上矢状窦起始段及其桥静脉属支的解剖学研究

目的:探讨上矢状窦血栓形成的原因及上矢状窦与其它硬脑膜静脉窦之间吻合的意义。方法:观察3例新鲜胎儿及婴儿尸体头部制作ABS铸型标本,15例湿性成人尸头标本的上矢状窦起始段形态及注入该部位桥静脉的支数、管径及其与周围其它硬脑膜静脉窦之间的吻合情况。结果:上矢状窦起始段的前端均为闭锁端,起始段长度为(10.9±1.0)cm,由前向后逐渐变宽,注入上矢状窦起始段的桥静脉多位于大脑半球的外侧面,左侧和右侧分别为(6.4±4.2)支和(5.6±3.4)支。上矢状窦通过大脑中浅静脉与海绵窦的吻合。结论:上矢状窦管腔内横穿小梁和纤维索以及桥静脉的锐角逆行注入是血栓形成的形态学和血液流变学基础;上矢状窦借大脑中浅静脉与海绵窦的吻合是保证上矢状窦的静脉血回流的形态学基础之一。     

上矢状窦旁桥静脉的显微解剖与影像学观察

目的:通过对上矢状窦(SSS)旁大脑桥静脉的显微解剖、影像学观察及其对照研究,为各种纵裂间手术入路中桥静脉的保护提供基础。方法:分别对30例(60侧)上矢状窦和颈内静脉内灌注蓝色乳胶的成人头颅湿标本、40侧DSA静脉相和16侧CTV进行显微解剖和影像学观察。结果:上矢状窦前部和后部分别有一缺乏桥静脉注入段,显微解剖、DSA和CTV观察上矢状窦旁桥静脉的数量分别为11.2支、8.9支和7.0支,DSA和CTV观察发现桥静脉注入上矢状窦处常显示不清。结论:熟悉和比较上矢状窦旁桥静脉的解剖学和影像学特征有利于各种纵裂间手术入路和手术过程中桥静脉的保护。     

上矢状窦旁桥静脉注入口的显微解剖学观察及其意义

目的通过显微解剖观察上矢状窦旁桥静脉注入口的形态特点,为脑静脉血栓形成发病机理的解释提供形态学依据。方法 30例(60侧)成人头颅湿性标本,观测记录注入口的数目、分布、类型及走行。结果上矢状窦旁桥静脉共有注入外口367个(桥静脉与硬脑膜连接处,位于上矢状窦腔外),注入内口(桥静脉在上矢状窦腔内的开口)375个,其中有8个注入外口分别对应两个注入内口。注入口集中分布在上矢状窦前段和后段,分直接注入和间接注入(注入外口经脑膜静脉或硬膜旁窦走行一段距离后到达注入内口)两种类型。37%的上矢状窦后段注入口为间接注入,其中85%使得桥静脉由逆行注入上矢状窦变为垂直或顺行注入。结论上矢状窦旁桥静脉注入口复杂多样,且常使桥静脉逆行、垂直和顺行注入上矢状窦内的方式发生改变,在一定程度上可以对抗脑静脉血栓形成的发生。     

上矢状窦旁桥静脉的解剖及其血流动力学数值模拟

目的 通过对上矢状窦旁桥静脉的血流动力学数值模拟,为脑静脉血栓形成发病机制的解释和影像学诊断提供形态学证据。方法 对6例（12侧）上矢状窦和颈内静脉灌注蓝色乳胶的成人头颅湿标本进行观测,测量各支桥静脉的直径及其注入上矢状窦的角度;利用解剖数据,应用计算流体力学分析软件Fluent,建立上矢状窦旁桥静脉的血流动力学模型,对不同模型的壁面剪切力进行比较分析。结果 上矢状窦旁桥静脉共计137支,分为前后两组,其中后组桥静脉的直径较大,注入上矢状窦的角度较小。共建立模型137个,桥静脉直径>1.2mm、65°≤注入角度<105°时,注入处下游上矢状窦壁壁面剪切力下降明显;桥静脉直径>1.2 mm、注入角度<65°时,注入处下游上矢状窦壁和注入处上游桥静脉壁壁面剪切力下降明显,桥静脉壁壁面剪切力最低值为上矢状窦壁上的63%。与前段组桥静脉模型相比较,后段组模型上矢状窦壁和桥静脉壁壁面剪切力最低值较小,距注入处较远。结论 桥静脉直径>1.2mm,且注入角度<65°时,血管壁面剪切力急剧下降,脑静脉血栓形成容易发生。血栓好发于上矢状窦后段的注入处上游桥静脉壁。     

上矢状窦内纤维索结构的显微解剖和临床意义

目的:观察上矢状窦腔内纤维索的形态分类、分布,了解纤维索的功能和意义.方法:10具尸头标本,沿上矢状窦上壁长轴中线纵行剖开,体视学显微镜下观察腔内各种纤维索的形态分类、分布特点,记录各类纤维索的数目.结果:纤维索多分布于上矢状窦中段和后段,主要有3种类型:瓣膜状、小梁状和板层状.10具标本纤维索总数210个,瓣膜状纤维索100个,小梁状纤维索64个,板层状纤维索46个,分别占总数的47.62%、30.47%和21.91%.瓣膜状纤维索覆盖大脑上静脉注入上矢状窦的人口处,开口方向和静脉注入上矢状窦方向相同;小梁状纤维索以单个、多个或不同角度交叉方式出现,位于窦中央或一侧;板层状纤维索宽大,跨度长,将上矢状窦管腔分隔成两个分流腔,几乎都位于上矢状窦后段,结论:(1)上矢状窦内纤维索有瓣膜状、小梁状和板层状3种类型;(2)瓣膜状纤维索,具有防止窦内血流逆流入大脑上静脉的作用;(3)小梁状纤维索有增加窦壁弹性、增强窦壁抗压性、为瓣膜状纤维索提供摆动的着力点等作用;(4)板层状纤维索町以防止血流变慢和血液湍流、保证窦内血液迅速向窦汇回流.     

上矢状窦窦腔内纤维索分布的解剖学特征

目的:观察上矢状窦不同节段窦腔内纤维索的分布特征,探讨其功能和意义.方法:成人头颅湿性标本,15例沿上矢状窦上壁长轴中线纵行剖开,5例沿垂直眦耳线的冠状面作连续断层切片.将上矢状窦分为有桥静脉注入的前段、缺乏桥静脉注入的前缺乏段、有桥静脉注入的后段和上矢状窦后部的后缺乏段,观察纤维索结构在上矢状窦各段窦腔内的分布情况及形态.结果:上矢状窦窦腔内纤维索总数目为277个,其中瓣膜状纤维索131个,覆盖53%逆行注入上矢状窦的桥静脉注入口,74%的瓣膜状纤维索分布在上矢状窦注入后段,22%分布在注入前段;小梁状纤维索85个,58%分布在上矢状窦注入后段,20%分布在注入前段;板层状纤维索61个,64%分布在上矢状窦注入后段,33%分布在后缺乏段接近窦汇处.断层解剖能准确区分3种纤维索结构.结论:上矢状窦窦腔内纤维索具有节段性分布的特征,可能与上矢状窦血栓形成的发生有关.     

上矢状窦引流桥静脉的彩色多普勒超声观察

目的：通过对上矢状窦引流桥静脉的彩色多普勒超声观察,为脑静脉血流动力学研究提供新的参考数据。方法：选择20例神经外科开颅术后1年的患者,经术后骨窗彩超观测上矢状窦引流桥静脉。结果：桥静脉呈节段性集中分布,分为前段组和后段组两组。前段组桥静脉数目为(3.1±1.4) 支,直径为(2.7±0.7) mm,注入角度为(96±33) °,平均血流速度为(10.0±2.8) cm/s。后段组桥静脉数目为(5.8±1.0) 支,直径为(3.2±1.2) mm,注入角度为(41±24) °,平均血流速度为(11.4±2.8) cm/s。与前段组相比较,后段组桥静脉的数目较多,直径较大,注入角度较小,血流速度较快。结论：彩色多普勒超声通过术后骨窗能够观测到上矢状窦引流桥静脉的形态和血流速度,为脑静脉血流动力学研究提供了新的参考数据,并为神经外科术后监测提供了新的方法。     

大脑半球底面的静脉及其吻合

一、本文所用材料是专供研究的小儿脑100侧半球(50个大脑),观察了脑底部静脉的条数,归流与吻合。二、大脑上静脉:额叶底面前部的静脉向前走,归流于大脑上静脉居首位占70±4.58％,而部分的静脉直接注入上矢状窦者占10±3％,此外,一部分流入上矢状窦,一部分归流于大脑上静脉或部分注入大脑中静脉占20±4％。三、大脑中静脉:大脑中静脉的干数,窦的开口和吻合支。干数有1—4条者,其中以 3条居多数,4条和缺如者占少数。窦的开口以海绵窦和进入二个窦以上者居首位,其次开口于岩上窦和翼丛,而开口于蝶顶窦,横窦,乙状窦和缺如者占少数。大脑中静脉与大脑下静脉在脑底的支间吻合,吻合支的位置大多数在侧副裂前部和颞下沟前部相一致,而在颞中沟前部以及吻合与沟不一致者占少数。四、大脑下静脉:大脑下静脉的条数以5条为最多,其次是4条,而9条最少。开口于二个窦以上者(开口于横窦,乙状窦,岩上窦和海绵窦)较多,占70±4.58％,唯单独开口于静脉窦者较少,占30±4.58％。五、大脑上静脉与大脑中静脉的支间吻合:在脑底额叶下面可见到大脑上、中静脉有细小吻合支存在,有的也很明显。     

横窦引流小脑桥静脉的形态特点及其临床意义

目的:通过显微解剖和铸型方法观察横窦引流小脑桥静脉的形态特点,为小脑幕下手术入路的选择提供形态学依据.方法:分别观测30例(60侧)静脉内灌注蓝色乳胶的成人头颅湿标本和观察12例胎儿和幼儿的脑静脉血管铸型.结果:横窦引流小脑桥静脉按其注入小脑幕处所在位置的不同,分为窦汇组(28%)、小脑幕组(36%)和岩部组(36%)3组,3组桥静脉的数目差异无统计学意义,各组桥静脉的直径分别为(1.6±0.7)mm, (1.9±0.7)mm, (1.9±0.7)mm.7%的病例缺乏窦汇组桥静脉,13%的病例缺乏小脑幕组桥静脉,每侧显微解剖标本至少存在一根岩部组桥静脉.结论:小脑幕下手术中,旁正中入路损伤桥静脉的机会最小,术前建议进行影像学检查以选择合适的手术入路.     

大脑半球内侧面的静脉及其吻合

观察50个小儿脑(计100例大脑半球)内侧面静脉的条数、行径、归流及其吻合情况。大脑半球内侧面的静脉主要有:1.大脑上静脉,常见有9～12条,归流于上矢状窦。2.扣带后静脉,多半为1条,沿胼胝体沟后行,注入大脑大静脉。3.大脑前静脉,与同名动脉伴行,但分布范围小得多,最后注入脑底静脉。4.大脑后静脉,一般为1条,注入大脑大静脉或脑底静脉。5.注入下矢状窦的静脉,细小且不恒定。在上述静脉间存在吻合支,多见的为大脑上静脉间吻合,出现率为52％。     

Microsurgical anatomy of the superior orbital fissure

The microanatomy of the superior orbital fissure (SOF) was studied in 96 sides of cadaver specimens. The SOF is a narrow bony cleft that lies at the apex of the orbit between the greater and lesser wings of the sphenoid. Through this fissure, many important structures enter the orbit from the middle cranial fossa including the third, fourth, sixth cranial nerves, and the ophthalmic branch of the fifth nerve. In addition, the superior opthalmamic vein exits the orbit to drain into the cavernous sinus via the SOF. The fissure can be divided into three anatomical regions by the annulus of Zinn (common annular tendon): the lateral, central, and inferior regions. The lateral wall of the SOF can also be divided between the upper and lower segments, and the angle between them was measured to be 144.27 degrees +/- 20.03 degrees . Defining these regions is useful in describing the course and placement of the nerves and vasculature in the SOF. Managing lesions at the orbital apex requires an extensive knowledge of the cranial base and the intracranial and extracranial relationships of the anatomical structures coursing through the SOF. The goal of this study was to describe the microanatomy of the SOF region in detail and to provide a reference for surgical procedures involving the orbital apex.     

眶上裂区的显微外科解剖学研究

目的:为眶上裂(superior orbital fissure,SOF)区手术提供显微解剖学基础。方法:①观测30例(60侧)成人头颅干标本SOF骨性结构;②在手术显微镜下观测15例(30侧)成人头颅湿标本SOF区穿行神经、血管位置及毗邻关系。结果:①sOF外侧壁上、下半边夹角144.27°±20.03°;②泪腺神经距SOF外侧端(4.17±1.70)mm;③动眼神经上支至SOF内侧壁(1.83±0.62)mm;④滑车神经紧贴Zinn腱环外侧人SOF;⑤眼上静脉海绵窦段具有静脉窦结构。结论:SOF区穿行神经、血管位置的观测,对临床开展SOF区手术有参考意义。     

Relation of the external branch of the superior laryngeal nerve to the superior pole of the thyroid gland: an anatomical study

The external branch of the superior laryngeal nerve (ELN) is intimately associated with the superior thyroid artery (STA) in relation to the superior pole of the thyroid gland, rendering it vulnerable to injury during the ligation of this vessel during thyroidectomy. Although most texts acknowledge the fact that the nerve is in close relation to the STA, there has not been an anatomical study to relate the position of the ELN to the superior pole of the thyroid gland. The aim of this study was to determine the shortest distance, from the most superior point of the thyroid gland, to the ELN. Bilateral micro-dissection on 43 adult cadavers, excluding those with thyroid pathology and previous thyroidectomies, was undertaken. The most superior point of the superior pole of the thyroid gland was identified and the shortest distance to the ELN was measured with a digital calliper (accuracy 0.01 mm). The metric study indicated a mean distance from the ELN to the superior pole of a normal sized thyroid gland of 5.76 mm (range: 2.00-11.26) on the right, and 6.17 mm (range: 2.78-13.48) on the left. From the literature, it is clear that the ELN may even be closer to the superior pole of an enlarged thyroid gland. The recommendation to stay on the substance of the superior pole of the thyroid gland when ligating the STA remains valid, as the nerve is extremely close in relation to the superior pole of the normal thyroid gland.     

臀上动脉深上支髂骨骺移植的解剖学研究

目的 :为带血供的髂骨骺移植提供解剖学依据。方法 :在 40侧经动脉灌注红色乳胶的成人臀部标本以及 2侧儿童标本上 ,观测臀上动脉深上支的行程、分支及滋养支 ;选用 5 0块髋骨 ,观察髂骨嵴前外侧部的滋养孔。结果 :儿童臀上动脉深上支的分支、分布与成人相似 ,位于臀中肌深面和臀小肌上缘 (相当臀前线 ) ,循髂骨嵴弓形向前 ,达髂前上嵴 ,沿途分出平均 (4 .2± 1.1)支外径 0 .5～ 1.1mm的髂嵴支 ,分布髂嵴骨膜 ,并发细小分支进入滋养孔。从髂前上棘至结节区 ,在距髂嵴缘下方 2cm范围内 ,平均有(2 2 .4± 6.7)个滋养孔。结论 :以臀上动脉深上支及其分支为蒂 ,在髂嵴前部可切取带骺骨瓣 ,以修复长管骨骨骺缺损。     

Ieiomyosarcoma of the superior vena cava producing superior vena cava syndrome and heart tamponade

An autopsy case of primary leiomyosarcoma arising in the superior vena cava is presented. A 44 year old Japanese man presented with superior vena cava syndrome and eventually died due to heart tamponade and acute renal failure. Autopsy revealed that the superior vena cava was occluded with a tumor that had invaded the pericardium and right thoracic cavity. Primary caval venous leiomyosarcoma is a rare but lethal disease and most cases arise from the inferior vena cava. This case represents a very rare case of leiomyosarcoma with the rare clinical findings of superior vena cava syndrome and heart tamponade.     

腹腔镜下肠系膜上动脉优先入路和上静脉入路在右半结肠癌治疗中的对比性研究

目的探讨对比肠系膜上动脉优先入路法和上静脉入路的腹腔镜手术治疗右半结肠癌的安全性及可行性。方法选择2015年1月至2018年12月于肇庆市第一人民医院手术治疗的右半结肠癌的患者76例,其中男性40例,女性36例;年龄49~66岁,平均年龄50.89岁;体质量指数(BMI)21.78~27.45 kg/m^2,平均BMI 24.79 kg/m^2;病程7~20个月,平均病程10.97个月;病灶位于结肠肝曲23例,升结肠23例,盲肠30例。依据肠系膜上动脉优先入路法及肠系膜上静脉优先入路法行腹腔镜手术根治,将患者分为观察组和对照组,每组38例。记录并分析两组患者所用手术时间、术中出血量、清扫淋巴结数量、阳性淋巴结个数及中转开腹例数;记录并分析两组患者接受手术后恢复排气排便时间、引流时间、引流量、镇痛时间、进食时间及住院时间情况;记录并分析两组患者术后早期肠梗阻、吻合口出血、吻合口瘘等短期并发症。结果两组患者的一般资料比较,差异均无统计学意义(P>0.05);与静脉优先入路方式相比,动脉优先入路方式清扫淋巴结总数和阳性淋巴结个数均显著增多,出血量显著减少(P<0.05);观察组引流时间长,引流量大,与对照组比较,差异有统计学意义(P<0.05);两组所用手术时间、中转开腹率、术后恢复排气和排便时间、镇痛时间、进食时间、住院时间和术后短期并发症总发生率差异均无统计学意义(P>0.05)。结论采用肠系膜上动脉优先入路的腹腔镜手术治疗右半结肠癌,能更彻底地清扫淋巴结从而彻底清除癌症病灶,保证肿瘤的根治程度,减少术后复发率,显著改善患者预后,同时未增加更多的手术风险,安全有效,可行性高。     

Persistent left superior vena cava

Congenital venous anomalies are relatively common and some have clinical implications. An example of persistent left superior vena cava was found during a routine dissection. This vein was carefully dissected and followed to its termination in the right atrium. The same cadaver also presented four branches from the arch of the aorta. A left superior vena cava occurs in early development but disappears later. The clinical significance of such a persistent left superior vena cava assumes importance during cardiac catheterization via the left subclavian vein.     

Hemodialysis through persistent left superior vena cava

We report a case of end stage renal disease patient who displayed a persistent left superior vena cava (PLSVC) after placement of hemodialysis (HD) catheter through left internal jugular vein, as revealed by routine post-procedure X-ray chest. The diagnosis of PLSVC was confirmed by arterial blood gas, two-dimensional echocardiography, computed tomography thorax and angiographic examination. This anomaly is rather rare; few studies on safety of PLSVC for HD have been reported. The catheter was uneventfully used for HD for 2 months with careful continuous monitoring and removed after arteriovenous fistula was successfully cannulated. Physicians who place HD catheters in the left jugular/subclavian vein should be aware of the existence of PLSVC.     

Responsiveness of cells in the cat's superior colliculus to textured visual stimuli

Summary Responses to texture motion (visual noise) were investigated in the superior colliculus of paralysed cats, lightly anaesthetized with N₂O/O₂ supplemented with pentobarbitone or Althesin. Within the superficial layers two classes of texture-sensitive neurones were found: Type I units with weak responses to noise, often related to specific elements in the texture and Type II units which were driven independently of the texture structure, and tended to be recorded deep to the Type I units. Type III units recorded from the deep collicular layers were insensitive to texture. Anatomical bases for this differential sensitivity and the notion of two collicular subsystems are discussed.     

经眼上静脉入路行海绵窦栓塞的应用解剖学

目的：为经眼上静脉入路行海绵窦栓塞术，治疗颈动脉海绵窦瘘提供解剖学依据。方法：成人头部标本２４个，解剖观测眼上静脉及其眶外属支的形态、长度及外径等。结果：①眼上静脉由眶上静脉支和内眦静脉交通支组成。眶上静脉支穿经眶上孔处外径为１．３ｍｍ。内眦静脉外径为１．４ｍｍ，距内眦６～８ｍｍ，其交通支外径为１．４ｍｍ；②眼上静脉在眶腔内分为三段，外径平均达２．１～２．５ｍｍ。结论：经眼上静脉眶外属支入路具有可行性。