头静脉与贵要静脉伴行汇合注入腋静脉1例

在供学生局部解剖的40具成人尸体中,发现单侧头静脉与贵要静脉汇合注入腋静脉的变异,此种变异罕见,现报告如下.     

头静脉汇入腋静脉或锁骨下静脉夹角对经头静脉入路PICC置管术的影响

目的　探讨头静脉汇入腋静脉或锁骨下静脉夹角对经头静脉入路上肢外周静脉穿刺中心静脉置管（peripherally inserted central catheters，PICC）操作的影响。 方法　解剖38具（76侧）捐献者遗体，测量和分析上肢外展0 °和90 °时男、女两侧头静脉汇入腋静脉或锁骨下静脉的夹角。 结果　头静脉汇入腋静脉或锁骨下静脉的前外侧壁，汇入处管径平均为（7.27±2.94）mm，95%可信区间为6.51~8.03 mm，夹角有锐角、直角和钝角3种类型。上肢外展0 °时，夹角平均为（47.14±27.02）°，95%可信区间为40.97°~63.32°；上肢外展90°时，夹角平均为（63.88±24.26）°，大于上肢外展0°时夹角，95%可信区间为53.96°~65.64°。上肢外展0°时，男、女夹角无明显差异，而上肢外展90°时男性夹角大于女性夹角。上肢外展0°和90°时，左、右侧夹角均无明显差异。 结论　经头静脉入路PICC术时，男、女两侧头静脉汇入腋静脉或锁骨下静脉的夹角不影响导管通过，但有少部分人夹角接近或大于90°，尤其男性上肢外展90°可能增加导管通过夹角的难度，操作中需加以注意。     

Applied anatomy on reconstructions of the portal vein and renal vein using the femoral vein

目的:探讨股静脉作为血管移植材料替代门静脉和肾静脉的可行性与安全性.方法:解剖观察60具成年人尸体(男32具,女28具)的114侧下肢的股静脉、腘静脉、股深静脉及交通支,以及门静脉主干和左、右肾静脉.测量股深静脉汇入股静脉点至收肌腱裂孔下缘的股静脉段长度和压扁外径,即股静脉可切取的解剖长度,以及门静脉主干,左、右肾静脉的长度及压扁外径.结果:男性股静脉可切取的解剖长度为18.8 cm±2.3cm,压扁外径15.8 mm±0.8mm;女性股静脉可切取的解剖长度为15.1 cm±1.5 cm,压扁外径14.0mm±1.1 mm;股静脉可切取的长度与性别和身高之间存在相关关系,男、女股静脉压扁外径比较差异有统计学意义.14.0％肢体存在双股静脉的变异现象;42.1％肢体存在一支外径较粗(＞2 mm)的股-腘静脉侧支;33.3％肢体存在一支外径较粗(＞2 mm)的股深腘静脉交通支;仅17.5％肢体不伴有股-腘静脉侧支和股深-腘静脉交通支.门静脉主干长度和压扁外径分别为6.8cm±0.8cm,19.2 mm±0.8 mm;左肾静脉长度和压扁外径分别为6.5 cm±0.6 cm,20.4 mm±0.6 mm;右肾静脉长度和压扁外径分别为2.8 cm±0.5cm,17.4 mm±0.7mm.门静脉主干及左、右肾静脉的长度和压扁外径不存在性别差异.结论:大隐静脉和股-腘静脉侧支或股深-腘静脉交通支的存在,保证了切取股静脉作为血管移植材料是可靠的、安全的;可切取的股静脉能够满足门静脉、肾静脉重建的长度及口径要求.     

头静脉注入颈内静脉1例

<正>作者在局部解剖学尸体解剖过程中发现1例成年男尸左侧头静脉注入颈内静脉,这种变异非常少见,为了积累解剖学资料,现报道如下。本例标本身长178 cm。左上肢头静脉起自手背静脉网桡侧,在"鼻烟窝"区内形成,沿前臂桡侧上行,于距腕横纹8.5cm处转行至前臂前面继续上行。在肘窝注入肘正中静脉,于     

Facial vein terminating in the external jugular vein An embryologic interpretation

The external jugular v. (EJV) is increasingly being used for therapeutic procedures and monitoring by clinicians. In view of this clinical relevance, dissection was done on the head and neck regions in 40 adult cadavers of Indian origin to detect variations of the EJV. Though several patterns of tributaries were found, a facial v. (FV) of considerable size was observed coursing obliguely to join the EJV in the neck in four cases (5%). The distance of the junction of the FV and the EJV from the angle of the mandible ranged between 55 and 104 mm. This may represent a persistent communication of the primitive linguofacial v. with the secondarily developing EJV. This anastomotic channel is present for some time in the fetus but later undergoes retrogression. Its persistence in some individuals results in this variation.     

An additional renal vein

A routine cadaveric dissection in an adult male revealed the emergence of two renal veins at the hilum of the right kidney that presented two separate openings in the inferior vena cava (IVC), one above the other. At the hilum the segmental branches of the right renal artery were sandwiched between the two veins. An additional venous tributary was present posterior to the right renal pelvis. A single renal vein emerged at the hilum of the left kidney. The various tributaries observed on the right and left sides were measured. The possible developmental basis for this variation suggests the persistence of the embryonic pattern observed in the 22 mm embryo.     

The great cardiac vein

Summary The great cardiac vein is the longest venous vessel of the heart; in the majority of our cases it originated at the lower third of the anterior interventricular sulcus (58%). The great and the middle cardiac veins merge at the apex of the heart, forming together with the coronary sinus into which they both empty, a complete venous ring around the left ventricle (13%). On reaching the area of the coronary sulcus, the great cardiac vein crosses the anterior interventricular branch and the circumflex branch of the left coronary artery forming the triangle of Brocq and Mouchet in which the vein is mainly superficial (61%). One, two or three anterior ventricular branches of the left coronary artery traverse this triangle; the relations of the vein and these arteries are very variable and practically unpredictable in 30% of the cases.

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La grande veine du cur

Résumé La grande v. du cur est le plus long vaisseau du cur. Dans la majorité des cas que nous avons étudié, elle prend son origine au tiers inférieur du sillon inter-ventriculaire antérieur (58%). Les grandes et moyennes v. du cur confluent au sommet du cur réalisant, avec le sinus coronaire dans lequel elles se drainent, un anneau veineux complet autour du ventricule gauche (13%). Pour atteindre le haut du sillon coronaire, la grande v. du cur croise la branche inter-ventriculaire antérieure et la branche circonflexe de l'a. coronaire gauche délimitant ainsi le triangle de Brocq et Mouchet où la veine est le plus souvent superficielle. Ce triangle est traversé par une, deux ou trois branches ventriculaires antérieures de l'a. coronaire gauche. Les relations de cette veine avec ces artères sont très variables et en fait imprévisibles dans 30 % des cas.

     

Pulmonary vein myxoid leiomyosarcoma

A case of myxoid leiomyosarcoma located in the right pulmonary veins is presented. The patient complained of progressive dyspnea, orthopnea, sputum cruentum and right chest pain. Angiography revealed an obliteration of right pulmonary veins by a tumor mass that expanded into the left atrium. Histologically, the lesion contained densely packed fusiform cell areas that alternated with other much less cellular and richer in interstitial myxoid matrix. The tumor cells showed specific immunoreactivity to desmin antibodies and contained abundant thin filaments with focal densities and micropinocytic vesicles.     

Left renal vein variations

Summary The highly complex embryological development of the left renal vein compared to its right counterpart results in greater variations which are clinically significant. The study aimed to identify these variations and to document its incidence. Cadaveric study: 153 kidney pairs were harvested en bloc, dissected, 100 resin casts prepared and 53 plastinated; renal venography performed on further 58 adults and 20 foetal cadavers. Clinical study: (retrospective analysis): a) radiological study, 104 renal venograms; b) live related renal transplantation, 148 donor left kidneys; c) abdominal aortic aneurysm surgery, 525 patients. Total sample size: 1008. Renal collars observed in 0.3%; retro-aortic vein 0.5%; additional veins 0.4%; posterior primary tributary 23.2%, (16.7% Type IB; 6.5% Type IIB, cadaveric series, only). Our results differ significantly in incidence to that reported in the literature: renal collar 0.2–30%; retro-aortic vein 0.8–7.1%; additional renal vein 0.8–6%. Variations are clinically silent and remain unnoticed until discovered during venography, operation or autopsy. To a transplant surgeon, morphology acquires special significance, since variations influence technical feasibility of operation. Prior knowledge of circum-aortic vein is important when blood samples from suprarenal or renal veins are collected. Collar may provide developed collateral pathway immediately after surgery if renal interruption planned without awareness of its presence. Variations restrict availability of vein for mobilisation procedures. In aortic aneurysm repair, retro-aortic vein is important. During retroperitoneal surgery, the surgeon may visualise a pre-aortic vein but be unaware of an additional retroaortic component or a posterior primary tributary, and may avulse it while mobilising the kidney or clamping the aorta.

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Variations de la veine rénale gauche

Résumé Du développement embryologique très complexe de la veine rénale gauche, comparé à son homologue droit, il résulte d'importantes variations, significatives du point de vue clinique. Le but de cette étude est d'identifier ces variations et de préciser leur fréquence. 1-Recherches cadavériques : (153 paires de reins ont été prélevées en bloc, disséquées) 100 moulages par résines et 53 plastinations. En outre, des phlébographies rénales post-mortem ont été réalisées, 58 chez des adultes, 20 chez des ftus. 2-Etudes cliniques (analyse rétrospective) : a) radiologiques : 104 veinogrammes rénaux, b) lors de transplantations rénales : 148 reins gauches de donneurs, c) au cours de la chirurgie de l'anévrysme de l'aorte thoracique : 525 patients. Soit, au total, 1008 reins. Le collier rénal a été observé dans 0,3 % de la série ; la v. rétro-aortique, 0,5 %, des vv. rénales supplémentaires : 0,4 % ; enfin, un collecteur rénal postérieur existait dans 23,2 % des séries cadavériques (16,7 % du type IB de notre classification et 6,5 % du type II B). Nos résultats diffèrent de façon significative par leur faible fréquence de celle relatée dans la littérature : collier rénal (0,2–30 %), veine rétro-aortique (0,8–7,1 %), veine rénale supplémentaire (0.8–6%). Les variations sont silencieuses cliniquement et demeurent méconnues jusqu'à leur découverte par phlébographie, opération ou autopsie. Pour le chirurgien transplanteur, la morphologie a une signification particulière puisque les variations déterminent la faisabilité technique ou non de l'opération. La connaissance préalable de la veine circum-aortique est importante lors du prélèvement d'échantillons sanguins des veines surrénaliennes ou rénales. Le collier rénal peut favoriser la formation d'un réseau collatéral dense immédiatement après l'opération, si l'interruption de la veine rénale est pratiquée sans connaissance de ce dispositif. Les variations restreignent l'utilisation de la veine dans les techniques de mobilisation. Lors de la cure d'un anévrysme aortique, l'existence d'une veine rétro-aortique est importante à connaitre. Lors d'une intervention rétro-péritonéale, le chirurgien repère la veine pré-aortique, mais il méconnait une branche rétro-aortique supplémentaire, ou un tronc primaire postérieur qu'il peut léser en mobilisant le rein ou en clampant l'aorte.

     

Great cardiac vein variations

A novel variation in the relationship of the great cardiac vein to the circumflex artery was observed in an otherwise normal cadaver heart. Vessels originated and terminated normally, but in their midcourse they were twisted around each other such that each made one complete loop around the other. This variation did not seem to be involved in any pathologies. Variations in the course of the great cardiac vein have been little studied until recently, but their simplicity emphasizes the uniqueness of our intertwined case. Commonly, the great cardiac vein varies with respect to presence, location, and the superficial or deep relationship of single crossings of the anterior interventricular and circumflex arteries. Although rare, the intertwined variation described in the present case may have important basic science implications for understanding mechanisms of vasculo-angiogenesis, and clinical implications for catheter-based procedures and surgeries in the region of the coronary sulcus. Also, a review of great cardiac vein variations is presented herein.