优先精准解剖肾上腺中央静脉在后腹腔镜肾上腺肿瘤切除术中的应用

目的 探讨后腹腔镜优先精准解剖肾上腺中央静脉在肾上腺肿瘤切除术中的应用价值。方法 回顾性队列研究。纳入2014年3月—2018年10月徐州医科大学附属淮安医院行后腹腔镜肾上腺肿瘤切除患者76例,其中男41例、女35例,年龄33～67(42±11)岁,左侧42例、右侧34例。按手术方式不同分为两组,其中采用传统“三层面法”的患者纳入传统组(38例),采用术中优先精准解剖肾上腺中央静脉后再游离肾上腺的患者纳入精准解剖组(38例)。比较两组患者手术时间、术中出血量、腹膜后引流管留置时间、肠蠕动恢复时间、住院时间及术后并发症等。结果 两组患者年龄、性别构成、体质量指数(BMI)、肿瘤位置、肿瘤类型和平均直径等基线资料比较,差异均无统计学意义(P值均＞0.05)。两组患者均顺利完成手术,无中转开放手术者。患者术后均获得随访6~24(18.5±4.5)个月,未见肿瘤复发及转移。传统组手术时间、术中出血量、留置引流管时间、肠蠕动恢复时间和住院时间分别为(61.4±15.9)min、(66.84±19.25)mL、(3.6±0.6)d、(1.8±0.3)d、(7.9±2.1)d,精准解剖组分别为(66.2±13.7)min、(50.34±15.66)mL、(2.2±0.4)d、(1.7±0.3)d、(6.2±1.4)d。精准解剖组术中出血量、留置引流管时间、住院时间均少于传统组,差异均有统计学意义(t=4.099、11.396、3.990, P值均＜0.05);两组手术时间、术后肠蠕动恢复时间比较,差异均无统计学意义(P值均＞0.05)。两组患者在术后均未见肾上腺危象、皮下气肿、高碳酸血症等严重并发症发生。结论 后腹腔镜肾上腺肿瘤切除,术中优先精准解剖肾上腺中央静脉并结扎,具有出血少、手术视野清晰,安全性高,值得进一步深入研究。     

成人肾上腺的影像解剖学

目的:测量统计成人肾上腺的影像形态学数值,为影像学诊断及临床诊治提供解剖学影像资料。方法:对168例成人进行64排螺旋CT下平扫加增强扫描后处理数据。统计测量肾上腺大小、形态、位置,所得数值按年龄、性别、侧别进行分组统计处理并进行相关性分析。结果:右侧肾上腺高于左侧者占67·50%,等高者占24·25%,低于左侧者占8·25%。左侧肾上腺体积平均(4·07±1·02)cm3,右侧(3·78±0·83)cm3,男性大于女性,左侧大于右侧。结论:肾上腺体积与年龄、性别相关,56岁以后体积缩小,男性大于女性。肾上腺形态不一,但轮廓清楚,侧缘较平直或略凹,偶见侧缘有小锯齿。未见明显侧凸或呈圆形、椭圆形,异形者可能提示腺体病变。     

肾静脉和肾上腺静脉插管的应用解剖

为给临床提供肾静脉和肾上腺静脉插管的应用解剖学数据,在45具成尸上,对肾静脉和肾上腺静脉的回流部性、角度、外径和长度等进行了观测。     

肩关节影像解剖

肩关节是人体活动度最大因而也是最容易遭受损伤的关节。各类肩关节创伤性疾病是临床常见病。以往对肩关节疾病的诊断主要借助临床检查和肩部Ｘ线检查 ,包括Ｘ线肩关节造影。随着ＣＴ及核磁共振扫描仪的出现及其在肩关节成像方面的应用 ,使肩关节疾病诊断有了有力的手段。尤其是核磁共振常规成像 (ＭＲＩ)和 2 0世纪 90年代初开始应用的核磁共振肩关节造影 (ｍａｇｎｅｔｉｃｒｅｓｏｎａｎｃｅａｒｔｈｒｏｇｒａｐｈｙ ,ＭＲＡ)技术 ,可以清晰的显示肩关节软组织和骨的病变 ,特别是盂肱关节内的关节囊—盂唇—韧带结构。从而能够准确、无…     

翼腭间隙的断层影像解剖及临床意义

目的为翼腭间隙疾病的影像诊断提供解剖学资料。方法选取成年尸体头颈部20例和40名志愿者,分别沿眶耳线(OML)制成连续横断层面和CT影像,观察翼腭间隙及其周围结构的解剖学关系,利用游标卡尺和求积仪分别测量其长径、宽径、面积。结果翼腭间隙的形态变化大,在经蝶骨体横断层面及CT影像上较固定,与翼突的形态密切相关。在标本和CT影像上经蝶骨体、翼突、翼窝的面积分别为:(113.40±3.33)mm2和(115.86±2.58)mm2,(92.24±2.73)mm2和(93.60±3.17)mm2,(5.36±3.04)mm2和(5.40±2.93)mm2。横断层面及CT影像可清晰显示翼腭间隙前、后、内侧、外侧壁上的结构和翼管、蝶腭孔、翼上颌裂、眶下裂等自然通道。结论翼腭间隙的断层影像解剖对翼腭间隙疾病的影像诊断具有重要临床意义。     

超声定位颈内静脉穿刺的影像解剖及临床研究

目的：探讨颈内静脉穿刺最佳部位.方法：随机选择择期手术患者39例,全麻后调整手术床头低15°,头偏向左侧45°.采用便携式彩超,高频探头扫描颈内静脉,通过二维显像观察颈内静脉走行及其与胸锁乳突肌锁骨头及颈总动脉关系,测量颈内静脉内径;超声定位下进行颈内静脉试穿.结果：在甲状软骨上缘水平以下,颈内静脉位于胸锁乳突肌锁骨头内后面者为85%,位于内侧者为15%;在锁骨上缘水平,颈内静脉内径为（1.712±0.025）cm;静脉纵轴与穿刺点与同侧乳头连线夹角偏内5°左右.超声定位下颈内静脉试穿刺成功率100%.结论：超声定位下颈内静脉穿刺安全可靠,成功率高,并发症少;或选择胸锁乳突肌三角顶点平面,锁骨头前内侧为进针点,安全可靠.     

咽旁间隙的横断层影像解剖及临床意义

目的为咽旁间隙疾病的影像识别和诊断提供断层解剖学依据。方法选用成人尸体头颈部20例,CT扫描后制成横断面,经咽隐窝层面观察咽旁间隙及咽旁结构的解剖学关系,利用游标卡尺和求积仪分别测量其径线及面积。结果在咽隐窝层面上,咽旁间隙呈近似三角形,面积分别为(447.6±2.18)mm2(左)、(446.4±2.10)mm2(右),两侧咽旁间隙及咽旁结构呈对称性。自茎突至咽隐窝的连线将咽旁间隙分为咽旁前、后间隙,CT图像能较好地显示咽旁后间隙内各结构的相互关系。结论咽旁脂肪组织、颈内动脉、颈内静脉、茎突和翼内肌是CT影像诊断的重要解剖学标志,咽旁间隙的横断层解剖对该区疾病的影像诊断具有重要的临床意义。     

新生儿左肾上腺静脉动脉化异体移植的外科解剖

在47具新生儿左肾上腺及有关静脉系统的解剖观测基础上,着重探讨了新生儿左肾上腺静脉动脉化导体移植的可行性。为解决新生儿左肾上腺静脉细小的问题,本文提出将在肾上腺、肾上腺静脉及肾静脉整块取出,在肾门处结扎切断左肾静脉,利用左肾静脉根部与受者的动脉吻合。     

断层影像解剖标本盒的制作技术

制作精美的断层影像解剖学标本,采用有机玻璃盒装,对增强标本的结构显示和外形美观有很大的作用,并能经久耐用,长久保存。有机玻璃平板是甲基丙烯酸甲酯单体聚合的典型产品,具有一系列优异的理化特性,光学性能透光率为92％,有较高的机械强度及热塑加工性能,耐酸、耐碱、耐腐蚀能力强。根据有机玻璃特性,可顺利地制作出各种理想的标本盒。下面介绍断层影像解剖标本盒的设计及制作技术。     

活体肾上腺血管的解剖观测及临床意义

目的：研究活体肾上腺血管的应用解剖。方法：对１８例２４侧肾上腺手术时分离出血管，测量血管外径及长度，对６个完整肾上腺灌注染色。结果：右膈下动脉从下腔静脉右缘至末支肾上腺上动脉长８．５（７．５～１１．０）ｃｍ，外径２．５～３．０ｍｍ；左膈下动脉从腹主动脉左缘至末支肾上腺上动脉长８．０（７．０～９．０）ｃｍ，外径２．５～３．１ｍｍ；肾上腺上动脉１～６支，均源于膈下动脉。肾上腺中动脉右侧长１．７～２．２ｃｍ，外径１．０～１．５ｍｍ；左侧长１．５～２．０ｃｍ，外径１．０～１．５ｍｍ。肾上腺下动脉两侧基本相同，长１．５～２．０ｃｍ，外径１．０～２．０ｍｍ。肾上腺中心静脉右侧长０．４～０．８ｃｍ，左侧长３．０～４．０ｃｍ，外径３．０～４．０ｍｍ。结论：肾上腺血管加部分膈下血管的长度可供带血管蒂肾上腺转位治疗柯兴氏病；活体切取供移植的肾上腺；选择性肾上腺血管造影等。     

Sectional anatomy of the adrenal gland in the coronal plane

To provide practical anatomic data for the imaging diagnosis and surgical treatment of adrenal disease, we investigated the anatomy of the adrenal gland and its relationships to regional structures using 31 sets of serial coronal sections of upper abdomen of Chinese adult cadavers and correlated coronal magnetic resonance (MR) images of ten upper abdomens of adult healthy volunteers and coronal reconstructed multislice spiral computed tomography (MSCT) images of five patients without lesions in the adrenal gland. The adrenal glands were visualized mainly on the successive coronal sections between 18 mm anterior to the posterior margin of inferior vena cava and 24 mm posterior to the posterior margin of inferior vena cava. In general, the left adrenal gland was visualized two sections earlier than the right adrenal gland. On the plane through the anterior parts of bilateral renal hili (A₁₈), the appearance rate of bilateral adrenal glands was 100%, and the maximal measurements of bilateral adrenal glands were visualized. The length, width, thickness of right adrenal body, thickness of medial limb and lateral limb were, respectively, 34.02 ± 2.12 mm, 10.91 ± 0.89 mm, 5.82 ± 0.26 mm, 2.78 ± 0.08 mm, 2.62 ± 0.06 mm, whereas the measurements of left adrenal gland were 28.31 ± 2.46 mm, 18.40 ± 1.06 mm, 6.84 ± 0.24 mm, 3.02 ± 0.08 mm, 2.86 ± 0.07 mm, respectively. The coronal plane has superior advantage in showing the bilateral adrenal glands. The shapes of adrenal glands are various, whereas the range of adrenal thickness is quite narrow. The thickness of adrenal medial and lateral limbs, especially the thickness of lateral limb are useful for the diagnosis of the bilateral adrenocortical disease.     

翼腭间隙的CT影像解剖及临床意义

目的为翼腭间隙疾病的CT影像诊断提供解剖学资料。方法选用40例扫描对称的正常CT片,观察翼腭间隙及其结构的解剖学关系,利用游标卡尺和求积仪分别测量其径线及面积。结果翼腭间隙的形态多变,在蝶骨体层面较固定,与翼突的形态密切相关。经蝶骨体、翼突和翼窝层面的面积分别为(110.20±3.32)mm2(左)、(115.56±2.52)mm2(右),(93.20±2.76)mm2(左)、(90.82±3.12)mm2(右),(5.48±3.02)mm2(左)、(5.26±2.74)mm2(右),两侧翼腭间隙及其结构呈对称性,断面长径、宽径和面积均无显著性差异(P>0.05)。CT图像可清晰显示翼腭间隙前、后、内侧和外侧壁上的结构及翼管、蝶腭孔和翼上颌裂等自然通道。结论翼腭间隙的影像解剖对翼腭间隙疾病的CT诊断等具有重要临床意义。     

Subaortic left brachiocephalic vein: computed tomography and magnetic resonance angiography findings

A case of anomalous (subaortic) position of the left brachiocephalic vein was incidentally detected on computed tomography images. Magnetic resonance angiography was performed to demonstrate the relationship of this vessel with other vascular structures. The anomalous vein was formed by the union of the left internal jugular and left subclavian veins. This vein passed downward along the left lateral side of the aortic arch, entered the aorticopulmonary window, descended in the mediastinum between the ascending aorta and the trachea and joined with the right brachiocephalic vein to form the superior vena cava. No cardiac anomalies accompanied the subaortic left brachiocephalic vein in the present case. We present the computed tomography and magnetic resonance angiography findings of this rare anomalous vein.

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Veine brachiocéphalique gauche sous-aortique. Constatations en tomodensitométrie et en angiographie par résonance magnétique

Résumé Un cas de position anormale sous-aortique de la veine brachiocéphalique gauche a été détecté accidentellement au cours d'un scanner. L'angiographie par résonance magnétique a été réalisée pour montrer les rapports de ce vaisseaux avec les autres structures vasculaires. La veine anormale était formée par l'union des veines jugulaire interne et subclavière gauches. La veine se dirigeait vers le bas le long du côté gauche de l'arc de l'aorte, traversait la fenêtre aorto-pulmonaire, descendait dans le médiastin entre l'aorte ascendante et la trachée et rejoignait la veine brachio-céphalique droite pour former la veine cave supérieure. Aucune autre anomalie cardiaque n'accompagnait la veine brachiocéphalique gauche sous-aortique dans le cas présenté. Nous présentons les données tomodensitométriques et d'angiographie par résonance magnétique concernant cette rare veine anormale.

     

CT血管成像乳突导静脉影像解剖学研究

目的　对乳突孔及乳突导静脉管进行形态观察及定位,为临床手术操作提供解剖依据。　方法　回顾性重建67例采用头部或头颈部CTA检查患者的乳突孔影像,测量乳突孔位置及观察乳突导静脉管走行。 结果 乳突孔数量及位置变异较大,乳突导静脉管走行多样,其外口明显多于内口,乳突导静脉管外口主要位于星点与乳突尖连线的后方1.5 cm范围内,且位于星点侧靠近中点1.5 cm范围内,内口大部分位于星点到乳突尖连线前上方1 cm范围内,并且主要集中在星点与乳突尖中线两侧1 cm范围内,上述区域即为乳突导静脉管走行区域。 结论　乳突孔、乳突导静脉管及走行其中的导静脉正常解剖变异复杂,CT三维成像能够对其很好评价。     

Normal vascular and biliary hepatic anatomy: 3D demonstration by multidetector CT

Due to constant innovations in radiological and surgical techniques, more accurate results are expected in the diagnostic and therapeutic procedures related to hepatic pathology. The aim of this work was to demonstrate the normal hepatic vascular and biliary anatomy using cadaveric livers and CT scans of the affected livers. Furthermore, using the CT scans, the authors intended to illustrate the most common morphological variations of the vascular and biliary anatomy. Four human cadaveric livers were injected with colored silicone mixed with radiological contrast solution in the common bile duct, in the proper hepatic artery, in the portal vein and in the inferior vena cava near the ostia of the hepatic veins (only one of these structures was injected in each liver). After obtaining the CT scans, 3D rendered models were created, which demonstrated the normal hepatic anatomy of the vascular and biliary structures. The International Anatomical Nomenclature was used for their classification (based on Couinaud's work). The 3D rendered CT models were also modified to illustrate the most common normal variations of the hepatic anatomy (found in the literature).     

咽旁间隙的CT影像解剖学及临床意义

目的　为咽旁间隙疾病的CT诊断提供影像解剖学资料。方法　选用 6 0例扫描对称的正常CT片 ,在咽隐窝水平层面观察咽旁间隙及咽旁结构的解剖学关系 ,用游标卡尺及关联方格测量其宽度和面积。结果　咽旁间隙呈近似三角形 ,断面面积分别为左 (4 2 6± 3 1 2 )mm2 和右 (4 3 1± 2 96 )mm2 ,两侧咽旁间隙及咽旁结构呈对称性 ,断面面积和宽度无显著性差异 (P >0 0 5 )。自茎突至咽隐窝的连线将咽旁间隙分为咽旁前、后间隙 ,CT图像能较好显示咽旁后间隙内各结构的相互关系。咽旁脂肪组织、颈内动脉、颈内静脉、茎突、翼内肌是CT诊断的重要解剖学标志。结论　咽旁间隙的影像解剖学对咽旁间隙疾病CT诊断具有重要的临床意义     

Radiologic anatomy of the inferior lung margins as demonstrated on computed radiography with enhancement of low frequencies

The aim of this work was to describe the radiologic anatomy of the inferior lung margins (ILMs). The method was to enhance the low frequencies of 50 normal chest computed radiographs. On each side, the anterior and posterior ILMs were divided into two halves. The frequency of visibility of each half of each ILM was calculated as their shape, lateral and medial continuities, depth, and vertebral level. The differences were compared by a paired Student t-test. The right posterior ILM was always visible and usually concave upward (94%). Its height was 8.7 ± 1.6 cm. Its most inferior part faced L1 or L2 in 92% of cases. It was continuous medially inside with the azygo-esophageal recess in 96% of cases. The left posterior ILM was not visible laterally in 34% of cases and medially in 60% of cases. It was most often concave upward (82% of cases). Its height was 6.9 ± 1.5 cm. Its most inferior part was at the level of L1 or L2. It was continuous medially with either the left paraspinal line or the paraaortic line. The right anterior ILM was visible in 76% of cases. It was most often oblique upward and medially (46%) or concave upward (33%) and often notched (38%). The left anterior ILM was visible in 64% of cases and more often oblique inward and upward (58%). It was continuous medially with the left inferior precardiac recess. The anterior ILMs were more variable than the posterior. The posterior ILMs were very similar in shape and inferior level and differed in depth only by the difference of height of the diaphragmatic cupolas.     

预防大隐静脉术中股静脉损伤的应用解剖

目的 :探讨大隐静脉术中可能造成股静脉损伤的解剖学因素 ,并提出相应的预防措施。方法 :对 5 2条患肢和 40条下肢标本的隐静脉裂孔及大隐静脉根部的局部解剖结构进行观察与测量。结果 :隐静脉裂孔形态以卵圆形和盾形者为主 ,其纵径 (40 .0± 12 .0 )mm ,横径 (2 8.0± 9.0 )mm ,大隐静脉根部属支以 3或 4支为多见。结论 :根据隐静脉裂孔特点及属支解剖情况 ,作者认为 :①切口要足够大 ;②正确识别解剖层次 ;③掌握正确的高位结扎部位。是防止术中股静脉损伤的关键。