喉返神经的喉内解剖及其临床意义

喉返神经前支依次发出环杓后肌支、杓间肌支、环杓侧肌支及甲杓肌支;后支与喉上神经内支后下支形成吻合支.前支之间、前支与喉上神经内支,前支与喉上神经外支之间亦可构成交通支.喉上神经内支与喉返神经后支可包含运动纤维.识别内收肌支与外展肌支的重要标志是环甲下韧带与环甲关节.甲状软骨翼建立窗口,识别喉返神经前支分支,选择性实施外展肌支与内收肌支吻合,对于保护喉功能、减轻患者症状、提高生活质量有着重要临床意义.     

狗喉返神经袢的形态及纤维性质的鉴别

目的：为喉返神经提供比较解剖学资料,并为研究喉返神经选择动物实验提供解剖基础.方法：用成年杂种狗14只,在全麻痹状态下放血,解剖出喉返神经,观察其喉返神经及分支的形态,取其喉返神经及分支,喉返神经分支与颈交感干之间的交通支.甲醛固定、明胶包埋、恒冷切片后用Kamovsky乙酰胆碱酯酶组化方法,对上述材料进行观察.结果：①狗喉返神经分支按其分布范围可分为喉支和喉外支,前者在入喉前多分为前支、后支.②28.5%的狗喉返神经分支呈树枝状,称树枝型（多支型）;71.5%喉返神经分支与分支或分支与交感神经链间吻合成袢状,称喉返神经袢.③喉返神经干及分支内含有髓酶反应阳性和阴性纤维及无髓酶反应强阳性纤维.结论：狗喉返神经袢出现率较高,含有交感神经节后纤维、躯体运动及感觉纤维,为混合性神经.     

环杓后肌神经的显微外科解剖

本文借助SXP-Ⅰ型手术显微镜观察了30例成人喉返神经终末支支配环杓后肌的分支,并用改良的karnovsky-Roots AchE染色方法鉴定了喉返神经终末分支的性质。结果表明,喉返神经以前、后二终支入喉,前支是运动支,后支为感觉支;环杓后肌神经来自前支和前支的分支——杓间肌支,支数多,长度短。组织学研究表明,前支内,环杓后肌神经纤维和其它神经纤维随机分布在一起,未形成一个独立的神经束。     

应用Sihler氏染色研究人喉神经分支分布类型

采用Sihler氏染色,经过染色后,在立体显微解剖镜下、可清晰地观察到喉内肌肌肉神经支配类型及神经间的联系,结果:(1)喉返神经支配除环甲肌以外的所有喉内肌,环甲肌由喉上神经外支支配.(2)喉上神经内支不仅支配声门上粘膜,也支配杓间肌(包括的横肌和杓斜肌)和声门下粘膜.(3)在每侧杓间肌肉.喉返神经和喉上神经内支之间百多个吻合支.(4)喉返神经的杓间肌神经和环杓后肌神经之间常有交通支.     

喉神经区域的损伤与保护在颈部手术中的临床价值

目的探讨颈部手术中喉返神经、喉上神经损伤的原因,提出喉神经区域的保护对策。方法选取我院近2年颈部手术20例,10例术中解剖出喉返神经、喉上神经外侧支为观察组;10例术中未解剖出喉返神经、喉上神经外侧支为对照组,对其损伤的原因进行分析,总结出喉神经区域的保护方法。结果电凝、夹损、缝扎造成喉返神经、喉上神经损伤的发生率平均为20.00%,其中观察组发生率为10.00%,对照组发生率为30.00%,差异具有统计学意义(P<0.05)。结论颈部手术中电凝、夹损、缝扎等会造成喉返神经、喉上神经损伤;更好地保护喉神经区域,前提是要熟练掌握颈部解剖结构、甲状腺、喉上神经和喉返神经的解剖特点,术中尽量解剖出喉神经,避免喉神经区域损伤。     

喉返神经的应用解剖

目的为甲状腺手术中误伤喉返神经提供解剖学基础。方法对50具成人尸体的颈前外侧区进行局部解剖,重点观察了喉返神经行程与甲状腺下动脉的关系,分布于喉的分支情况;测量了喉返神经、甲状腺下动脉的直径。结果喉返神经横径为(1.93+0.35)mm。喉返神经入喉支以2～5干型为多见,占70.0%。甲状腺下动脉的直径为(2.61+0.23)mm。喉返神经和甲状腺下动脉之间的关系,左右均有明显差异。喉返神经在甲状腺峡平面分支最为多见。喉返神经位于甲状腺动脉主干之后的有54.0%。结论左、右侧喉返神经与甲状腺动脉位置关系有明显差异,右侧喉返神经多行于动脉之前,左侧喉返神经多行于动脉之后,为临床颈部手术提供了参考。     

喉返神经的应用解剖研究

目的为甲状腺手术术中对喉返神经的定位和保护提供解剖学基础。方法采用经福尔马林固定的60具成人标本(男40,女20)共120侧,用解剖学方法对喉返神经及其分支进行定位观测,以及观测甲状腺下动脉、甲状软骨下角和甲状腺下极等3种解剖标志与喉返神经的毗邻关系。结果(1)喉返神经的分支有喉支和喉外支,前者在喉前多分为前、后支。(2)喉返神经与甲状腺下动脉的关系分5种类型。(3)91.7%(110侧)喉返神经的喉支多在距甲状腺下角尖端(16.9±7.2)mm处分前、后支,喉外支多在其下(10.4~70.3)mm范围内发出。(4)59.2%的喉返神经分支发出部位在甲状腺下极平面以上,距甲状腺下极平面距离(11.25±7.1)mm。结论在甲状腺手术中应注意喉返神经的变异,通过暴露和辨认喉返神经及其分支防止其损伤。     

与颈部手术相关的喉返神经的应用解剖

目的 :为颈部手术中喉返神经的定位和保护提供形态学和局部解剖学基础。方法 :解剖 5 0具 (10 0侧 )成人颈部尸体标本 ,对喉返神经及其分支进行定位观测。结果 :(1)喉返神经的分支有喉支和喉外支 ,前者在入喉前多分为前支、后支。 87%的喉返神经分支呈树枝状 ,13 %的喉返神经分支之间或分支与颈交感干之间相互吻合呈袢状。 (2 )有 2 %的双喉返神经和 1%的非返喉下神经。 (3 ) 94%的喉返神经的喉支多在距甲状腺下角尖端 (16.9± 7.6)mm处分为前、后支 ,喉外支多在其下 10 .4～ 70 .4mm范围内发出。 (4 )喉返神经与甲状腺下动脉的关系分为 5种类型。 (5 )喉返神经与颈部食管及颈动脉鞘的位置关系复杂。结论 :在颈部相关手术中应注意喉返神经的变异 ,通过显露和辨认喉返神经防止其损伤。     

喉返神经及其分支与甲状腺下动脉关系的应用解剖

目的为颈部手术中喉返神经及其分支的定位和保护提供形态学基础。方法对47具(男30具,女17具)成人尸体喉返神经和甲状腺下动脉之间的关系进行解剖、观测。结果喉返神经入喉支以2～5支型为多见,占69.15%;喉返神经和甲状腺下动脉之间的关系分为5种类型,左右侧有明显差异(P<0.01)。结论在颈部相关手术中应注意喉返神经的变异,结扎甲状腺下动脉前,应仔细分离、单独结扎该动脉,以免损伤喉返神经及其分支。     

喉返神经分支与变异的临床解剖研究

目的为喉返神经相关手术区中喉返神经分支与变异的定位、保护和临床应用提供解剖学基础。方法解剖25具(50侧)成人尸体颈部标本进行定位观察研究。结果 (1)22.0%的喉返神经存在分支情况,呈爪形袢状分布;(2)14.0%的喉返神经出现变异,根据不同的变异形式,可分为3种情况:①其分支与交感干之间相交通者4侧(8%);②其分支与喉上神经之间相交通者2侧(4%),其中1侧(2%)伴双喉返神经;③从喉返神经发出主动脉神经者1侧(2%)。结论喉返神经分支和交通支存在多种变异,在喉返神经相关手术区进行手术时,要避免损伤喉返神经和其分支。     

The communicating branch of the 4th cervical nerve to the brachial plexus: the double constitution, anterior and posterior, of its fibers

Twenty-four adult cadavers (48 sides) were used to investigate the incidence of a branch arising from the ventral ramus of the fourth cervical nerve (C4) with the phrenic nerve and subsequently joining the brachial plexus. Six brachial plexuses with spinal cords and phrenic nerves were dissected under a surgical microscope to investigate localization of fibers contained in the C4 branch to the brachial plexus. The incidence of the C4 branch was 23% (11/48 sides). Branches from C4 to the brachial plexus divided into anterior and posterior divisions on four sides (4/6 sides). On two sides, the branch did not divide but consisted entirely of an anterior division (2/6 sides). In the brachial plexus, anterior division fibers of the C4 branch were intertwined with fibers from the anterior divisions of the ventral rami of the fifth and sixth cervical nerves. They then passed to the suprascapular nerve and the anterior division of the superior trunk (6/6 sides). On the other hand, posterior division fibers of the C4 branch were intertwined with fibers from the posterior divisions of the ventral rami of the fifth and sixth cervical nerves. They then passed to the suprascapular nerve (2/6 sides) and the posterior division of the superior trunk (4/6 sides). The anterior division of the C4 branch received fibers from the ventral rootlets of the entire fourth cervical segment, whereas the posterior division received fibers from the ventral rootlets of the caudal half of the fourth cervical segment only. The fact that the suprascapular nerve received fibers from both the anterior and posterior divisions of the C4 branch was considered to support our claim that the human suprascapular nerve belongs to both the anterior and posterior divisions of the brachial plexus.     

The Contribution of the Left Phrenic Nerve to Innervation of the Esophagogastric Junction

The contribution of the left phrenic nerve to innervation of the esophagogastric junction. The esophagogastric junction is part of the barrier preventing gastroesophageal reflux. We have investigated the contribution of the phrenic nerves to innervation of the esophagogastric junction in humans and piglets by dissecting 30 embalmed human specimens and 14 piglets. Samples were microdissected and nerves were stained and examined by light and electron microscopy. In 76.6% of the human specimens, the left phrenic nerve participated in the innervation of the esophagogastric junction by forming a neural network together with the celiac plexus (46.6%) or by sending off a distinct phrenic branch, which joined the anterior vagal trunk (20%). Distinct left phrenic branches were always accompanied by small branches of the left inferior phrenic artery. In 10% there were indirect connections with a distinct phrenic nerve branch joining the celiac ganglion, from which celiac plexus branches to the esophagogastric junction emerged. Morphological examination of phrenic branches revealed strong similarities to autonomic celiac plexus branches. There was no contribution of the left phrenic nerve or accompanying arteries from the caudal phrenic artery in any of the piglets. The right phrenic nerve made no contribution in any of the human or piglet samples. We conclude that the left phrenic nerve in humans contributes to the innervation of the esophagogastric junction by providing ancillary autonomic nerve fibers. Experimental studies of the innervation in pigs should consider that neither of the phrenic nerves was found to contribute. Clin. Anat. 33:265–274, 2020. © 2019 Wiley Periodicals, Inc.     

大鼠膈神经移位迷走神经支配心脏的实验解剖学研究

目的：为大鼠膈神经移位迷走神经支配心脏提供显微解剖学依据。方法：20只健康雄性SD大鼠在10倍手术显微镜下解剖双侧膈神经、迷走神经及其分支。用游标卡尺（精确度为0．02mm）测量膈神经分支直径、长度，迷走神经各段的直径、长度及其与膈神经起始端的距离。结果：（1）大鼠膈神经分支有胸骨支、前外侧支、后支，迷走神经分支有咽支、喉前神经、返神经、心支和胸腹腔支。（2）大鼠膈神经主干起始端直径为（0．22±0．04）mm，其与迷走神经咽支、喉前神经、左侧返神经、右侧返神经、心支、锁骨上水平部的距离分别是（8．46±0．06）mm、（35．98±0．06）mm、（25．66±0．04）mm、（22．88±0．06）mm、（42．06±0．04）mm、（2．46±0．82）mm。结论：迷走神经锁骨上水平发出的主干与膈神经主干起始端较接近，可以与膈神经直接缝合。     

人膈肌内神经分支分布

目的：探讨人膈的神经支配和肌内神经分支分布特点。方法：改良Sihler’s肌内神经分支染色法。结果：(1)一侧膈神经入肌后一般分为3—4支(3支型4例,4支型2例),1支(前支)向前内侧走行,支配胸部,1～2支(前外侧支)向外侧走行,支配肋部,最后1支(后支)最粗大,向后下走行,分为后外侧支和后脚支,分别支配膈中心腱外侧叶后外侧的肋部和腰部,各级神经的分支在肌束中部密集排列成神经丛。(2)6例标本均未发现左侧或右侧膈神经越过中线至对侧。(3)2例带肋间肌的标本肉眼未见有肋间神经分支进入膈。结论：(1)左、右膈神经分布于膈,未见左右侧膈神经重叠支配和优势支配。(2)膈神经的终末分支在肌束中部密集排列形成似“肾形”的神经丛带。     

Anatomic study of human laryngeal ganglia: number and distribution

We have studied 12 laryngeal nerves: six internal branches of the superior laryngeal nerve (ILN) and six recurrent laryngeal nerves (RLN) from three human adult larynges (two males and one female). After dissection of each individual laryngeal nerve using a surgical microscope, the nerves were preserved in 10% formalin, embedded in paraffin wax, serially sectioned transversely at a thickness of 10 microm and stained with hematoxylin and eosin. We found 2-4 ganglia associated with the ILN. At least two ganglia were always present (six out of six cases), the largest one being associated with the branch of the nerve innervating the vestibule and the smallest one associated with the branch innervating the aryepiglottic fold. Other ganglia were found associated with the branches for the glosso-epiglottic fold and vallecula (four out of six cases) and interarytenoid muscle (three out of six cases). The RLN showed from two to six ganglia, all of them located in its anterior terminal division. Two of the ganglia were located in the part of the nerve between the origin of the branches for the interarytenoid and lateral cricoarytenoid muscles (three out of six cases). The remaining ganglia were located close to or at the origin of the muscular branches innervating the intrinsic laryngeal muscles. The cytology of the ganglia reported suggests that they were all autonomic in nature, probably parasympathetic.     

大鼠迷走神经和膈神经的解剖相关性实验研究

目的 为大鼠迷走神经移位膈神经重建高位颈髓损伤大鼠的膈肌功能提供显微解剖学依据。 方法　10只健康雌性SD大鼠在10倍手术显微镜下解剖双侧膈神经、迷走神经及其分支。用数显卡尺测量迷走神经与膈神经在“膈神经主干起始平面”、“锁骨上平面”、“入膈肌平面”的相对距离,用读数显微镜测量各平面迷走神经和膈神经的直径。 结果　在颈部,迷走神经直径为（0.3284±0.0247）mm,膈神经直径为（0.2267±0.0164）mm,二者的相对距离很接近,无论是在“膈神经主干起始平面”还是“锁骨上平面”,平均都不超过2.5 mm;在“入膈肌平面”平面,迷走神经直径为（0.2912±0.0326）mm,膈神经直径为（0.2794±0.0282）mm,二者的相对距离较颈部远,左侧为（8.71±0.804）mm,右侧为（6.203±0.952） mm。 结论　(1)在颈部,迷走神经与膈神经的直径相差不大,相对距离很接近,二者可直接无张力缝合。(2)在入膈肌平面,迷走神经与膈神经的直径大致相同,相对距离稍远,但将膈神经和迷走神经向上游离一段距离后仍可实现二者的直接无张力缝合。     

小脑下前动脉与前庭蜗神经关系的解剖学观察

目的观察人小脑下前动脉的走行和与前庭蜗神经间的解剖学位置关系。方法对20具甲醛固定的人尸颅进行测量,重点观察了小脑下前动脉及主要分支的走行和与前庭蜗神经间的位置关系。结果小脑下前动脉出现率为100％,回返穿通动脉为100％,小脑下前动脉袢为100％。回返穿通动脉位于面神经、前庭蜗神经之间有32例(80％)。前庭蜗神经血管接触率为95％,2支或2支以上血管与前庭蜗神经接触的有20例,占50％。结论实验结果为桥脑小脑角手术提供解剖学资料。     

喉返神经及其分支的变异与临床意义

目的：为甲状腺手术中对喉返神经的定位和保护提供解剖学基础.方法：解剖50具（100侧）人颈部尸体标本.在甲状腺手术区对喉返神经及其分支进行定位观测.结果：（1）86.0%的喉返神经分支呈树枝状,称树枝型（多支型）;14.0%喉返神经分支与分支或分支与交感神经链、喉上神经间吻合成袢状,称喉返神经袢.（2）根据不同的交通形式,可分为3型：A型,喉返神经分支与分支相交通者3侧（3%）;B型,其分支与交感链之间相交通者2侧（2%）;C型,分支与喉上神经交通者2侧（2%）;D型,分支与分支、分支与交感链、喉上神经之间相交通者7%（7侧）.结论：在甲状腺及颈部手术中,应仔细分离、注意喉返神经的各种变异,以免损伤喉返神经和（或）其分支.