舌脉诊法的血管形态学研究

为整理提高中医的舌脉诊法,对舌的动脉及其分支、静脉及静脉瓣进行了系统研究。结果表明舌脉是舌下神经伴行静脉及舌神经伴行静脉及其属支;囊泡样改变为有静脉瓣部位的静脉壁扩张;舌侧的细络在舌体为舌神经伴行静脉的微小属支,在舌根为舌根静脉微小屑支。舌质红活的根本原因是血供丰富,有50支左右的舌体动脉密布,又有诸多吻合。     

舌动脉的常见类型及其临床意义

目的:为临床医学提供舌动脉常见类型的形态学资料。方法:通过78侧成人舌动脉剥制标本和铸型标本进行观察。结果,依据舌动脉变化最大的起始段形态,可分为上弓型、下降型、与面动脉共干型和与甲状腺上动脉共干型四个类型。结论:舌的两侧各由1条粗大的舌动脉供血,其第一段的位置、形态个体差异很大,临床外科有关手术尤应注意,第2～4段的位置和形态较为恒定。     

舌瓣设计的解剖学基础

为外科舌瓣的设计提供解剖学基础。用解剖剥制25具(50侧)成人舌动、静脉标本,制作7具(14侧)舌血管铸型标本,观察舌动脉和静脉分布的规律性。结果:舌主要由2条舌动脉供血;舌的静脉每侧有5个流向,多数静脉不与动脉伴行。结论:根据需要舌瓣的蒂部可设在舌体周围的多个部位,多数舌瓣由动脉网供血,但每个舌瓣可获得一个自然的静脉引流渠道。     

舌静脉引流的研究

目的:为中医舌诊和外科舌瓣提供舌的静脉引流规律.方法:用32具成年尸体进行观测,其中有7具为新鲜尸体的静脉腐蚀铸型标本.结果:舌的静脉引流,按管径及引流范围的大小,依次为舌下神经伴行静脉、会厌谷静脉、舌神经伴行静脉、舌根静脉和舌动脉伴行静脉.结论:中医舌诊所见的舌脉基础为舌下神经伴行静脉及舌神经伴行静脉;舌瓣的蒂部必须保留一个较通畅的静脉引流渠道.     

舌静脉瓣的形态学研究

目的;为外科去瓣设计和中医舌诊分析,阐明舌静脉瓣的形态、功能及病理生理中的作用.方法:用32具成人标本进行观测,其中有7例制成舌静脉腐蚀铸型标本.结果:舌静脉内静脉瓣丰富,其瓣窦的外形可分为半球型、全球型和悬球型三类;结构可分为双瓣、单瓣和静脉嵴三种.结论:香静脉瓣多,防逆流功能强,各种影响头颈静脉血循环的因素,可在舌诊得到表达和分析判断;舌瓣设计的蒂部和吻合部位,要顺应静脉瓣的位置和朝向.     

吻合腓血管腓肠神经移植的解剖学研究

在51侧成人下肢标本上,观察到腓动脉发往腓肠神经的营养动脉,平均有2.7支。通过吻合腓动脉和腓静脉,可以设计成有血供的腓肠神经移植。     

肝癌介入治疗中肝动脉狭窄闭塞及肝外侧支血管对肝癌供血的分析

目的 探讨在肝癌介入治疗中肝动脉狭窄闭塞后肝外侧支血管的形成对肝癌介入治疗的意义。材料与方法 观察和统计787例肝癌血管造影中见到的37例肝动脉狭窄闭塞者肝外侧支血管的部位及其发生率。结果 右膈下动脉和胃左动脉是形成肝外侧支的主要血管,分别占40．5％、29．7％,而胰十二指肠下动脉、胃十二指肠动脉、肠系膜上动脉分别占8％、5．4％8％。肝右叶7、8段肿瘤侧支血供主要来自右隔下动脉,5、6段肿瘤主要来自胆总管周围动脉,肝左叶肿瘤侧支血供主要来自胃动脉。经 肝动脉狭窄闭塞的主要原因为重复导管化疗和操作不当。结论 肝左叶肿瘤侧支血供主要来自胃左动脉。引起肝动脉狭窄闭塞的主要原因为重复导管化疗和操作不当。结论 肝动脉狭窄闭塞后肝外侧支血管成为肝肿瘤的主要供血动脉。了解侧支血管发生的部位及其发生率对肝癌患者的进一步治疗有重要意义。     

MRI在舌鳞癌与舌淋巴瘤的诊断与鉴别诊断中的应用

目的 研究舌鳞癌和舌淋巴瘤的MRI影像学征象,探讨MRI在舌鳞癌与舌淋巴瘤的诊断与鉴别诊断中的应用.方法 回顾性分析经手术病理证实为舌鳞癌和舌淋巴瘤共39例患者术前MR影像资料和临床资料.结果 舌鳞癌表现为好发于舌体舌周缘的肿块,局部舌黏膜破坏;舌弥漫大B细胞淋巴瘤表现为好发于舌根部的黏膜下信号均匀的肿块,局部黏膜多完整;舌NK/T细胞淋巴瘤表现为舌弥漫性肿大,信号不均,边界模糊.结论 舌部肿瘤检查首选MRI;舌淋巴瘤和舌鳞癌的MRI征象及好发部位有区别,所以MRI不仅可以诊断舌肿瘤,还能对舌鳞癌及舌淋巴瘤的鉴别诊断提供非常有价值的影像信息.     

跟腱血液循环的显微构筑及临床意义

以１５例新鲜小腿标本采用单色灌注法，体视显微镜下巨微解剖．研究跟腱及周围动脉显微构筑形态特点，并以３６例婴儿瘫后遗马蹄足及８６例跟腱外伤断裂病例为临床对照．发现跟腱血供来源以胫后动脉为主：（１）跟腱动脉内侧支：４浅支、２深支．（２）跟腱深纵支，系重要营养动脉．其次为腓动脉源．跟腱动脉构筑为三层：腱外膜浅层动脉网，膜内动脉吻合干及爪形终末支．因节段供血，临床宜重点保护腱外膜．经腱纤维观察，认为小切口跟腱延长法较优．据小腿中下段皮肤血供特点，手术以跟腱旁内侧切口较好．     

主-髂动脉闭塞侧支循环形成的CTA表现

目的 探讨主-髂动脉闭塞伴侧支血管形成的多层螺旋CT血管成像(MSCTA)表现. 资料与方法 分析9例主-髂动脉闭塞伴侧支血管形成的MSCTA表现. 结果 9例主-髂动脉完全性闭塞,CTA显示侧支血管主要通过以下三条通路吻合:下位肋间后动脉与旋髂深动脉吻合、腹壁上动脉与腹壁下动脉吻合以及肠系膜下动脉(IMA)远段通过迂曲扩张的Riolan动脉弓与肠系膜上动脉(SMA)形成吻合. 结论 MSCTA可显示主-髂动脉闭塞患者的主要侧支血管情况.     

舌下络脉诊法的组织学基础

为阐明中医舌下络脉的实质,采用连续组织切片结合局部解剖追踪观察舌腹面粘膜下静脉及肌层血管,并与犬和大鼠相对照。结果:舌下络脉在舌腹面外带为舌神经伴行静脉及其属支;内带为舌下神经伴行静脉及其属支,舌边细络为舌神经伴行静脉与舌根静脉属支。它们均分布在粘膜下层,犬与大鼠有相同分布。舌静脉有丰富的静脉瓣,有的静脉瓣连续出现,其瓣窦扩张,该处静脉管则呈葫芦串状。     

Doppler sonography of the deep lingual artery

Purpose: To clarify the Doppler sonographic features of the lingual artery in normal subjects and to evaluate those of patients with cancer of the tongue.Material and Methods: Sixty-seven volunteers and 12 patients with cancer and/or leukoplakia of the tongue were examined with an intraoral sonographic probe. The visibility of the deep lingual artery was determined on transverse and anteroposterior images. On the transverse images, the vascular index, which was defined as the number of colored pixels, was measured on bilateral lingual arteries. Thereafter, the degree of symmetry was evaluated for normal subjects and patients.Results: In normal subjects, between younger and older volunteers, there were no significant differences in visibility of the trunk but differences were found between the two groups for the dorsal branches. The vascular indices of the right and left sides were not different. The characteristic Doppler sonographic feature was vasculature in and around the tumors in the patients with cancer of the tongue. The symmetry indices of the cancer patients were significantly different from those of normal subjects.Conclusion: Doppler sonography should be an important procedure for evaluation of tongue neoplasms.     

Catheter position for adequate intra-arterial chemotherapy for advanced pancreatic cancer: evaluation with CT during arterial injection of contrast material

PURPOSE: To identify the drug infusion vessel for use in obtaining the best drug distribution in arterial infusion chemotherapy for advanced pancreatic cancer. MATERIALS AND METHODS: In 16 cases of advanced pancreatic cancer (pancreatic head, n = 12; pancreatic body and/or tail, n = 4), computed tomography during arterial injection of contrast material was performed at the time of angiography. The sites of catheter placement were celiac artery, superior mesenteric artery, and their branches, such as gastroduodenal artery, inferior pancreatico-duodenal artery, or dorsal pancreatic artery. RESULTS: In the cases of pancreatic head cancer, all except one with hepatomesenteric vascular variation were supplied by the celiac artery and superior mesenteric artery (dual supply). In the cases of pancreatic body and/or tail cancer, two were supplied by celiac artery alone and two showed dual supply. In the cases of pancreatic head cancer, when the areas supplied by the main trunk were compared with those supplied by its branches, three of nine cases on the celiac artery side and four cases on the superior mesenteric artery side showed that the areas were not consistent, with a partial defect observed in the areas supplied by branches of the superior mesenteric artery. In the cases of pancreatic body and/or tail cancer, on both sides, one of two cases was not consistent. CONCLUSIONS: To achieve optimal drug distribution in arterial infusion chemotherapy for advanced pancreatic cancer, drug infusion via both the celiac artery and superior mesenteric artery is required in the majority of cases. In many cases, optimal drug distribution is not attainable with drug infusion via a branch; therefore, drug infusion should be administered via the main trunk.     

Origins of Feeding Arteries of Hepatocellular Carcinoma Located Near the Umbilical Fissure of the Left Hepatic Lobe: Angiographic Evaluation

Purpose

To analyze the origins of the feeding arteries of hepatocellular carcinomas (HCCs) near the umbilical fissure of the left hepatic lobe.

Methods

Twenty-eight HCCs with a mean?±?SD tumor diameter of 3.4?±?1.0?cm (range 1–4.4?cm) in contact with the right or left side of the umbilical fissure were treated by superselective transcatheter arterial chemoembolization (TACE). The origins of the tumor-feeding arteries were analyzed with arteriograms and computed tomography or cone-beam computed tomography images obtained during and 1?week after TACE.

Results

Twenty-one HCC lesions were located in segment 3 and seven were located in segment 4. Of 21 tumors in segment 3, 13 (61.9%) were supplied by the lateral inferior subsegmental artery (A3), three (14.3%) by the medial subsegmental artery (A4), three (14.3%) by both A4 and A3, one (4.8%) by a branch arising from the left lateral hepatic artery, and one (4.8%) by a branch of the right gastric artery. In particular, all tumor-feeding branches arising from A4 were the first branch of A4. Of seven tumors in segment 4, four (57.1%) were supplied by A4 and three (42.9%) by A3. In particular, all tumor-feeding branches arising from A3 were the first branch of A3.

Conclusion

This study demonstrates crossover blood supply to HCC lesions located near the umbilical fissure, in addition to direct feeding from a separate branch. In particular, the first branch of the opposite subsegmental artery may feed tumors when crossover blood supply is present.     

新虚拟单能技术对提高髂股部动脉成像图像质量的价值

目的 评价双能量CT(DECT)新虚拟单能技术(mono-plus)在提高髂股部动脉成像图像质量的价值.方法 收集40例患者行下腹DECT增强扫描.扫描数据经Siemens Syngo.via VB10A工作站处理,分别获得40 keV mono-plus图像、最佳单能量图像和混合能量图像.分别计算并比较3组图像中的髂股部9支动脉的CT值、信噪比(SNR)、对比噪声比(CNR)以及图像质量主观评分.结果 9支动脉40 keV mono-plus图像组的CT值及CNR均明显高于其余2组(P<0.003).7级动脉分支(旋股外侧动脉横支及旋股内侧动脉深支)40 keV mono-plus图像组的SNR值与其余2组间的差异无统计学意义(P>0.05).6级及以上动脉分支40 keV mono-plus图像组的SNR值低于其余2组(P<0.05).40 keV mono-plus图像组主观质量评分显著优于其余2组(P<0.001).结论 与最佳单能量图像及混合能量图像比较,40 keV mono-plus图像可以提高髂股部动脉的显示效果,尤其是在细小分支的显示上,具有明显的优越性.     

Variations in feeding arteries of hepatocellular carcinoma located in the left hepatic lobe

The left hepatic lobe is divided into three subsegments according to anatomical landmarks; however, there are several variations in the vascular territories of the left hepatic arterial branches. Hepatocellular carcinoma (HCC) located near the umbilical fissure or at the left side of the umbilical portion of the left portal vein has frequent crossover blood supply. HCC located in the caudal aspect of the lateral segment has a variety of feeding arteries, and is infrequently supplied by the caudate artery or the medial subsegmental artery (A4), and by the lateral left hepatic arteries. HCC located in the posterior aspect of segment 4 is frequently supplied by the caudate artery or a small A4 branch arising from the caudate artery. In addition, the left inferior phrenic, right and left internal mammary, right and left gastric, cystic, and omental arteries are well known extrahepatic collateral pathways supplying HCC in the left hepatic lobe, especially when the hepatic artery is attenuated by previous transcatheter arterial chemoembolization (TACE). Interventional radiologists should have sufficient knowledge of vascular territories in the left hepatic arterial branches and extrahepatic collaterals to perform effective TACE for HCC located in the left hepatic lobe.     

子宫肌瘤栓塞术:子宫动脉卵巢支分析

目的：研究子宫肌瘤的供血特点和子宫动脉卵巢支造影表现。方法：164例子宫肌瘤，行选择性双侧子宫动脉插管造影,分析子宫肌瘤的供血特点和子宫动脉卵巢支的发现率以及血管造影表现。结果：所有病例的双侧子宫动脉均参与子宫肌瘤供血，79．9％的病例子宫动脉发出卵巢支，其中80．9％有双侧子宫动脉卵巢支。子宫动脉卵巢支与子宫肌瘤 血管共同起源于迂曲的子宫动脉子宫段，向外、上行供应卵巢。结论：子宫肌瘤由双侧子宫动脉供血，大多数子宫动脉发出卵巢支，子宫肌瘤栓塞术不能避免栓塞卵巢支。     

大鼠犬猴舌与人舌的组织学比较观察

为探索舌组织结构的生物学特性，并评价舌下络脉诊实验研究的适合动物，对大鼠、Ｂｅａｇｌｅ犬、恒河猴与人舌进行系统观察对比。结果：舌乳头、味蕾、唾液腺体组织结构，恒河猴与人最近似，犬、大鼠则处于较低层次。认为研究舌诊：观察舌背以恒河猴为理想；从舌腹面粘膜下静脉显示来看以犬为明显，研究舌下络脉诊以Ｂｅａｇｌｅ犬为佳；实验样本较大宜选用大鼠，其瘀证模型的病理变化亦与人相似     

口咽恶性肿瘤侵犯舌下间隙的CT表现

目的 研究口咽恶性肿瘤侵犯舌下间隙的CT表现，为临床治疗提供更为准确的信息。方法 回顾分析58例经病理证实的口咽恶性肿瘤，对其中14例肿瘤侵犯舌下间隙者的CT表现进行分析。结果 14例口咽恶性肿瘤侵犯舌下间隙者中，经舌根侵犯者7例(咽侧壁鳞癌1例、扁桃体鳞癌1例、舌根癌5例)，经咽旁间隙侵犯者3例(咽侧壁鳞癌2例、扁桃体恶性淋巴瘤1例)，经翼下颌韧带侵犯者2例(咽侧壁鳞癌)，另有2例(咽侧壁鳞癌)分不清侵犯途径。舌下间隙受侵表现为间隙内脂肪间隙消失，间隙内血管与软组织相贴或被软组织包绕。结论 口咽恶性肿瘤可以侵犯与其邻近的舌下间隙，表现为间隙内脂肪消失，舌动脉被包埋或推移，其主要途径有经舌根侵犯、经翼下颌韧带侵犯及经咽旁间隙侵犯。