右下肺静脉及其属支分布与汇合模式分型的多层螺旋CT影像解剖学研究

目的 探讨右下肺静脉(RLL)属支的多层螺旋CT血管造影(MSCTA)影像解剖学分布特征、汇合模式分型及其临床应用价值。方法 采用回顾性横断面研究方法。自2017年3月—2018年7月泰山医学院附属医院行MSCTA检查的病例中,筛选肺静脉及属支显示优良者100例,其中男54例、女46例,年龄24～86(58.9±13.54)岁。将MSCTA原始图像传到后处理工作站,进行容积再现(VR)和多平面重组(MPR),观察右下肺静脉属支数目、分布特征及汇合方式,进而对其进行命名和分型。结果 右下肺静脉整体汇合方式分型有RLLⅠ型(2支型)、RLLⅡ型(3支型)、RLLⅢ型(4支型),分别占67%(67/100)、28%(28/100)、5%(5/100)。RLLⅠ型最常见,有2种汇合方式、5种分型;RLLⅡ型最复杂,有6种汇合方式、7种分型;RLLⅢ型最少见,有4种汇合方式、4种分型。少见的静脉引流模式中,异位中叶静脉(异位V4、异位V4+V5)和异位上叶静脉(异位V2)分别占7%(7/100)和4%(4/100)。上段静脉分为单干型和双干型,分别占88%(88/100)、12%(12/100)。内侧底段静脉(V7)为最细小的底段静脉,其汇入处无规律,共统计了10种汇入情况。前段静脉(V8)、外侧底段静脉(V9)、后底段静脉(V110)有二分支型、三分支型和四分支型3种型式,分别占95%(95/100)、4%(4/100)和1%(1/100)。结论 右下肺静脉属支引流及汇合模式复杂多变;手术前MSCTA可清晰显示肺静脉属支的分布规律,从而提高胸腔镜下解剖性肺段切除术的安全性。     

三维CT血管造影在右肺上叶静脉解剖中的应用

目的　应用多层螺旋CT血管造影（MSCTA）联合后处理容积重建（VR）技术显示右肺上叶静脉,对其解剖结构进行分类。 方法　95例患者行肺动静脉造影,应用VR技术显示右肺上叶静脉,研究其分支类型及引流静脉归类概况。 结果　（1）右肺上叶前静脉有多支,95例患者共268支,走形复杂,主要收集右肺上叶前段和尖段血液,有18例走形于右肺水平裂,收集右肺上叶前段和右肺中叶的血液;右肺中央静脉为1支,共95支,走形于右肺上叶前段和尖段支气管中间;右肺上叶后静脉较少出现,共14支,其中5支直接汇入左心房。（2）右肺上叶肺静脉分型中,“前+中央静脉”型最为常见,有81例（85.2 %）,“前+中+后静脉”型14例（14.8%）,单纯的“前静脉”型和“中央静脉”型本研究未发现。 结论　MSCTA联合后处理VR技术可以真实直观地显示右肺上叶静脉的分支形式。     

左肺上叶静脉解剖分型MSCT评价及临床应用

目的　应用多层螺旋CT（MSCT）对健康人左肺上叶肺静脉解剖及引流模式分型,为解剖性肺段切除术提供帮助。 方法　收集200例肺无异常胸部CT影像资料,通过容积重建（volume reconstruction,VR）获得静脉解剖及引流模式图,统计各静脉分型出现率;重建5 mm轴位最大密度投影（maximum density projection,MIP）图,辨识对应各分型。 结果 左肺上叶静脉根据共干情况不同可分为：V1+2型,V2+3型,及V1+2a V2+3bc型,其出现率分别为69%（138/200）、17.5%（35/200）、13.5%（27/200）。其特点为：V1+2为V1与V2共干,其各自发出属支相互无联系;V2+3型中V2与V3共干,V1与V2+3分别汇入左上肺静脉干;V1+2a V2+3bc型,此型主要是V2变异较大。左肺上叶舌段静脉V4、V5共干时,其属支各自无联系,V4存在与V3b共干的情况,并各自具有不同的引流特点。 结论 左肺上叶因舌段的存在,其静脉分型更为复杂,MSCT所得静脉解剖及引流模式图结合5 mm轴位MIP图可清楚显示肺静脉解剖分型,作为其解剖识别常规手段。     

右肺中叶肺静脉变异1例

<正>患者女,65岁,因发现右肺上叶磨玻璃样结节6月入院,入院后完善相关检查行胸腔镜下右肺楔形切除术,病理诊断微小浸润性腺癌,决定行胸腔镜下右肺上叶切除+淋巴结清扫术,术中发现右肺中叶肺静脉变异,右肺中叶肺静脉内外两支并未汇合成共干支注入上叶肺静脉主干,而是一支汇入上叶     

基于CT三维重建技术对肺部病变患侧肺段支气管解剖类型及变异情况的影像学观察

目的探讨基于CT三维重建影像的肺部病变患者病灶侧肺段支气管的解剖类型与变异情况。方法横断面研究。纳入2019年12月—2022年8月新疆医科大学第一附属医院胸外科行胸部薄层增强CT扫描的615例患者的影像资料, 其中男250例、女365例, 年龄38～70岁(中位年龄58岁)。615例患者中, 肺癌488例, 肺结核及肺部其他炎性病变127例。CT检查显示病变部位:右肺359例, 其中右肺上叶205例、中叶43例、下叶111例;左肺256例, 其中左肺上叶184例、下叶72例。根据患者CT扫描数据重建患侧肺支气管和血管, 观察统计患侧各肺段支气管的解剖类型及解剖变异情况。结果 (1)右肺359例:a)右肺上叶支气管解剖类型分为3种类型, 两分支型105例(29.2%)、三分支型233例(64.9%)、四分支型11例(3.1%);三分支型中的B1, B2, B3亚型215例(59.9%)是右肺上叶支气管最常见的解剖类型。此外, 观察到10例(2.8%)少见解剖变异。b)右肺中叶支气管解剖类型分为3种类型, 两分支型343例(95.5%)、三分支型15例(4.2%)、四分支型1例(0.3%...     

心脏解剖中左肺静脉共干变异1例

随着医疗技术的不断发展和对肺静脉相关疾病的逐渐认识,充分了解肺静脉的正常解剖关系及变异显得越发重要。通常人类有4根肺静脉从心脏后部汇入左心房,即左上、左下肺静脉和右上、右下肺静脉[1]。人类肺静脉的解剖形态、结构存     

心包内处理肺静脉根部或切除部分左房在晚期肺癌手术中的应用

目的:探讨切开心包处理肺静脉或切除部分左心房对提高晚期肺癌患者的外科手术切除率及提高手术疗效的作用.方法:对21例晚期肺癌患者施行肺叶或全肺切除时,在心包内处理肺静脉或切除部分左心房.其中左肺下叶切除6例、左全肺切除4例、右肺中下叶切除6例、右肺下叶切除3例、右全肺切除2例.结果:21例均手术顺利;术后并发心律失常2例,肺炎2例,均治愈.本组1年生存率61.9%(13/21)、3年生存率38.1%(8/21),其中2例生存＞5 a.结论:晚期肺癌累及肺静脉根部或左心房时,通过切开心包处理肺静脉或同时切除部分左心房可提高肿瘤的根治率.     

左肺静脉变异一例

正笔者在解剖1例老年男性标本时,发现其左肺上、下静脉在肺门处共干及其属支变异。该变异类型较为罕见,国内未见报道,为了丰富国人解剖学资料和临床应用提供形态学依据,现报道如下。该例左肺标本,在肺门处可观察到肺静脉干、肺动脉、左主支气管的管口及尖后段静脉,其中,尖后段静脉走形比较特殊,沿肺动脉与左主支气管前面由前外至后下垂直汇入肺静脉干(图1)。进一步解剖可观察到尖后段静脉主干较细长,长度为33.94 mm,汇入时外径为5.50 mm,并     

肺段和亚肺段支气管和血管的冠状断层解剖学研究

目的研究肺段和亚肺段支气管、肺动脉和肺静脉在冠状断面上的配布规律。方法利用加例胸部连续冠状断层标本和4例成人胸部多层螺旋CT图像,追踪观察肺段和亚肺段支气管、肺动脉和肺静脉。结果在冠状断面上有6个识别肺段和亚肺段支气管和血管的关键层面：1．升主动脉层面,切及尖段静脉、后段静脉、外侧段静脉、尖后段静脉、前段静脉和上舌段静脉;2．肺动脉权层面,于肺动脉权或左肺动脉下方可见到左、右上肺静脉注入左心房,在ll例（55％）标本中出现尖后段静脉、前段静脉和舌静脉干同时汇入左上肺静脉的情形;3．气管权层面,于气管权下方可见到左、右下肺静脉汇入左心房;4．中间支气管层面,可见到两肺下叶肺段支气管、肺动脉和肺静脉的起源;5．胸主动脉层面,主要为两肺上段和外后底段的支气管和血管;6．脊柱层面,两肺下叶主要表现为上段、外侧底段和后底段的支气管和血管。结论在胸部冠状断面上,以支气管分支为向导可准确辨认肺段和亚肺段的肺动脉和肺静脉。     

肺静脉解剖变异的多层螺旋CT研究

目的 应用多层螺旋CT描述肺静脉的解剖变异并分型,为房颤射频消融术和心胸外科手术提供解剖依据。方法 回顾性分析250例应用MSCT行冠状动脉CTA检查的患者,通过多平面重建（MPR）、最大密度成像（MIP）和容积重建（VR）观察肺静脉解剖结构,对其分型并统计出现频率。结果共同静脉出现率38.8%,副肺静脉出现率14.8%,均无性别差异。左心房-肺静脉连接方式可分4型：标准型最常见,有130例（52%）;共干型83例（33.2%）,是最常见的变异类型;副静脉型23例（9.2%）;混合型14例（5.6%）,最少见。两侧肺静脉引流模式的变异率为54%,右侧26.8%,左侧42%,均无性别差异。结论肺静脉具有较大变异性,MSCT可详细显示肺静脉,是研究其解剖结构的有效手段。     

Anatomical study of partial anomalous pulmonary venous return with special references to the bronchial vein: supplementary report

After the authors' previous report an additional case of partial anomalous pulmonary venous return was encountered during dissection practice for medical students. In an 87-year-old Japanese male cadaver, the anomalous vein from the right upper lobe drained into the superior vena cava at a point just below the entrance of the azygos vein. This case is similar to the first case in the authors' previous report, but the anomalous vein was recognized before dissection of the lung began. Therefore, findings were more precisely observed. The anomalous pulmonary vein was 16 mm in diameter and had three branches, which drained the regions of the apex, the anterior segment and a part of the posterior segment of the right upper lobe. The other veins from the right lung gathered into two pulmonary veins, measuring 21 mm and 18 mm in diameter, respectively, and returned to the left atrium as usual. It is noteworthy that the anomalous vein received the bronchial vein from the right upper lobe bronchus. The azygos vein also received the bronchial veins from the lower part of the trachea and from the right middle and lower lobe bronchi. The theory that the bronchial vein plays an important role in the occurrence of the anomalous pulmonary drainage is further supported by this finding.     

Anatomical variations of pulmonary venous drainage in Thai people: multidetector CT study

Objective:

To evaluate the patterns of pulmonary venous drainage into the left atrium and to determine the frequency of each variant of pulmonary venous anatomy.

Materials and methods:

After institutional review board approval (No. 09JUL011148), 300 studies of thoracic multidetector computed tomography were retrospectively reviewed for the anatomical features of the pulmonary vein and its drainage pattern into the left atrium. The percentage of each pattern was calculated.

Results:

The anatomy of pulmonary venous drainage in 300 patients (150 male and 150 female, mean age 60.16 years) showed some variation. In the right pulmonary vein, the most common drainage pattern was two ostia (90.33%), followed by three to five ostia (6.33%) and a single ostium (3.33%). There were one or two separate middle lobe vein ostia in groups of more than two openings. On the left side, there were two patterns; a single venous ostium (59%) was much more common than two ostia (41%). In both right and left pulmonary veins, there were five cases (2 male, 3 female) that had a single pulmonary venous ostium, bilaterally. However, there were only 17 cases (5.67%), out of 300 enrolled in this study, that had bilateral pulmonary venous ostial variations.

Conclusion:

A classification system to succinctly describe pulmonary venous drainage patterns was developed. In left-sided drainage, a single left pulmonary ostium was the most common variation. The right-sided venous drainage varied more in both number and pattern than those of the left side; nevertheless, bilateral pulmonary venous ostial variation was not frequently found.     

Three patterns of extra-testicular venous drainage in the rabbit. Divergence from a traditional concept

Summary Seventy-eight male New Zealand white rabbits were autopsied and found to have variable left extra-testicular venous anatomy. Our observations reveal that in the rabbit the left testis is drained in one of three ways, identified as either A (18%), B (30%) or C (52%) —type drainage. The right testicular vein in all cases drained directly into the inferior vena cava immediately superior to the right iliolumbar vein.In type A drainage, the left testicular vein drained directly into the inferior vena cava at the level of the left iliolumbar vein. In type B drainage, the left testicular vein emptied into the left iliolumbar vein, which in turn drained into the inferior vena cava. In type C drainage both the left testicular and iliolumbar veins anastomosed to form a lumbotesticular trunk which emptied directly into the left renal vein.These three patterns of left venous vascular anatomy in the rabbit can be explained on the basis of their embryologic development. Our observations suggest that it is the caudal segment of the left pelvic subcardinal vein and its anastomosis with the caudal cardinal complex which persist as the left testicular vein and that the more cranial segment of this vein, heretofore presumed to remain patent, atrophies to the level of the developing left renal vein.     

A case of anomalous bronchial artery ramified from coronary artery

There have been no anatomical reports on the origin of the bronchial artery derived from the coronary artery. In a 2006 cadaveric dissection course, an anomalous bronchial artery that reached the middle lobe of the right lung from the left coronary artery was observed in an 88-year-old Japanese man. In this specimen, the circumflex branch of the left coronary artery passed under the left auricle in the coronary sulcus and bifurcated to three branches (left marginal branch, posterior left ventricular branch, atrial branch), which were 3.2–3.4 mm in diameter. The atrial branch intersected on the surface of the great cardiac vein, ran along the oblique vein of the left atrium, and reached the atrial side of the transverse pericardial sinus, and then divided into two branches. One of them led to the right atrium. The other branch passed between two right superior pulmonary veins, which derived from superior and middle lobes of the right lung, respectively, through the hilum of the lung along the right superior pulmonary vein derived from the middle lobe, and finally became the bronchial artery in the middle lobe of the right lung. In the middle lobe, the bronchial artery divided into a thin branch along the pulmonary vein for the lateral segment, ran along the surface of the right middle bronchus, and then reached the medial segment, being wedged between the segmental bronchus and vein.     

An anatomical study of the human cardiac veins with special reference to the drainage of the great cardiac vein

Many case reports in which the main aim was to clarify the development of the superior vena cava (SVC) with persistent SVC have so far been published. However, there have only been a few systematic studies of the cardiac veins. Therefore, we macroscopically investigated the cardiac veins using 337 human adult hearts to obtain a detailed understanding of the morphology of the heart.

From our study, we obtained the following results.

1. The frequency of persistent left SVC including one case of bilateral SVC was observed to be higher 7 cases (2.1%) than in previous reports.

2. We observed a second case in which the great cardiac vein drained directly into the right SVC (the first case being reported by Bergman et al. 1988).

3. Variations in the drainage of the great cardiac vein (GV) were observed from the right SVC to the left SVC, while the middle cardiac vein (MV) showed less variations of the drainage and course.

4. The drainage boundary between the GV and MV was classified into 3 types: MV-dominant type in 123 cases (36.5%), intermediate type in 182 cases (54.0%), and GV-dominant type in 32 cases (9.5%).

From our results, we speculated that the MV did not generate any variations due to its short course before draining into the right atrium, while the GV had many variations due to its long course before draining into the right atrium. From the few GV-dominant types, the halfway boundary between the anterior (GV) and posterior (MV) route for drainage into the right atrium could be considered to be the anterior side rather than the Apex cordis.     

肺静脉畸形

对２５例肺静脉畸形进行分析，其中肺静脉发育不良或闭锁４例，肺静脉共同腔闭锁２例，部分性肺静脉异位引流４例和１５例完全性肺静异位引流。２５例１２例为弧立性畸形，１３例为合并性畸形，如合并单心室畸形、右心室发育不良、室缺或左房双腔等。     

An anatomical classification of the variations of the inferior phrenic vein

The majority of anatomical textbooks of gross anatomy offer very little information concerning the anatomy and distribution of the inferior phrenic vein (IPV). However, in the last decade, an increasing number of reports have arisen, with reference to the endoscopic embolization of esophageal and paraesophageal varices, as well as venous drainage of hepatocellular carcinomas (HCC). The IPV is one of the major sources of collateral venous drainage in portal hypertension and HCC. The aim of this study was to identify the origin and distribution of the IPVs (right and left), both in normal and (selective) pathological cases. We have examined 300 formalin-fixed adult cadavers, without any visible gastrointestinal disease, and 30 cadavers derived from patients with HCC. The right IPV drained into the following: the inferior vena cava (IVC) inferior to the diaphragm in 90%, the right hepatic vein in 8%, and the IVC superior to the diaphragm in 2%. The left IPV drained into the following: the IVC inferior to the diaphragm in 37%, the left suprarenal vein in 25%, the left renal vein in 15%, the left hepatic vein in 14%, and both the IVC and the left adrenal vein in 1% of the specimens. The IPVs possessed four notable tributaries: anterior, esophageal, lateral and medial. The right IPV served as one of the major extrahepatic draining veins for all 30 cases of HCC. These findings could have potential clinical implications in the transcatheter embolization of esophageal and paraesophageal varices, as well as in mobilizing the supradiaphragmatic segment of IVC.     

Persistent left hepatic venous connection with the right atrium and the ductus venosus

An anomalous left hepatic vein opening independently of the coronary sinus into the right atrium was found in the cadaver of an 88-year-old Japanese man. This vein originated from the left lobe of the liver, perforated the diaphragm at the left side of the vena caval foramen and opened into the right atrium. The left hepatic vein anastomosed mutually with the middle hepatic vein at the level of venule. The ligamentum venosum originated from the left branch of the portal vein and was connected directly to the left hepatic vein. The development of the central systemic venous system and a possible explanation for the morphogenesis of this anomaly were reviewed. As a result, the occurrence of this anomalous vein was explained as being due to the persistence of the left vitelline connection with the left sinus horn and the ductus venosus.