左外叶活体肝移植的解剖学研究

目的：模拟左外叶活体肝移植门静脉、肝动脉和胆管的切取方法。方法：解剖正常人肝脏标本30具，观察肝脏铸型标本30具，测量门静脉、肝动脉及胆管长度、管径及属支或分支分布情况。结果：左外叶门静脉的血供来自门静脉左支，主要为左外叶上段门静脉支、左外叶下段门静脉支；动脉主要来源于肝固有动脉、肝左动脉、肝中动脉，偶有迷走动脉支；胆道引流属支有左外叶上段胆管支、左外叶下段胆管支。结论：左外叶解剖变异较多，活体取肝前应仔细研究其结构特点，设计合理的切取模式；对门静脉、肝动脉和胆管支需行必要的整形，以便与受体相应的管道进行吻合。     

Organization and structure of branches in the rat pulmonary arterial bed

Pulmonary arteries were fixed by perfusion under constant pressure and filled with rubber. The hardened rubber cast delineated the arterial bed, permitting dissection of axial vessels and all branches. Each segment was prepared for scanning electron microscopy and transmission electron microscopy. Branches arising at acute angles from the axial artery and the first two generations of its branches, regardless of diameter, had the same concentric muscle layer structure as parent vessels. Endothelial cells of the parent vessel were oriented into the ostia of these branches. Branches that came off the axial vessel or its branches at right angles had spiral muscle bundles and led to nonmuscular precapillary vessels. Right angle branches also had similar wall structure regardless of diameter. Near the ostia of right angle branches, endothelial cells of the parent vessels did not show orientation of their long axis into the branch lumens. It was concluded that branch arteries arising at acute angles are conduits which carry blood to distant parts of the lung while right angle branches are a histologically different group which distribute the blood to local capillary beds.     

Anatomical study of the pancreas in the house musk shrew (Suncus murinus), with special reference to the blood supply and innervation

To examine the macroscopic structure, blood supply, and innervation of the pancreas in the house musk shrew (Suncus murinus), we performed gross anatomical dissection and whole-mount immunostaining of the autonomic nerve of Suncus pancreases based on neurofilament protein (NFP) immunoreactivity. The adult Suncus pancreas is clearly separated into right and left lobes that are not fused. The right lobe of the Suncus pancreas is located in the dorsum of the duodenum and to the right of the common bile duct independently. The right lobe is supplied by branches of the superior mesenteric artery, and is innervated by branches that originate from the superior mesenteric plexus and run along the arterial branches of the superior mesenteric artery. The left lobe occupies 9/10 of the entire pancreas and is located to the left of the common bile duct. It is supplied mainly by branches of the splenic and common hepatic arteries, and is innervated by branches that originate from the celiac plexus and run along the splenic and common hepatic arteries. According to previous studies on the blood supply and innervation of the human pancreas, the right and left lobes of the Suncus pancreas correspond to the pancreatic parts derived from the ventral and dorsal pancreatic buds. The current results suggest that the Suncus pancreas is a suitable experimental model for studying the development of the human pancreas.     

基于三维可视化技术对巨块型肝癌肝动脉血管分布规律的分析与研究

目的:基于三维可视化技术对CT数据处理、分析,研究巨块型肝癌肝动脉的分布规律。方法:收集93例正常人（正常组）和93例巨块型肝癌患者（肝癌组）CT数据,利用IPS软件三维重建,研究正常组与肝癌组肝动脉的差异以分析其变化规律。结果:肝癌组肝固有动脉、肝固有动脉左支、肝固有动脉右支和肝中动脉起始处血管平均直径均比正常组相应部位血管管径增粗,差异有统计学意义（P<0.05）;肝癌组肝固有动脉右支血管分支多于正常组动脉血管分支,差异有统计学意义（P<0.05）;巨块型肝癌位于肝左叶者,与正常组对比有76.9%膈动脉分支包绕/嵌入肝癌肿瘤,可认为其为肝癌供血的新生血管;巨块型肝癌位于肝右叶和肝中部者,新生血管呈球状包绕肝癌。结论:巨块型肝癌肝动脉的变化规律可从血管直径、分支及新生血管位置研究,为临床精准介入治疗提供指导价值。     

Comparative anatomical study of the kidney position in amniotes using the origin of the renal artery as a landmark

The anatomical relationship between the kidney position and its arterial supply was investigated in 21 mammals, 1 bird, and 3 reptiles (n = 1 for each species) and in 43 human cadavers. The following observations were made. (1) Although the right kidney was located caudal to the left kidney in 29 out of 43 human cadavers (67.4%), the origin of the right renal artery from the aorta was located cranial to the origin of the left renal artery in 36 human cadavers (83.7%). Therefore, the relative positions of the kidneys do not correspond with the relative origins of the renal arteries in humans. (2) Among the mammals that were examined, the position of the kidney and the branching level of the renal artery on the right side were usually cranial to those on the left side. (3) In the bird and most reptiles that were examined, kidneys were typically located in the pelvic region and were supplied by segmental arterial branches. These results suggest that the right kidney and its arterial supply are generally located cranial to the left kidney in phylogeny of mammals. While the presence of a human accessory renal artery in 9 out of 86 sides (10.5%) and a cranial origin of the left renal artery relative to the right renal artery in 7 out of 43 cadavers (16.3%), shows some variation in the arterial supply to the kidneys, the origin of the renal arteries can generally be used as phylogenetic landmarks indicating the relative positions of the kidneys. Hence, from an ontological perspective, the human right kidney may be initially situated cranial to the left kidney during the early stages of development. Thereafter, the human right kidney may shift downwards secondary.     

Arterial supply of the soleus muscle: anatomical study of fifty lower limbs

Soft tissue defects of the lower limb are a formidable challenge to the plastic surgeon but a soleus muscle flap often provides the solution. Various types of soleus muscle flap have been described, based mainly on the vascular supply. The arterial blood supply of the soleus muscle was studied in 50 cadaveric lower limbs. The blood vessels and their branches to the muscle were dissected. The distance of the origin of the perforators was measured from fixed bony landmarks. Branches of the popliteal artery trunk, the posterior tibial artery, and the peroneal artery supplied the soleus muscle. The number of branches to the soleus muscle from these main arteries were analyzed. The medial part of the muscle was supplied throughout its length by perforators arising from the posterior tibial artery. This constant feature makes the medial part of the muscle reliable as a proximally or distally based flap. The average distances of the lower perforators arising from the posterior tibial artery were 6.5 cm, 11.6 cm, and 16.8 cm from the medial malleolus. The branches of the peroneal artery were mostly distributed in the upper half of the muscle. These large pedicles allow a composite transfer of the soleus muscle with the fibula. Lower perforators were demonstrated to arise from the peroneal artery in 60% of the limbs but the scarcity of perforators in this region limits the clinical usefulness of an inferiorly based lateral hemisoleus flap. The study demonstrates the distribution of arteries entering the soleus muscle and how the information may be used in the design of soleus muscle flaps. The average numbers of the perforators arising from the vessels and their distribution have been highlighted.     

肺内支气管动脉分布的应用解剖

目的：为选择性支气管动脉造影提供解剖学依据。方法：选用40例肺血管灌注标本和8例肺腐蚀铸型标本进行观测。结果：40侧成人肺标本中．共有59支支气管动脉,左肺l～3支．右肺为1-2支。支气管动脉分为3型．左肺2支型最多．右肺1支型最多。肺门支气管动脉平均外径．右肺1支型口径显著大于2支型．左肺各型口径无显著性差别。支气管动脉进入肺门后,一支动脉分布到几个肺叶者：左侧占72．7％,右侧占92．3％．专入某一肺叶者：左侧占27．3％,右侧占7．7％。肺叶支气管动脉和肺段支气管动脉均以2支最常见。结论：对于肺内支气管动脉的去向应引起重视。     

人Heubner回返动脉的应用解剖学研究

目的研究Heubner回返动脉的显微解剖,为经翼点手术入路提供应用解剖资料。方法20侧(10例)成人头颅标本,10%多聚甲醛固定,经血管灌注彩色乳胶,模拟双侧翼点入路开颅,研究Heubner回返动脉起止位置、走行路径及其与相邻解剖结构之间的显微解剖关系。结果本组10例标本20侧中,19侧有Heubner回返动脉存在(有1侧为3支,2侧为2支,其余16侧为1支)。均起源于同侧大脑前动脉,以前交通动脉远、近侧2mm内最多。大脑前动脉水平段(A1)远侧,距前交通动脉2mm附近,常有Heubner回返动脉发出逆向伴行。Heubner回返动脉发出后以向A1段上方、内上方为主,向后上方走行。本组有3支回返动脉同内侧豆纹动脉间有吻合,未见回返动脉与大脑中动脉的直接分支有吻合支,但可见向后发出的细小穿支分布于胼胝体、基底节、下丘脑及额叶脑组织。结论Heubner回返动脉的识别并明确其与大脑前动脉A1段、额极动脉以及额眶动脉的关系,对经翼点入路的手术安全显露术区,避免损伤重要的血管和神经结构具有重要意义。     

Comparative anatomical studies of thyroid and thymic arteries: I. Rat (Rattus norvegicus albinus)

The thyroid and thymic arteries were investigated in 50 male and 50 female rats. In more than 70% of the animals, on both sides the cranial thyroid artery forms a common trunk with the ascending pharyngeal artery. The caudal thyroid artery arises not from the deep cervical but from the pericardiacophrenic artery. It may be replaced, however, by a branch of some other artery, such as the brachiocephalic, subclavian, vertebral, or ascending cervical, suggesting a shift of its origin from the internal thoracic artery to the thyrocervical trunk as in man. All the thoracic lobes of the thymus are supplied directly by a thymic branch of the internal thoracic artery or indirectly by a branch of the pericardiacophrenic artery. More than half of the specimens have a cervical thymic lobe of variable size, which is supplied by a branch of the cranial thyroid, external carotid, and/or occipital arteries. Some of these thymic arteries, except those from the external carotid and occipital arteries, reach the thoracic lobe. The thoracic lobes lacking a cervical lobe may be supplied by the thymic branch arising only from the cranial thyroid artery. Other anomalous arteries supplying the thoracic lobe are derived from the superficial cervical and/or the right common carotid arteries. These results show that the thymic arteries of rats are basically similar to those of man, although they display a clear difference in their frequency and origin.     

胎儿脾动脉（脾外部分）的解剖学观察

本文用30例胎尸,经灌注后进行解剖剥离.在手术放大镜下进行观察,并对脾动脉的分支及侧支循环进行了观察,其结果如下.(1)脾动脉均起于腹腔干并沿胰腺上缘走行,脾动脉发出胰腺支,胃短动脉,胃网膜左动脉,胃后壁动脉,脾叶动脉和脾极动脉.(2)脾动脉的侧支循环十分丰富,脾动脉与胃左动脉,左膈下动脉,胃网膜右动脉,肠系膜上动脉,胰动脉等均有侧支吻合,并且胃网膜左动脉与胃网膜右动脉吻合形成网膜弓.     

Studies on the vasa vasorum of the human renal artery.

The transplantation of a donor kidney is currently the treatment of choice for terminal renal insufficiency. However, major postoperative problems may be caused by vascular complications. It was therefore decided to look for possible correlations between these vascular problems and the arterial wall supply. The following methods were used to elucidate the origin and distribution of nutrient vessels: 1. Injection of the abdominal aorta with resin in three fresh cadavers. 2. The precise microscopic location of the branches originating from the renal arteries in eighteen autopsy subjects. 3. Abdominal angiography and selective angiography of the first left lumbar artery and left renal artery in one patient. It was found that the renal artery receives its blood supply from both internal and external nutrient vessels. The external vascular supply of the renal arterial wall originates from the aorta itself, from the inferior suprarenal artery (which sometimes has connections with the first and/or second lumbar artery) or from the diffuse vascular system of the retroperitoneal space. Because of the variety in number, course and origin of these nutritional vessels, an ideal point for the anastomosis of the renal artery cannot be indicated.     

Ramification of the portal vein at the porta hepatis in humans

The ramification of the portal vein at the porta hepatis was studied by anatomic dissection performed in 32 formalin fixed human livers. In all the specimens there were branches which ran towards the caudate lobe, arising from the portal vein and either from the left or the right portal branches. Tri-and quadrifurcation of the portal vein was observed. In 5 cases (16%) there were branches arising from left portal branch or portal vein and directed anteriorly to the quadrate lobe or to the region of the gall-bladder sulcus. These branches ranged from 1.0 to 6.0 mm in diameter. The portal caudate branches were divided into 3 groups.Group 1: Branches to the papillary process; 1 or 2 branches in 26 cases (82%), 3 or 5 branches in 3 cases (9%) and no branches in 3 cases (9%);     

Stomach serosal arteries distinguish gastric regions of the rat

Because the stomach in situ has few distinctive surface features and changes shape dramatically with food intake, we have used micro-CT imaging combined with two distinct contrast agents to (1) characterize the pattern of arteries, potential landmarks, on the stomach wall and (2) evaluate how meal-related shape changes affect the size of the different regions. Images generated with a contrast agent injected directly into the heart during perfusion enabled a thorough look at the organizational features of the stomach angioarchitecture. The stomach receives its blood supply primarily from two pairs of vessels, the gastric and gastroepiploic arteries. Each of the three regions of the stomach is delineated by a distinctive combination of arterial fields: the corpus, consistent with its dynamic secretory activity and extensive mucosa, is supplied by extensive arterial trees formed by the left and right gastric arteries, travelling, respectively, on the ventral and dorsal stomach surfaces. These major arteries course circularly from the lesser towards the greater curvature, distally along both left (or ventral) and right (or dorsal) walls of the corpus, and branch rostrally to supply the region. The muscular antrum is characterized by smaller arterial branches arising primarily from the right gastroepiploic artery that follows the distal greater curvature and secondarily from small, distally directed arteries supplied by the large vessels of the left and right gastric arteries. The forestomach, essentially devoid of mucosal tissue and separated from the corpus by the limiting ridge, is vascularized predominantly by a network of small arteries issued from the left gastroepiploic artery coursing around the proximal greater curvature, as well as from higher order and smaller branches issued by the gastric and celiac arteries. These distinctive arterial fields appear to distinguish the major gastric regions, irrespective of the degree of fill of the stomach. Volume assessments of stomach compartments were made from images of iodine-stained stomachs. By varying the delay time between eating and perfusion, we were able to probe the emptying behavior of the stomach and demonstrate that the regions of the stomach empty at different rates, thus changing the relative dimensions of the organ regions. Notably, and despite these shape changes, the gastric arteries appear to form a regular, particularly recognizable, and lateralized pattern corresponding to the corpus that should be of use in guiding surgical and experimental interventions.     

The developing bronchial arteries in a fetus of the twelfth week

In the human fetus bronchial arteries appear, as such, between the ninth and twelfth week as highly variable arteriolar outgrowths from the aorta itself or from proximal portions of right (or left) posterior intercostal rami of the aorta. Thus, they constitute a secondary system implanted relatively late upon the peripheral coats of the bronchial tree and large pulmonary vessels. The process is thought to be an inductive one depending partly upon the approximation of parts during the descent of heart and lungs into the thorax and partly upon the advancing degree of maturity of the bronchial tree. In the fetus of the twelfth week, to be described below, there are three bronchial arteries to the left lung and at least one to the right. The lowest of these (the left aorticobronchial artery) can be traced along the superficial coasts of the left lower lobe bronchus to the level just preceding that in which cartilages are differentiating: for example, to the third of what will comprise, eventually, some 25 generations of branches of the posterior basal segmental bronchus. Beyond this shifting level of differentiation the segmental pulmonary arteries constitute the sole arterial supply to the bronchi and parenchyma of the lung. It is assumed from recent reports in the literature that the bronchial arterioles will have established continuity with pulmonary arteries and with the pulmouary parenchyma not later than the twenty-sixth week of gestation.     

Origin and course of the coronary arteries in normal mice and in iv/iv mice

This paper reports on the origin and distribution of the coronary arteries in normal mice and in mice of the iv/iv strain, which show situs inversus and heterotaxia. The coronary arteries were studied by direct observation of the aortic sinuses with the scanning electron microscope, and by examination of vascular corrosion casts. In the normal mouse, the left and right coronaries (LC, RC) arise from the respective Valsalva sinus and course along the ventricular borders to reach the heart apex. Along this course the coronary arteries give off small branches at perpendicular or acute angles to supply the ventricles. The ventricular septum is supplied by the septal artery, which arises as a main branch from the right coronary. Conus arteries arise from the main coronary trunks, from the septal artery and/or directly from the Valsalva sinus. The vascular casts demonstrate the presence of intercoronary anastomoses. The origin of the coronary arteries was found to be abnormal in 84% of the iv/iv mice. These anomalies included double origin, high take-off, slit-like openings and the presence of a single coronary orifice. These anomalies occurred singly or in any combination, and were independent of heart situs. The septal artery originated from RC in most cases of situs solitus but originated predominantly from LC in situs inversus hearts. Except for this anomalous origin no statistical correlation was found between the coronary anomalies and heart situs or a particular mode of heterotaxia. The coronary anomalies observed in the iv/iv mice are similar to those found in human hearts. Most coronary anomalies appear to be due to defective connections between the aortic root and the developing coronaries. iv/iv mice may therefore constitute a good model to study the development of similar anomalies in the human heart.     

Total anomalous arterial supply to the liver and gallbladder from the gastroduodenal artery: a case report

Anomalous arteries to the liver are not uncommon and usually arise from the superior mesenteric artery, the left gastric artery or directly from the aorta. We report a case of total replacement of the arteries to the right and left liver by separate right and left hepatic arteries arising from the gastroduodenal artery. The proper hepatic artery was absent. The gallbladder was supplied from the anomalous right hepatic artery.     

Variations of pulmonary vessels: Some practical implications for lung resections

Anatomical variations of the bronchi and lung vessels may be important obstacles during lung resection if overlooked. We designed this study to determine the frequency and types of variations of lung vessels during lung resections. In a 3[1/2]‐year‐period, anatomical variations were recorded and registered by digital photography at the hilar and/or interlobar areas during lung resection surgery on 140 patients. Variations of the pulmonary blood vessels were observed in 23 patients. Of these, 12 patients had variations of the middle lobe vessels. Middle lobe veins emptying into the right inferior pulmonary vein, and middle lobe arteries originating from the artery for the basal segments, were observed in four patients each; two separate middle lobe arteries and a low origin of the middle lobe artery existed in three and one patient, respectively. Among seven patients with variations of the lingular vessels, the lingular artery originating from the artery for the basal segments was found in three patients; the remaining variations referred to absent or low origin of the lingular artery (in one patient each), and to an aberrant lingular vein, separate from the upper lobe vein (two patients). A single unilateral pulmonary vein and a left‐sided bronchial tree completely behind the pulmonary artery existed in three and one patient, respectively. Potential problems related to these variations during resectional lung surgery are discussed. Awareness of the most frequent variations is of utmost importance for safe lung resections. Clin. Anat. 22:698–705, 2009. © 2009 Wiley‐Liss, Inc.     

Origin and distribution of portal blood in the cat and the rabbit

The portal vein in the rabbit is formed by union of the gastrosplenic vein, which extends caudally and to the right, and the relatively larger and cranially directed mesenteric vein, formed from cranial and caudal mesenteric and caudal pancreaticoduodenal tributaries. The gastroduodenal vein, which receives blood from the distal pylorus, greater omentum, pancreas and duodenum, joins the rabbit portal vein opposite the branch to the caudate lobe. In the cat, the portal vein is formed by the junction of the gastrosplenic, which is directed transversely or cranially, and the mesenteric, and receives two main tributaries: the gastroduodenal, which is the main vein from the stomach, and the cranial pancreaticoduodenal. When ¹³¹I-rose bengal was injected into the spleen of conscious standing cats and entered the portal vein in the gastrosplenic, it was distributed preferentially to the right branch and the left lateral ramus of the left branch. In the rabbit, there was no evidence for preferential distribution of splenic blood, but blood from the cranial mesenteric vein was distributed preferentially to the right and caudate branches and that from the caudal mesenteric to the caudate. This distribution was affected by the entry of blood in the gastrosplenic vein. Although statistically significant differences did occur in the intrahepatic distribution of blood derived from the portal tributaries, the absolute differences were small.     

Superficial palmar arch: an arterial diameter study

Although anatomical variations in the arterial pattern of the hand have been the subject of many studies, information on the diameter of the superficial palmar arch contributing vessels and its branches are rarely found in the literature. The objective of the current study was to evaluate these arterial variations, with special attention to the diameter of the superficial palmar arch contributing vessels and its major branches. Forty-six hands from male embalmed human cadavers were evaluated, 21 right hands and 25 left hands. Complete arches were present in 43% on the right and in 52% on the left. Arches were completed by the median artery in two cases. Variations were more common at the radial side of the arch and on left hands. Comparison of vessel diameters revealed the radial artery to be significantly larger than the ulnar artery but the ulnar artery to be larger than the superficial branch of the radial artery. The diameters of the common digital arteries were not different with regard to complete or incomplete arches, or with regard to the presence of the median artery.