脉显微解剖结构的临床应用研究

目的研究脉络丛前动脉显微解剖结构的临床应用及其意义。方法用体视显微镜和手术显微镜对21例（42侧）成人脑标本进行观察,研究脉络丛前动脉显微解剖结构特点。结果脉络丛前动脉来源于颈内动脉者37侧（88.1%）;来源于大脑中动脉者3侧（7.2%）;来源于后交通动脉者2侧（4.8%）。左侧脉络丛前动脉比右侧粗大者占78.9%。脉络丛前动脉的起始处管径变异较大,平均（0.79±0.27）mm。管径从起始部发出随行程延伸越来越细,中段管径0.35~0.71 mm;末段管径0.16~0.33 mm。脉络丛前动脉主干长（2.88±0.48）cm。海马旁回钩前沟定位与交点的距离右侧为（11.17±1.78）mm,左侧为（10.93±2.13）mm。结论双侧脉络丛前动脉管径无明显差异,发生痉挛易导致视束的供血障碍。相关颞叶内侧附近手术时,海马旁回钩前沟定位比较准确,手术时要注意在以海马旁回钩前沟为标志的交点处保护脉络丛前动脉。     

视束血供形态学研究及其临床意义

目的：研究视束动脉起源、数量、分布以及相关动脉的病理变化，为视束因缺血所致视野缺损提供形态学依据。方法：在体视显微镜和手术显微镜下，对45例90侧成人脑标本进行观察，研究视束动脉的起源、数量、分布，对其中50—70岁年龄的60侧脑标本的视束相关动脉做病理切片观察。结果：视束的血供主要来自颈内动脉、大脑中动脉、大脑前动脉、后交通动脉、和脉络丛前动脉的分支，呈节段性分布，上述动脉有动脉粥样硬化改变者占88．3％，动脉粥样硬化斑块引起视束动脉完全阻塞的占6．7％(4侧)，部分阻塞的占5．0％(3侧)。结论：50岁以上者出现一过性或持续性不同程度的视野缺损，若除外其他疾患则可能是脑底动脉粥样硬化引起视束血供障碍所致。     

人外侧膝状体的血液供应及其临床意义

目的：为外侧膝状体（LGB）缺血所致的视野缺损提供形态学依据。方法：手术显微镜下观察成人和胎儿脑的LGB动脉的来源和微血管构筑,部分脑标本用组织切片方法观察营养LGB动脉的粥样硬化病理改变。结果：LGB营养动脉第一级来自颈内动脉和大脑后动脉,二级为脉络丛前动脉、脉络丛后外动脉和丘脑膝状体动脉,三级构成LGB的小动脉。50岁以上的标本,LGB的一、二级动脉有硬化改变的占88％,二级小动脉被阻塞占10％。结论：二级动脉在LGB内有各自的供血区,脉络丛前动脉是供应LGB前部和外侧部的唯一动脉,大脑后动脉营养LGB的其余部分。不同动脉的阻塞可导致不同种类的视野改变,是视野缺损的原因之一。     

人海马区血管显微解剖

目的：探讨人海马血供的形态学特征，为海马区血管介入或外科手术的入路提供理论依据。方法：对固定的成人尸体海马区进行显微解剖，追踪动脉来源和分布，并测量各动脉的口径。结果：海马血供具有多源性。海马前区、海马头、海马体、海马尾、海马后区分别由多种来源动脉供应，但动脉主要来自大脑后动脉及其分支(83．85％)和脉络膜前动脉(16．15％)。口径自0．31mm到0．77mm不等。结论：海马血供具有多源性。主要来自大脑后动脉及其分支和脉络膜前动脉。介入时要到达脉络膜前动脉或大脑后动脉才能有效地改善海马血供。海马内侧有许多大血管和重要的脑结构，经颞叶切除海马才是安全可靠的入路。     

The neurovascular relationships of the oculomotor nerve

In this study, the arterial supply of the cisternal (initial) and the subcavernous parts of the oculomotor nerve (ON) and the relation between the nerve and adjacent vascular structures like posterior cerebral artery (PCA) and superior cerebellar artery (SCA) were investigated. A total of 140 formalin fixed hemispheres from 70 human cadaveric brains were examined. The nutrient branches reaching the cisternal and subcavernous parts of the ON were investigated, along with branches of adjacent vascular structures penetrating the nerve and passing through it. In the material examined, the ON, after arising from the midbrain, mostly continues laterally between PCA and SCA or between PCA and the rostral SCA trunk. However, in three hemispheres of our specimens, the ON run between the rostral and caudal SCA trunks. We observed that the branches of PCA-P1 segment supplied the cisternal part of the ON in all specimens. In one specimen, the cisternal part of the ON was supplied by a branch arising from the rostral SCA trunk which was also originating from PCA. Differently, in four hemispheres, branches arising from PCA or SCA perforated the cisternal part of the ON and passed through it. We also observed a tortuous caudal trunk of duplicated SCA in one of our specimens and considered it as a rare variation. The anatomy of the ON and its vascular relations is significant in terms of not only understanding the compression syndromes and its vascular dysfunctions, but the exact diagnosis and treatment as well.     

兔海马的血管构筑

用血管铸型扫描电镜术，动－静脉连续灌注法、组织化学ＤＡＢ法和生物体视学方法研究了兔海马的血管构筑。结果如下：兔海马由大脑后动脉和脉络膜前动脉供血。前者的初级分支发出一系列耙状分支进入海马，根据进入海马的部位可分为扇面动脉和海马背动脉。它们更发出分支至海马各区和齿状回。大脑后动脉经五级分支形成毛细血管网。海马各区和齿状回的毛细血管平均密度ＣＡ３＞ＣＡ４＞ＣＡ２＞齿状回＞ＣＡ１。海马静脉与动脉不完全伴     

内踝区动脉网的显微解剖与隐神经营养血管远端蒂皮瓣的设计

目的：为隐神经营养血管远端蒂皮瓣设计提出解剖学依据。方法：30侧经动脉灌注红色乳胶成年下肢标本，解剖观测内踝区动脉来源、分支、分布及吻合。结果：内踝区动脉有9个来源，构成3条纵向的血管网：(1)内踝前动脉和踝上支的前纵向血管网；(2)骨皮穿支的中纵向血管网；(3)胫后动脉肌间隙支和踝管动脉穿支的后纵向血管网。形成3个层面的血管网：(1)骨膜血管网；(2)深筋膜血管网；(3)皮神经浅静脉血管网。内踝区骨膜、筋膜、大隐静脉、隐神经和皮肤的营养血管同源。结论：内踝区血供来源为多源性，有明显的方向性，吻合十分丰富，可以设计3种包含浅深筋膜、皮神经、浅静脉及其营养血管的小腿内侧远端蒂皮瓣：(1)以胫后动脉肌间隙支为蒂，旋转轴点在内踝最凸出点上3cm；(2)以内踝前动脉筋膜穿支为蒂；(3)以踝管区动脉穿支为蒂，旋转轴点在内踝最凸出点平面。     

Variations in collateral contributions to the blood supply to the sternum

The blood supply of the sternum plays a major role in healing of the sternum after sternotomy. The sternal blood supply is derived mainly from the medial horizontal branches of the internal thoracic artery (ITA). The ITA is usually described as giving off sternal, anterior intercostal and perforating branches supplying their respective areas. The aim of the present study was to describe variations in the arterial branching pattern of collateral contributions to the sternum. The study was conducted on 30 fresh specimens of anterior thoracic wall in which cellulose acetate butyrate was injected into the ITA. The branches of the ITA in the first to sixth intercostal spaces were dissected and any additional artery supplying the sternum in each intercostal space was observed. In the present study, the ITA gave off non-collateral branches - sternal, anterior intercostal and perforating. The ITA was also found to have branches which divided into two to supply two destinations which could establish collateral flow to the sternum: (1). A sterno-intercostal branch (1-12 mm in length) divided and diverged in a Y or T shape. The medial limb supplied the sternum and the lateral limb supplied the adjoining thoracic wall, anastomosing with the terminal part of the posterior intercostal artery. (2). A sterno-perforating branch supplied the sternum either anteriorly or posteriorly before perforating and supplying the pectoral region and anastomosing with the thoracoacromial artery. This study reinforces the practice of ligating branches of the ITA close to its trunk as they have the potential to develop collateral blood supply. In the present study the posterior intercostal artery was at times found to supply the sternum directly or via its collateral branch and was named the persistent posterior intercostal artery.     

大脑前动脉A1段的显微解剖与数字减影血管造影对照观测及临床意义

目的 为临床选择颅内血管支架的类型和放置部位提供解剖学基础。方法 选取尸头标本20具,经双侧翼点入路显微解剖观测大脑前动脉A1段及其穿支血管。选取无病变的全脑DSA 100例,观测大脑前动脉A1段的走行及其穿支的开口部位。结果 显微解剖大脑前动脉A1段的长度和直径分别为（13.55±1.43） mm、（2.43±0.37） mm,DSA血管造影的长度和直径分别为（13.42±1.57） mm、（2.28±0.40） mm,显微解剖与DSA血管造影直径的差异有统计学意义（P〈0.05）。大脑前动脉A1段的穿支发自其后上壁,近侧段穿支数目（2.55±0.39）支,中间段（0.52±0.46）支,远侧段（1.12±0.11）支,近侧、中间、远侧段的穿支数目的差异均有统计学意义（P值均〈0.05）。男性较女性的大脑前动脉A1段长、直径粗,两者差异均有统计学意义（P值均〈0.05）。结论 大脑前动脉A1段的显微解剖与数字减影血管造影对照观测对临床选择颅内血管支架的类型和放置部位,避免血管支架阻塞穿支开口处,防止术后穿支供应区域缺血等具有重要的临床意义。     

老年人内侧膝状体形态、血供和来源动脉的病理学改变

目的 :研究老年人内侧膝状体的形态、毗邻及供血动脉来源、分支、分布和病理改变。方法 :体视及手术显微镜下观察 60～ 80岁年龄的脑内侧膝状体的形态、毗邻和血供情况 ;取内侧膝状体来源动脉 (大脑后动脉 )光镜下观察动脉壁的病理改变情况。结果 :内侧膝状体呈半球形 ,动脉来源于大脑后动脉的分支 ,即丘脑膝状体动脉 ,脉络丛后内、外动脉和丘体动脉 ,每侧有小动脉 ( 6.8± 1 .5 )支 ,大脑后动脉粥样硬化改变者占 88.3 %。结论 :内侧膝状体动脉细小 ,仅由大脑后动脉供血 ,动脉硬化可致小动脉管腔狭窄 ,供血不足 ,可能是老年人听力下降的原因之一。     

人小脑上动脉的应用解剖学研究

目的研究小脑上动脉毗邻关系及分支分布,为颅后窝小脑、脑干病变手术提供形态学依据。方法选13个人颅脑标本,在眉弓与枕外隆凸连线行水平锯开,暴露小脑上动脉并进行显微解剖观测。结果小脑上动脉在小脑幕内下与滑车神经伴行并与之交叉后行于其上方,行程中分支到小脑上面的多为3～4支,第一支分布于本侧半球上面的前外侧部、第二支分布于中间部、第三支分布于内侧部、第四支分布于蚓部。其分支分布到中脑和脑桥背面的多为2-3支,第一、二支分布于中脑背外侧面,第三支分布于中脑和脑桥连接处的背面。结论小脑上动脉在小脑幕内下行于滑车神经上方,在影像学上是确定滑车神经的理想标志,其每侧主要分支不仅供应本侧小脑半球上面,而且发分支供应中脑和脑桥的背外侧面。     

经翼点入路鞍区手术间隙解剖学研究

目的　为鞍区显微外科手术提供解剖学参数。方法　对 10具成人尸体头颅的鞍区手术间隙及邻近血管、神经进行解剖学观察、测量。结果　大脑中动脉M1段在距颈内动脉分叉部 18.4± 3.2mm处形成初级分叉 ,向后上方发出约 14支穿支 ,分布至基底节区。鞍结节后缘至视交叉前缘相距 5 .6± 1.1mm ,两侧视神经内侧缘间最大距离 10 .5± 1.4mm。颈内动脉从内侧壁发出 3.2支垂体上动脉 ,终止于视神经、视交叉、视束和垂体柄 ;视神经 -颈内动脉三角三边长度分别为 6 .6± 0 .6mm ,6 .9± 0 .7mm ,4 .0± 0 .4mm。颈内动脉 -小脑幕三角三边长度为 8.8± 0 .7mm ,6 .7± 0 .7mm ,4 .4± 1.0mm ,后交通动脉起自颈内动脉后外壁距分叉部 7.7± 0 .5mm ,止于大脑后动脉 ,全长 18.7± 2 .3mm ,途中发出 7.4条穿通支。脉络膜前动脉从距分叉部 4 .4± 0 .6mm处发出 ,向后方走行 ,发出细小分支 ,分布于钩回、脉络丛。前交通动脉全长 1.9± 0 .3mm ,在前交通动脉上方 0 .9± 0 .2mm ,大脑前动脉A2段前外壁发出Heubner回返动脉 ,分布于胼胝体、基底节、下丘脑及额叶脑组织。结论　应用这些间隙的解剖学测量可指导与鞍区相关的手术 ,安全显露鞍区解剖结构 ,不损伤重要的血管和神经。     

胰腺外科学分段的解剖学基础及其意义

目的：为胰腺外科学分段提供解剖学基础。方法：在６４具灌注标本和４具铸型标本上观察胰内动脉分布、吻合。结果：头由胰十二指肠上动脉和胰十二指肠下动脉供血；颈为一乏血管区；体和尾由胰背动脉、胰支、胰大动脉和胰尾动脉供血。结论：全部胰腺可分为左侧段和右侧段     

Microvascular architecture of the rat choroid: corrosion cast study

This study presents the details of the microvasculature of the rat choroid visualized by scanning electron microscopy of vascular corrosion casts. Wistar Kyoto rats were anesthetized with intraperitoneal sodium pentobarbital. The vascular system was perfused with heparinized saline, and Mercox resin was injected into the cannulated carotid arteries. After polymerization of the resin, the vascular casts were macerated with potassium hydroxide, washed with water, and freeze dried. The casts were examined with a Hitachi S-2360N scanning electron microscope (SEM). Corrosion casts of the entire choroidal vasculature revealed that the two long posterior ciliary arteries supplied the entire uveal vasculature. In the posterior choroid, these arteries formed five to seven branches on each side supplying the adjacent choriocapillaris. No interarterial or arteriovenous anastomoses were seen. The choriocapillaris appeared as a nonhomogeneous and nonlobular monolayer capillary network, consisting of dense honeycomb and irregular patterns. There are two distinct venous systems in the rat choroid. The venous blood from the central region, peripapillary choroid, and sometimes the optic nerve head drain into the posterior ciliary vein. The venous blood from the iris, ciliary body, anterior choroid, and half of the posterior choroid drain into the vortex veins. Corrosion casts and the SEM have shown details of the choroidal vascular architecture. These three-dimensional observations indicate that the rat choroidal vasculature has different features from those of humans and other primates. Despite these interspecies differences, the establishment of a thorough baseline concept of choroidal vasculature should permit additional studies of the choroidal pathology and enable the proper interpretation of results from rat experimental models for extrapolation to humans.     

Heubner返动脉的显微解剖研究

目的：为有关鞍区手术提供Heubner返动脉的显微外科解剖资料。方法：应用手术显微镜对32例Heubner返动脉进行解剖学观察、测量。结果：返动脉恒定存在,起源于大脑前动脉或其分支,单支型90．6％,双支型9．4％;返动脉主干平均长度为29．4mm,起始处平均管径为1.02mm;57％于大脑前动脉外侧向后行走,89％行于颈内动脉床突上段上方,17％贴附于颈内动脉床突上段内侧缘后行,86％于前床突与大脑前动脉之间跨越视神经上方,100％从视交叉外侧缘外侧通过;77％在外侧裂池与颈动脉池交界处出现”U”形虹吸部;80％出现粗大终支从前穿质进入基底节区。结论：深入了解返动脉的解剖学特点及其与鞍区各结构的解剖关系,对于Willis动脉环动脉瘤的合理处置及经眶、经翼点人路鞍区手术神经血管的保护有重要的意义。     

The arterial supply of the temporalis muscle

Owing to the diverse applications of the temporalis muscle in reconstructive surgery, the study of its arterial supply is becoming an issue of great importance nowadays. The material of the present study consisted of 44 specimens, four obtained from two stillbirths and 40 dissected from 20 embalmed cadavers after injecting the external carotid artery with lead oxide solution. Direct branches from the second part of the maxillary artery and the middle temporal artery proved to be constantly furnishing the muscle from its superficial and deep surfaces. The muscular branch of the middle temporal artery supplied the middle and posterior thirds of the superficial surface and the posterior third of the medial surface of the muscle. The superficial temporal artery participated in supplying the muscle from its lateral surface, while the anterior and posterior deep temporal arteries lay deep to the anterior and the middle thirds of the muscle, respectively. The temporal branches of the middle meningeal artery anastomosed with the deep temporal arteries, thereby contributing to the supply of the temporalis muscle. An arterial pedicle arising from the third part of the maxillary artery constituted an additional supply in 9.1% of the specimens, providing an additional arterial pedicle for temporalis-muscle-flap elevation.     

颈内动脉床突上段的显微外科解剖学

目的 :探讨颈内动脉床突上段的毗邻关系、分支特点及其手术意义。方法 :在手术显微镜下观察 3 0侧标本颈内动脉床突上段的形态及周围关系。结果 :颈内动脉床突上段实为出海绵窦后的一段 ,常以纤维结构与周围牵连 ,主干分为眼动脉段、后交通动脉段及脉络膜动脉段 3段。后交通动脉大致发自中点水平 ,脉络膜前动脉大致发自后半的中点。眼动脉段均发出垂体上动脉 ,多数还发出眼动脉 ,少数发出前床突支。在视交叉池内 ,垂体柄前方所见的小动脉几乎均属于垂体上动脉的分支。结论 :有些颈内动脉床突上段术中推移有困难 ,需先松解其纤维连系。打开颈动脉池时应特别留意前床突支 ,防止损伤出血。供垂体柄的分支可以切断 1～ 2支小支 ,而至视路的分支均宜妥善保留。     

骨间总动脉及其分支在断臂再植术中的意义

目的：为减少前臂断肢再植后缺血性肌挛缩提供血管吻合的形态学依据。方法：在５２例成人上肢标本上对前臂的桡动脉、骨间总动脉、骨间前动脉、骨间后动脉、正中动脉和尺动脉的起源、位置、外径等进行了观测。结果：前臂肌肉的血供除桡动脉、尺动脉以外,骨间总动脉及其分支均为主要营养血管之一。桡动脉、骨间总动脉、骨间前动脉、骨间后动脉、正中动脉、尺动脉在前臂上段的下１／３处之比为１∶０．９∶０．７∶０．５∶０．５∶１。结论：在前臂上段进行断肢再植时,除吻合桡动脉、尺动脉外还应增加吻合骨间总动脉或其分支,能有效防止术后缺血性肌挛缩或坏死。