中国小儿颈部血管的研究—颈外动脉分支的观察

本文为系统研究小儿脉管系形态学课题之一，采用从初生到身长为１５０ｃｍ童尸７５具（１５０侧），观察了小儿颈外动脉分支的起始状况，测量了小儿颈外动脉分支的外径，颈外动脉始端到各分支始端的长度以及颈外动脉主干与分支间的夹角，为小儿头颈部血管形态及临床应用提供解剖学资料，并填补了有关方面的空白。     

颈外动脉及其分支异常1例

笔者在解剖一具成年男性尸体时发现其右侧颈外动脉及其分支异常 ,现报道如下 :右颈外动脉在甲状软骨上缘水平由颈总动脉分出 ,伴颈内动脉的内侧上行 ,其长度 1.71ｃｍ ,起始处的外径 9.1ｍｍ。在颈外动脉起始处上方 0 .2 5ｃｍ处 ,自其前壁发出一动脉干 ,长 0 .38ｃｍ ,起始处外径 3.3ｍｍ ,此动脉干末端分出 2个分支 (附图 ) :一为甲状腺上动脉 ,其走向前下方分布于喉和甲状腺的上部 ,其起始处外径为 1.5ｍｍ ;一为舌动脉 ,其先向后外然后呈“Ｕ”字型急转向前 ,穿舌骨舌肌分布于舌 ,其起始处外径为 1.7ｍｍ。颈外动脉本干沿着咽侧壁继续上…     

中国小儿颈部血管的研究——头臂干、颈总动脉、颈外动脉和颈内动脉颅外段的视察

本文为系统研究小儿脉管系形态学课题之一,采用从初生到身长为150cm的童尸180具(360侧),观察和测量了小儿头臂干、颈总动脉、颈外动脉和颈内动脉颅外段的位置、长度和外径。结果表明:头臂干、颈总动脉、颈外动脉和颈内动脉始端的位置与脊柱椎骨的对应关系较成人略高,各动脉长度和外径随身长增加而增加呈正相关关系,初步得出各动脉长度、外径与身长间的直线回归方程,填补了有关方面的空白。     

经颞浅动脉介入颈外动脉及其分支的解剖学基础

观测了４６ 侧颈外动脉各主要分支的起始点外径、起点至颞浅动脉与颧弓交叉点的距离及与颈外动脉的三维位置关系。结果表明，经颞浅动脉介入颈外动脉的其它一级分支，只须折过一个弯曲，且介入路径短，不涉及体循环的其它大血管。这些特点与Ｓｅｌｄｉｎｇｅｒ经股动脉穿刺插管法相比，经颞浅动脉穿刺插管，有利于减少介入诊疗并发症     

选择性颈外动脉分支栓塞对头皮血供影响的解剖学研究

通过动脉栓塞和灌注、X 线摄片、透明、组织学切片等方法,观测了10例足月胎儿和新生儿头皮动脉的分布和吻合,并比较了不同大小的栓塞颗粒行颈外动脉栓塞后对头皮血供的影响.结果表明,脑膜廇术前行颈外动脉栓塞,产生头皮局部缺血性坏死与其栓塞范围、皮瓣切口及栓塞颗粒大小有关.提出合理设计开颅皮瓣的切口和选用适当栓塞颗粒的预防措施.     

颈外动脉插管动脉内化疗的护理

随着化疗药物在肿瘤治疗领域中的应用 ,近年来 ,在头颈部癌的综合治疗方面得到了较好的进展。我科自 1987年开始采取颈外动脉插管动脉内化疗辅助治疗某些头颈部恶性肿瘤取得了一定的治疗效果。动脉插管动脉内化疗是利用动脉血流将高浓度抗癌药物直接输送到所选动脉分布的肿瘤组织中 ,提高局部药物浓度以发挥较强的药物治疗效果 ,减少全身反应 ,从而达到提高疗效的目的。因此护理工作在整个治疗中起了很大的作用。具体护理方法介绍如下 :1　动脉插管术后观察局部伤口情况如有渗出及时更换敷料。2　检查动脉插管有无回血及是否通畅如有回血用 …     

颈外动脉系血管病变的血循环特点及栓塞治疗

目的　分析颌面鼻咽部血循环特点,探讨安全有效的颈外动脉(ECA)超选择性插管栓塞技术。方法　37例患者,疾病包括鼻咽纤维血管瘤、颌面血管畸形、鼻出血、上颌窦血管瘤、右眶内骨折出血、颈静脉球瘤、颈静脉球瘤并颈动脉体瘤、脑膜瘤、颅底硬脑膜动静脉瘘。均经ECA及分支数字减影血管造影(DSA),有25例共行32支ECA及分支栓塞治疗。结果　均取得治愈或好转疗效。其中1例右眼失明,1例左颊及耳廓坏死。结论　颌面鼻咽部血供丰富,侧支吻合多,ECA及分支DSA可明确病变血供,了解侧支及危险吻合情况。应尽量高超选择直接栓塞病灶,以提高疗效和减少并发症。正确选择导管及熟练操作是高超选择性插管成功的保证。不能超选择性插入分支者采用血流再分布原理进行栓塞。对活动性出血不能超选择性插管时可采取主干栓塞后局部降压而止血。     

中国小儿颈部血管的研究—头臂干,颈总动脉,颈外动脉和颈内动…

本文为系统研究小儿脉管系形态学课题之一。采用从初生到身生为１５０ｃｍ的童尸１８０具（３６０侧），观察和测量了小儿头臂干，颈总动脉，颈外动脉 和颈内动脉颅外段的位置，长度和外径，结果表明：头臂干，颈总动脉、颈外动脉和颈内动脉始端的位置与脊柱椎骨的对应关系较成人略高，各动脉长长和外径随身长增加而增加呈正相关关系。初步得出各动脉长度，外径与身长间的直线回归方程，填补了有关方面的空白。     

颈浅动脉皮瓣修复4例小儿颌颈部瘢痕挛缩的护理体会

目的探讨应用颈浅动脉皮瓣修复小儿颌颈部瘢痕挛缩的护理要点。方法总结和分析4例应用颈浅动脉皮瓣修复颌颈部瘢痕患儿的护理方法,包括皮瓣转移术前及术后护理要点、患儿的转归及康复指导。结果本组4例患儿共用5块皮瓣,4块皮瓣完全存活,1块皮瓣的远端有局部坏死,经游离植皮后创面愈合。4例均获随访1个月~2年,皮瓣色泽、质地与外形良好,颈部活动均有明显改善,颌颈角生理角度恢复。讨论术前重视患儿心理护理、呼吸道准备及皮肤准备,术后加强健康宣教及术区的密切观察和护理,是提高手术成功率、减少术后并发症的重要因素。     

右颈总动脉异常分支伴甲状腺峡部缺如

我们在解剖标本中,发现一男尸,约50岁,身高165cm,颈部皮肤未见切口及手术疤痕,见其右侧颈总动脉发出甲状腺上动脉直至甲状腺侧叶上端并伴有甲状腺峡部缺如,现报道如下:该尸体右侧颈总动脉在舌骨体平面才分为颈内动脉和颈外动脉,比左侧颈总动脉分支高2.49cm。而甲状腺上动脉却在甲状软骨右板右上方,距下颌下腺下缘0.67cm处直接由颈总动脉发出,其起始部外径为0.26cm。起始后在胸锁乳突肌深面直接跨过甲状软骨右板沿胸骨甲状肌、肩胛舌骨肌、胸骨舌骨肌深面斜行向下至甲状腺侧叶尖端处分为3条终支,供应甲状腺。而左侧颈总动脉分支及甲状腺上动…     

颈内动脉海绵窦段分支及分布的显微解剖

目的 :为海绵窦的直接手术提供显微解剖学基础。方法 :采用 48侧成人新鲜海绵窦标本 ,颈内动脉灌注苯乙烯 (ABS) ,然后在手术显微镜下解剖观察。结果 :脑膜垂体干出现率为 10 0 % ,脑膜垂体干可分为两型 ,典型的脑膜垂体干出现率为 5 8.3 % ,非典型的脑膜垂体干又分为单干型和非单干型 ,前者出现率为 3 1.3 % ,后者为 10 .4%。海绵窦下动脉出现率为 95 .8% ,垂体被囊动脉为 3 1.3 %。另外眼动脉的出现率为 10 .4%。两侧颈内动脉海绵窦段分支之间的吻合 ,提供了重要的侧支循环血液供应。结论 :本文对颈内动脉海绵窦段分支的显微解剖结果 ,对临床显微外科、血管介入、影像学有指导意义。     

The diameters of common carotid artery and its branches in newborns

The common carotid artery (CCA) bifurcation is of clinical importance due to its vascular access site for intravascular intervention. Additionally, it is also one of the most common sites of atherosclerotic plaque formation. There are numerous studies on the diameters of CCA, internal carotid artery (ICA), and external carotid artery (ECA) in adults, but few studies on newborns. Cadaver and angiographic studies have shown dimensional variations in the carotid arteries within/between individuals and also between different sexes. It is well known that the initial lesions of atherosclerosis begin very early in fetal life. Therefore, it is important to know the anatomical details of the CCA and its branches. In the present study, the neck regions of 20 (11 males and 9 females) fixed newborn cadavers were dissected. The CCAs were cut below the bulb of the carotid bifurcation further; ICA and ECA were cut above the bulb of the carotid bifurcation. The internal diameters of the CCA, ICA, and ECA were measured using a light microscopy. ECA/CCA, ICA/CCA, ICA/ECA ratios, and outflow to inflow area ratio were calculated. The mean outflow to inflow area ratio was 1.14±0.28. Our results highly correlated with the defined optimal ratio (1.15). The ECA/CCA, ICA/CCA, and ICA/ECA ratios were 0.78±0.12, 0.71±0.13, and 0.93±0.16, respectively. There were no statistically significant differences between male and female and also between right and left sides. These findings are of importance in understanding the anatomy of carotid artery during newborn period.     

Anomalous artery directly connecting the external and internal carotid arteries

An anomalous artery directly connecting the external with the internal carotid artery was encountered on the right side of a 68-year-old Japanese female cadaver. This anomalous artery (5 mm in diameter, 12 mm in length) branched out from the posterior aspect of the external carotid at the level of the origin of the lingual artery, ran obliquely upward posteriorly along the course of the hypoglossal nerve, and was confluent with the anterior aspect of the internal carotid artery. No other variations were found in the morphological aspects of, or in the anatomical relationships between, the carotid arteries and their surrounding structures on either side. The carotid body-like structure was observed at the carotid bifurcation and was innervated by small branches of the glossopharyngeal, the vagus and the sympathetic trunk. Embryologically, it is conceivable that this anomalous artery may have derived from the right second branchial arch artery, although there is no abnormality in other derivative structures of the second pharyngeal arch. There may have been no effect from this anomaly on the functions of the arterial blood flow and blood supply under normal circumstances in the present case, but this report may be of embryological significance and contribute some insight into the mechanisms of the formation of the carotid circulation systems.     

颈动脉分叉区域的神经血管解剖及其对颈动脉内膜剥脱术的临床意义

目的　通过对尸体标本的颈动脉分叉区域内的神经、血管进行解剖研究,为安全有效地开展颈动脉内膜剥脱术提供形态学依据及解剖学基础。 方法 选取20例（40侧）无明确心、脑血管疾患的尸体解剖标本（男11例、女9例）,采取颈动脉内膜剥脱术式入路对颈动脉分叉区域内的神经、血管进行解剖研究,明确血管和神经的形态学及结构特点。 结果 颈总动脉分叉部形态可分为Ⅰ、Ⅱ、Ⅲ型,分别占比为10%、52.5%、37.5%。分叉位置以甲状软骨为界,左侧颈总动脉分叉部高度在其上缘以上、平上缘和上缘以下的占比分别为55%、37.5%、7.5%;相较之下右侧分别为62.5%、27.5%、10%。男性颈总、颈内、颈外动脉内径均大于女性（P<0.05）;男性颈动脉分叉角度大于女性（P<0.05 ）。双侧颈总、颈内、颈外动脉内径相比无统计学意义（P>0.0 5）;左侧颈动脉分叉角度大于右侧（P<0.05）。 结论　通过对颈动脉分叉区域内的神经、血管进行解剖研究,对颈动脉内膜剥脱术术中血管与神经的保护具有重要的临床意义。     

超选择性颈外动脉介入栓塞术在鼻咽部纤维血管瘤切除术前的应用

目的探讨鼻咽部纤维血管瘤切除术前介入栓塞的应用价值。方法 17例病理证实的鼻咽部纤维血管瘤患者,其中男性15例,年龄14～22岁;女性2例,年龄13～19岁。采用Seldinger’s法,选取5F Head-Hunter导管行双侧颈内、外动脉造影,了解患者颈内、外动脉有、无异常吻合及肿瘤供血情况后,评估栓塞风险,用明胶海绵栓塞鼻咽部纤维血管瘤的供血动脉。结果接受介入栓塞术患者,1～3d内行肿瘤切除,术中出血量显著减少（〈250mL）,手术视野清晰,手术时间缩短,有利于肿瘤完全切除。结论超选择性颈外动脉介入栓塞术在鼻咽部纤维血管瘤切除术前的应用,能显著降低肿瘤切除术中的出血量,提高全切率,减少并发症,是临床上行之有效的方法。     

Topography of carotid bifurcation: considerations for neck examination

Clinical examination and surgical procedures require the knowledge of anatomical structures of such a complex area as neck, especially the developmental anomalies in vascular drainage may occur. The aim of this study was to describe the common carotid artery bifurcation to its surrounding structures to locate it properly by using external and internal landmarks. Measurements were performed on 43 Thai cadavers by the direct inspection method. Carotid bifurcation level was compared to the level of cervical vertebra, isthmus of thyroid cartilage, angle of mandible and origins of superior thyroid artery, and lingual artery. Most of carotid bifurcations were found at the level of C3, between C3 and C4, and C4 vertebra, as well as the tendency to lower position in men was noted. Measurements to the angle of mandible on the left sides were significantly different in studied groups (P = 0.02), also with lower position of bifurcation in men. The mean level of carotid bifurcation was approximately 6 mm above ITC, which literally is at the level of the superior border of thyroid cartilage. Moreover, in four cases, common carotid artery did not bifurcate bilaterally, and in four cases, no bifurcations were found at the right side of neck. Further, many superior thyroid arteries originated from common carotid artery. To sum up, during the clinical procedures, the level of thyroid cartilage is mostly advised to follow to locate the carotid sinus. Further, the described variations in topography of carotid bifurcation and arteries origins may have important clinical implications.     

Anomalous branching pattern of external carotid artery: Clinical relevance to cervicofacial surgery

Anomalous branching pattern of the left external carotid artery (ECA) was detected in an old man. The ECA branched into high submental artery and large transverse facial artery ending as angular artery compensating for concurrent agenesis of ipsilateral facial artery. The lingual artery gave direct branch to the submandibular gland, whereas the superior thyroid artery arose directly from common carotid artery with high bifurcation level. This unreported branching pattern of the ECA may have important clinical relevance to cervicofacial surgery.     

Superficial temporal artery as an external landmark for deeper-lying brain structures

Additional localizing superficial landmarks for intracranial structures can be of use to the neurosurgeon. This study was performed to evaluate the usefulness of the superficial temporal artery (STA) as an external landmark for deeper brain structures. Thirteen adult cadavers (26 sides) underwent latex injection of their STA bilaterally. Dissections were next carried out to identify this vessel. Once the STA and its frontal and parietal branches were skeletonized, craniectomies were performed and the underlying dura mater excised. Measurements were made between the frontal and parietal branches of the STA and deeper brain structures. The STA was found to branch on average 3 cm superior to the tragus. The bifurcation of the STA was found to commonly bifurcate at the level of the floor of the middle cranial fossa or superior temporal gyrus. The Sylvian fissure was found at a mean of 2 cm superior to the STA bifurcation. The angle between the frontal branch of the STA and the zygomatic arch had a mean of 37 degrees. The angle between the frontal and parietal branches of the STA had a mean of 87 degrees. At the level of the glabella, the frontal branch of the STA was on average 3 cm posterior to the frontal pole. The temporal tip was located a mean of 3.2 cm anterior to the frontal branch of the STA. The plane of the foramen of Monro was found to lie at a mean distance of 2.3 cm posterior to the frontal branch of the STA. The parietal branch of the STA was noted to travel more or less parallel with the central sulcus in all specimens and to travel an average of 2 cm posterior to this sulcus. At the level of the lateral attachment of the tentorium cerebelli, the parietal branch of the STA was found to travel a mean of 4.8 cm anterior to the entrance of the vein of Labbé into the transverse sinus. The parietal branch of the STA was also found to travel a mean of 4.2 cm anterior to the angular gyrus and 3.9 cm anterior to the supramarginal gyrus. Palpation or Doppler identification of the STA and its branches with subsequent mapping on the lateral cranium may prove useful as an additional superficial landmark for the neurosurgeon.