电视胸腔镜下动脉导管闭合术的应用解剖

本文对32例成人尸体的动脉韧带及其毗邻结构进行了观测，为电视胸腔镜下施行动脉导管闭合术提供了以下资料：主动脉窗上、下缘的体表投影；左喉返神经勾绕动脉韧带的部位；左迷走神经与胸主动脉的毗邻关系及左支气管动脉与左肺动脉的毗邻关系。另外对胸腔电视镜孔的置入部位提出了建议。     

动脉导管三角的解剖及其临床应用

目的:研究动脉导管三角区,为动脉导管结扎术提供形态学依据。方法:在尸体标本上模拟动脉导管结扎术操作步骤对动脉导管三角进行解剖,并对相关结构进行观察测量,结果进行统计学处理。结果:左支气管动脉在动脉导管下窗发自降主动脉的占28.6%(4例),在动脉导管上窗发自主动脉弓的占7.1%(1例),动脉韧带长(11.1±1.4)mm,主动脉峡部外径(21.9±2.1)mm,二者之比为0.49±0.05,有直线相关性(r=0.892,P<0.001)。左喉返神经跨越动脉韧带的主动脉侧1/3者占57.2%,中间1/3及肺动脉侧1/3者均为21.4%。结论:熟悉动脉导管三角的解剖结构及其量化关系,有助于更好地避免动脉导管结扎术中并发症的发生。     

经左听诊三角胸膜外动脉导管结扎术的应用解剖

目的 :为从左听诊三角入路经胸膜外进行动脉导管结扎术提供解剖学基础。方法 :在 3 0例小儿固定尸体上模拟经左听诊三角入路手术 ,对与动脉导管结扎术有关的肌肉、胸膜、神经及血管进行了解剖学观测。结果 :经左侧听诊三角入路第 4肋间隙切口处距交感干 ( 2 .74± 0 .41)cm ,距胸主动脉 ( 3 .3 8±0 .61)cm ,距左肺根上缘 ( 3 .5 0± 0 .5 7)cm ,距动脉导管 ( 4 .2 5± 0 .5 7)cm ,推肺向前约 ( 2 .10± 0 .5 0 )cm。结论 :手术中应注意胸膜的剥离、肋间隙切口的大小及与其密切相关的神经和血管。以听诊三角为标志 ,经第 4肋间隙入路胸膜外行动脉导管结扎术安全可行。     

胎儿动脉导管缺如的尸体解剖分析

目的对胎儿先天性动脉导管缺如进行尸体解剖分析,以提高该疾病诊断的精准性。方法回顾2011年1月至2019年9月北京安贞医院经超声心动图畸形筛查发现胎儿先天性心脏畸形引产而进行尸体解剖病例400例,检查胎儿心血管畸形及内脏的畸形情况,对其动脉导管缺如进行分析总结。结果400例胎儿先天性心脏病中,动脉导管缺如24例,检出率6%,男女各12例,左位主动脉弓19例,右位主动脉弓5例,21例具有肺动脉主干,3例无肺动脉主干及分支。具体情况如下:(1)肺动脉狭窄伴动脉导管缺如15例,伴发主要心血管畸形:单心室6例,房间隔缺损6例,单心房4例,右心房异构4例,右心室双出口4例,静肺脉异位引流4例,法洛四联症3例,永存左上腔静脉3例;(2)肺动脉闭锁伴动脉导管缺如7例,3例无肺动脉主干,4例肺动脉闭锁伴有狭窄的肺动脉主干,均可见体-肺动脉侧支;(3)法洛四联症伴肺动脉瓣缺如综合征及动脉导管缺如1例,肺动脉扩张;(4)主-肺动脉间隔缺损伴动脉导管缺如1例,肺动脉正常。动脉导管缺如伴发主要心外畸形:脾缺如7例,肺异常7例,内脏反位7例。结论胎儿动脉导管缺如常合并复杂先天性心血管畸形;动脉导管缺如合并肺动脉闭锁常伴体-肺动脉侧支;内脏畸形与伴随的先天性心血管畸形有关。     

先天性动脉导管未闭1例

笔者在解剖 1具青年女尸时 ,发现其动脉导管未闭。现报道如下。该例导管位于主动脉弓和降主动脉交界的内侧与左肺动脉上缘之间。呈漏斗型 ,长度为 0 .9ｃｍ ,主动脉端的内径为 7.0ｍｍ ,肺动脉端的内径为 2 .5ｍｍ。据有关资料统计 ,先天性心血管病的发病率为1.0 8‰～ 13.7‰ ,儿童高于成人 ,而动脉导管未闭是先心病中较常见的一种 ,占所有先心病的 2 1.2 % ,动脉导管未闭的主要临床体征是肺动脉高压致右心室肥大 ,笔者解剖的此具女尸其心脏大小正常 ,未见明显异常。附图　先天性动脉导管未闭先天性动脉导管未闭1例@李长征$第一军医大学解…     

“椎动脉-硬膜动脉导管韧带”的解剖学及临床意义

目的　探讨椎动脉第3段（V3段）的垂直段（V3v段）与硬膜囊前壁和周围骨性结构间的连接及其临床意义。 方法　头颈标本16具（32侧）,在C3~4节段,将V3段周围的软组织及其相关联的连接结构分离,探寻“椎动脉-硬膜动脉导管韧带”,观察其解剖学特点。取该韧带与椎动脉壁相连部,石蜡切片、HE染色,光镜观察、摄片。 结果　所有标本在寰枕关节后内侧V3v段发现“椎动脉-硬膜动脉导管韧带”共11条（43.7%）,长度9.25~4.76 mm,平均（7.39±1.33）mm,直径为（1.16±0.15）mm。该韧带出现于硬膜外层,自V3v段发出,末端分叉或呈分枝状穿入枕骨或连于硬膜。组织学特点为空心管状,管腔与椎动脉相通。 结论　“椎动脉-硬膜导管韧带”是椎动脉连于硬膜和骨之间的空心圆索状结构,可能是椎动脉的脑膜后动脉闭锁形成,是有孔型椎动脉畸形的形态学基础,其对椎动脉的固定及头活动时颅内压的形成有一定作用。枕颈部显露椎动脉时此结构断裂可能是造成椎动脉大出血的原因。     

46例室间隔缺损合并动脉导管未闭的外科治疗

目的 本文总结了46例室间隔缺损合并动脉导管未闭的诊断和外科手术治疗体会.方法 全部在体外循环辅助下施行手术治疗,其中男性25例,女性21例,年龄9个月～40岁;合并畸形有房间隔缺损,所有病例均经肺动脉切口缝合;合并畸形均同期手术矫治.结果 全组病例无死亡,手术治疗后效果满意.结论 室间隔缺损合并动脉导管未闭一旦明确诊断,应该早期手术治疗;室间隔缺损合并动脉导管未闭临床上易与单纯室间隔缺损相混淆,术前容易漏诊、误诊而导致术中发生灌注肺.为术中避免打遭遇战,应加强术前诊断、术中探查和术后加强呼吸道管理.     

动脉导管三角的应用解剖

目的　为动脉导管三角区的临床手术提供形态学基础。  方法　随机选用经福尔马林固定的尸体50具,解剖观测动脉韧带（AL）、左迷走神经、左喉返神经(LRLN)等相关结构,所得结果进行统计学处理。  结果　（1）有94%（47例）AL连于主动脉弓和左肺动脉（LPA）,即经典的动脉导管三角内,6%(3例)AL连于降主动脉与LPA之间。（2）根据AL与主动脉弓和LPA附着关系的不同,可分为6种类型：Ⅰ.附于主动脉弓下缘和LPA上缘之间(76%); Ⅱ.附于主动脉弓前壁与LPA上缘之间(8%); Ⅲ.附于主动脉弓前壁与LPA前壁之间(8%); Ⅳ.附于降主动脉内侧缘与LPA上缘之间(4%); Ⅴ.附于降主动脉内侧缘与LPA后壁之间(2%); Ⅵ.附于主动脉弓下缘与LPA前壁之间（2%）。（3）LRLN在主动脉弓下缘由左迷走神经发出者占36%;在主动脉弓前壁下1/3、中1/3和上1/3段发出者分别占30%、14%和14%;在降主动脉内侧缘发出者占6%。（4）AL中轴与LPA中轴的夹角平均为（45.08±19.06）°,其中6%(3例)夹角仅为0°,4%(2例)夹角为90°。（5）所有LRLN均贴近动脉韧带主动脉端由左迷走神经发出并向后上方返折。  结论　AL的附着关系与经典描述之间存在差异。由于附着关系的不同,使其与LPA、LRLN等周围解剖结构的毗邻关系亦发生了改变。熟悉这些变化,对防止动脉导管结扎术并发症的发生有指导意义。     

动脉导管闭合机理探讨与临床

对３０具幼尸动脉导管（索）与主动脉弓（左下）夹角（θ），以及动脉导管（索）上端（Ａ）至左第四肋骨体后端下缘水平面与主动脉内缘交点（Ｂ）的距离（ＡＢ）进行解剖测量。结果θ值男性大于女性；（ＡＢ）平均值为６．１±３．５ｍｍ。作者认为动脉导管能否闭合，决定于θ值大小，θ越大，动脉导管越易闭合；反之，θ越小，动脉管越难闭合，当θ小到一定值时，导致动脉导管不闭合。文中讨论了θ及（ＡＢ）的临床意义。     

动脉导管的体表定位

动脉导管未闭是先天性心血管病的一种。但是动脉导管的表面定位尚未见介绍。动脉韧带是动脉导管的遗迹,它标志着动脉导管的位置。我们对100具成年尸体(男65,女35)的动脉韧带进行了表面定位的研究分析,目的为胸外科学提供应用解剖学资料。 定位方法:以胸骨角至第4胸椎下缘的假     

动脉导管溶栓治疗急性肢体动脉栓塞14例分析

目的 探讨动脉导管溶栓治疗急性肢体动脉栓塞的方法和疗效。方法回顾性分析14例肢体动脉栓塞的诊断方法和介入手术治疗方案。结果治愈11例，治愈率78．6％(11／14)；2例好转。无患肢缺血坏死或截肢，无术后因肾功能衰竭死亡。结论动脉导管溶栓是治疗急性肢体动脉栓塞有效的方法，值得进一步开展和探索。     

Anatomical conundrum: Unusual position of the aortic arch

At autopsy on a 72-year-old woman, the aortic arch showed an unusual arrangement, passing behind the trachea and esophagus and descending on the left side. The heart was normal, and death was due to unrelated causes. The nature of this anomaly is considered in respect of embryological development. Clin. Anat. 11:278–281, 1998. © 1998 Wiley-Liss, Inc.     

Unusual origin and course of the left pulmonary artery.

An infant with a cardiac murmur was found to have a patent arterial duct and an anomalous left pulmonary artery. The duct was surgically ligated at the age of 8 months, and she remained free of cardiac or respiratory symptoms up to her death at 6 years from an unrelated intestinal condition. An anomaly was discovered at post mortem examination; the left pulmonary artery arose from the right pulmonary artery and passed behind the trachea to enter the left lung. We describe and illustrate the anatomic features of this well-recognized entity, discuss the embryological substrate, and refer to the clinical implications.     

The diagnosis of the cause of the death of Venerina

Venerina (little Venus) is the name given to a wax model representing a pregnant young woman that was created in Florence (Italy) by Clemente Susini (1754–1814) in 1782. It is currently located in the historic Science Museum of the University of Bologna. The model was constructed so as to enable removal of the thoracic and abdominal walls and various organs, exposing the heart, diaphragm and an opened uterus with a well‐developed fetus. The woman is small, about 145 cm (4′ 9′) tall and of delicate build; she looks like a teenage girl. We know that Clemente Susini worked directly with the cadaver and copied the anatomical preparation exactly. This artist often represented the true structure using a wax mould; the existence of two other versions of this specimen suggests that this model was made in this way. Therefore, Venerina’s body may be a faithful representation of a young woman who died while pregnant. Observation of the body confirms that the organs are normal, except for the heart and great vessels. The walls of both ventricles are of equal thickness and the ventricles themselves of approximately equal size. The arch of the aorta and the enlarged pulmonary trunk are connected by a short duct about 3.5 mm in diameter. If this structure represents an open arterial duct, we can deduce that the two ventricles worked under the same conditions of blood pressure, hence their equal wall thickness. If the young woman died from this congenital disease, the cause of death has been diagnosed on a wax model of her body after more than two centuries.     

Analysis of the arterial supply of the extrahepatic bile ducts and its clinical significance

The purpose of this study is to describe the arterial supply of the entire extrahepatic bile duct system. The cross‐sectional area of all arteries that supply the ducts is measured under an operating microscope in 50 adult cadavers injected with red latex through the aorta. The extrahepatic bile duct system is divided into four topographic portions: cystic duct and gallbladder, right and left hepatic ducts, bile (common) duct and including its supra‐retroduodenal parts, and the pancreatic and intraduodenal portions. The arterial supply to each portion is carefully detailed. The ducts are supplied by more than seven arteries, of which the major arteries are the cystic artery, posterior superior pancreaticoduodenal artery, right hepatic artery, and retroportal artery. Collectively they provide 94.5% of the blood supply to the ducts. Arteries form three types of anastomotic patterns on the walls of the ducts, suggesting that ductal incisions can be made in ways that least disturb the blood supply. The patterns are: a network, a longitudinal anastomotic chain, and an arterial circle. These data emphasize the importance of the arterial supply in biliary surgery and especially the treatment of hemobilia. Clin. Anat. 12:245–249, 1999. © 1999 Wiley‐Liss, Inc.     

Experimental model of autotransplantation of the deferent duct on an arterio-venous pedicle

Adequate circulation in the transplanted autologous deferent duct can be restored by anastomosing the testicular artery and vein in the transplanted organ with the inferior epigastric vessels on the donor side of the intervention. An obligatory condition to preparation of the graft to transplantation is the presence of the epididymis; under its capsule the arterial and venous arches of the testicle, anastomoses of the terminal portions of the epididymal main vessels (the testicular basin) with the terminal portions of the deferent duct, are located. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 144, No. 10, pp. 476–480, October, 2007     

Extravasal occlusion of large vessels with titanic clips: efficiency,indications, and contraindications

The mechanism of extravasal occlusion of blood vessels with titanic clips "Atrauclip" and "Ligaclip extra" was studied in order to reveal indications and contraindications to their use. Occlusion with the clips of both types was ineffective in vessels with a diameter of >7.0 mm. Arteritis or the presence of an intravascular occlusion facility in the vessel were also the contraindications for clip occlusion. In overcases the procedure of occlusion with titanic clips was efficient and atraumatic.     

肝管的测量及其临床意义

在90具成人尸体上,测量了肝左管,肝右管及肝总管的长度,直径和有关的角度.肝左管平均长7.5mm,直径7.6mm,与肝总管形成的角度为34.9°;肝右管长9.6mm,直径6.2mm,与肝总管形成的角度为50.2°.结果表明肝左管粗、短而直,肝右管细,长而倾斜.肝管这种解剖形态学上的差异,似与临床上常见华枝睾吸虫病肝左叶肿大较多及肝左管结石较多有关。