岛叶动脉的显微解剖及临床意义

目的观察岛叶动脉的显微结构特点。方法 12例（24侧）国人成人头颅湿标本,半侧开颅显露半球,显微镜下解剖外侧裂及岛叶区,对岛叶动脉及M2段进行观察。结果岛叶血供均来自大脑中动脉的M2段,M2段起于膝部,终于环岛沟反折处;主分叉位于膝部17侧、膝部前2侧、膝部后5侧;以上、下干起始15侧,上、中间、下干7侧,单干1侧,四分叉1侧。M2段以2干起始15侧;最外侧豆纹动脉距岛尖部的距离≤20 mm。结论大脑中动脉M2段各分支发出的岛叶动脉供应岛叶,M2段的主分叉主要位于膝部、以上下干起始居多。     

犬左乳内动脉Y桥重建冠脉血运后血流量变化

测定犬心脏静息与负荷状态下左乳内动脉(LIMA)、左乳内动脉Y桥(LIMA-Y桥)、冠状动脉(简称冠脉,CA)及应用LIMA-Y桥进行冠脉血运重建后CA平均流量,评估LIMA-Y桥的血流量储备.结果显示,静息状态时,犬CA血流量为(101.6±8.5)ml/min,LIMA-Y桥重建CA后为(110.5±12.3)ml/min,两者相比,P>0.05;负荷状态时,犬CA血流量为(372.4±22.1)ml/min,LIMA-Y桥重建CA后为(189.5±21.5)ml/min,两者相比,P<0.05.认为用LIMA-Y桥行CA重建能满足犬心脏静息状态时的心肌供血,负荷状态时则不足.     

枕动脉-小脑下后动脉吻合术治疗颅内段椎动脉梭形动脉瘤四例

对部分椎动脉瘤,尤其是累及小脑下后动脉（poslerior Inferior cerebellar artery,PICA）的梭形夹层动脉瘤,因无法夹闭动脉瘤的同时,保证小脑下后动脉通畅,需要行枕动脉-PICA吻合术。因发病率低,手术困难,治疗风险大,文献报道较少^[1]。     

脐动脉预作为桥血管移植材料的生理解剖研究

目的:从脐动脉生理解剖方面探讨脐动脉作为冠状动脉血管移植材料的可行性。方法:采用血管超声检测35例孕龄约37~40周的胎儿在体脐动脉的内径;血管物理性能检测观察血管的顺应性及耐压性能;观察液压扩张技术对脐动脉解剖结构的影响。结果:在体脐动脉的内径为(3.47±0.36)mm,血流流速为(54.64±8.36)cm/s。血管物理性能检测发现脐动脉有良好的顺应性,而且具有良好的耐压性能(爆破压>300 mmHg)(1 mmHg=0.133 kPa)。由于脐动脉肌层发达,有自闭趋向,遂采用液压扩张技术增大脐动脉口径,使血管失去回缩作用;而且该实验发现液压扩张不引起血管解剖结构的明显损伤。结论:1.脐动脉从生理解剖方面具备作为冠状动脉搭桥血管材料的基本条件;2.液压扩张可增大脐动脉口径,预防痉挛发生,且不引起血管结构的明显损伤。     

颞叶桥静脉的显微解剖及其临床意义

颞叶表面的桥静脉在经岩骨入路术中极易损伤 ,应注意保护。对颞叶桥静脉可依据桥静脉引流的区域和桥静脉终点所在的部位进行分组。颞叶桥静脉的形态分为单支型、烛台型、多干型和静脉湖型。经岩骨入路术中除注意保护Labb啨静脉外 ,还应对天幕窦和岩嵴组桥静脉加以保护。     

枕下海绵窦的显微外科解剖和临床意义

枕下区域的椎动脉解剖复合体具有与海绵窦相似的解剖结构，又名枕下海绵窦。其显微外科解剖具有重要的临床意义     

肠系膜下动脉解剖分型在肠系膜下动脉结扎方式选择中的应用

目的探讨肠系膜下动脉（IMA）各种解剖分型及血管长度差异的相关因素,为结直肠癌低位结扎IMA提供参考。 方法前瞻性收集温州医科大学附属第一医院2019年7月至2020年4月因乙状结肠癌及直肠癌接受根治性手术治疗的患者的病例资料,术前使用增强CT对IMA进行重建,对IMA分型进行统计分析。并选取温州医科大学解剖教研室10具成人尸体,进行IMA解剖。 结果共纳入172例血管充盈可,重建效果佳的患者数据,纳入统计。按照Murono分型标准,其中Ⅰ型88例,Ⅱ型66例,Ⅲ型16例,Ⅳ型患者2例（不纳入后续统计分析）。170例患者中,IMA主干长（42.96±6.78）mm,体重是IMA主干长的主要影响因素（系数=0.253,P＜0.05）,IMA主干长度=23.12+0.253×体重（R²=0.181）。体重每增加一个单位（kg）,长度平均增加0.253个单位（mm）。 结论对IMA术前行增强CT可以了解IMA分型,有助于低位结扎位置的选择。可通过体重对IMA血管长度进行预估,从而选择最合适的血管处理方式。     

原位冠状静脉动脉化在常温冠状动脉搭桥术中的应用(附3例报告)

弥漫性冠状动脉病变一直是冠状动脉搭桥手术中很棘手的问题,以往的内膜剥脱术,或是心肌激光打孔均未能很好地解决。近年来,多数外科医生将注意力集中在原位冠状静脉动脉化上,希望借助心脏的静脉系统来改善心肌的血液供应。因为冠状动脉的主要分支都伴行有静脉,这些静脉的回流范围几乎和相应动脉的供血区域一致,而且心脏静脉没有静脉瓣,所以应用移植血管将动脉血导入这些静脉可以起到动脉搭桥的作用,我们在近期完成了3例,现报告如下。     

脑岛的临床显微解剖研究

目的研究脑岛的临床解剖,明确该区显微解剖特征,探讨脑岛部位手术治疗的特点及难点。方法选择成人尸脑40例,在显微镜下解剖双侧脑岛,直接测量其脑回的各个价值参数,根据脑图对脑岛的形态进行分类,观察脑岛与周围结构、大脑中动脉的关系。结果以脑岛短回分布将脑岛分为5回型（33/40）和7回型（7/40）。脑岛的血管分布与其脑回的类型相统一,行走于其脑沟内,形成覆盖脑岛皮质的动脉血管墙。结论脑岛部位的手术极具挑战性,大脑中动脉形成的动脉血管墙是该部位手术入路的最大障碍。     

3.0T流入反转恢复非增强磁共振血管成像评估副肾动脉解剖特征的可行性

目的：探讨3.0T流入反转恢复（inflow inversion relovery,IFIR）非增强磁共振血管成像（inagnetic resonance angiograph,MRA）显示副肾动脉解剖结构的可行性。方法：采用回顾性研究分析58例行3.0T IFIR MRA患者的检查资料,记录每侧副肾动脉的支数、直径及其入肾部位,比较副肾动脉解剖特点的差异。结果：58例患者中,副肾动脉发生率为30.6%(58/189);男性副肾动脉发现率>女性,差异有统计学意义（P<0.05）。副肾动脉有Ⅰ支型、Ⅱ支型及III支型,87.9%为Ⅰ支型;58例副肾动脉均发自腹主动脉,71.6%经肾门入肾,经肾门入肾的副肾动脉较不经肾门者直径粗（P<0.05）。副肾动脉的直径在性别及侧别的差异无统计学意义。结论：3.0T IFIR MRA对副肾动脉解剖结构的评估具有可行性。     

Hepatic artery system variations correlated to split-liver surgery: anatomic study in cadavers

BACKGROUND: The liver donor shortage and the higher demand on liver transplantation led to advanced liver surgery techniques in order to better utilization of the cadaveric liver donors. That is why the split-liver technique had been applicated in liver transplantation where the liver after been divided into two lobes would be implanted in two recipients. AIMS: This paper has the goal of study both the extra-hepatic arterial distribuition and anatomie of the liver with application on the split-liver transplantation separating the liver in right and left hepatic lobe. PATIENTS AND METHODS: The authors studied 60 livers from fresh cadaver looking at hepatic artery and its main anatomic variations correlating with split-liver surgery. The liver was split into two portions, right and left lobe. RESULTS: The total liver weight was 1536 +/- 361,8 g, right hepatic lobe 890,3 +/- 230,9 g and left hepatic lobe 649,3 +/- 172,6 g. Common hepatic trunk was found in one (1,6%) case and came from superior mesenteric artery and in another one (1,6%), both left hepatic artery and left gastric artery came from the abdominal aorta. The right hepatic artery raised from celiac trunk in 44 (73,3%) cases, and in 15 (25%) from superior mesenteric artery it was acessory in 11 (18,3%) cases and dominant in 4 (6,6%). The left hepatic artery was acessory of left gastric artery in 2 (3,3%) cases. Hepatic artery trifurcation was found in 9 (15%) cases out of this 6 (10%) to segment IV, 2 (3,3%) to segment III and 1 (1,6%) to segment II. Also we found 2 (3,3%) medium hepatic artery to segment IV. CONCLUSION: Hepatic artery variations allowed liver section into right and left hepatic lobe.     

Angiographic anatomy of the left Kugel's artery

The left Kugel's artery is an uncommon but sometimes important collateral between the proximal circumflex artery and whatever artery supplies the crux of the heart. It passes anterior to the mitral valve ring, coursing in the interatrial septum, to anastomose usually with the atrioventricular node artery. The left Kugel's artery was prospectively identified on coronary arteriograms in 3.6% of patients with significant disease in dominant circumflex or right coronary arteries with associated collateral circulation. It was occasionally as large as 1 mm in diameter. The angiographic anatomy of this vessel is described.     

Echocardiographic visualization of coronary artery anatomy in the adult

In the light of technologic advances and the development of new imaging planes, the feasibility of two-dimensional echocardiographic visualization of coronary artery anatomy was reevaluated in the adult. Thirty-five subjects were studied using an ultrasonograph equipped with a 3.5 and 5.0 MHz annular array transducer, digital processing and cine loop review. There were 18 normal subjects and 17 patients with heart disease, including 9 patients with valvular, 5 patients with coronary, 2 patients with congenital and 1 patient with cardiomyopathic disease. The mean age was 47 +/- 18 years (range 17 to 79). Modifications of standard parasternal and apical views permitted high quality images of portions of each of the major epicardial vessels adequate for assessment of luminal diameter. The left main coronary artery was seen in 30 (86%) of the 35 subjects and its bifurcation was seen in 15. The left anterior descending coronary artery was seen in 30 subjects (mean length 3.9 +/- 2.3 cm, maximal length 7.5), the left circumflex artery in 11 (1.1 +/- 1.0, maximal 3.0) and the right coronary artery in 32 (5.6 +/- 2.6, maximal 12). Proximal and mid portions of the left anterior descending artery were seen in 23 and 11 subjects, respectively. The average proximal length visualized was 4.2 cm, and the average luminal diameter visualized was 4.9 mm. The average length of the mid left anterior descending coronary artery seen was 1.9 cm and the average luminal diameter seen was 4.6 mm. The proximal right coronary artery was seen in 17 subjects (average visualized length 2.7 cm and average diameter 3.1 mm).(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical anatomy of the atrioventricular node artery

BACKGROUND AND AIM OF THE STUDY: The study aim was to describe the topographical relationship of the atrioventricular (AV) node artery and mitral valve annulus fibrosus with regard to AV node dysfunction following mitral valve replacement or ring annuloplasty. METHODS: The anatomy of the AV node artery was analyzed in 55 human hearts without previous pathological alterations. Selective coronary angiograms were performed to identify the AV node origin. Run-off of the AV node artery and its topographical relationship to the mitral valve attachment was analyzed in dry-dissected hearts. The position of the AV node was verified by histological sectioning. RESULTS: The AV node artery originated from the right coronary artery in 73% of examined cases, and from the left coronary artery in 27% of cases. The left AV node artery was closely related to the mitral valve attachment, especially at the area of the left proximal part of the posterior leaflet. CONCLUSION: These morphological data were compared to clinical reports emphasizing the postoperative incidence of AV block after mitral valve implantation and ring annuloplasty. The occurrence of early postoperative AV node block ranged from 20% to 37%. By comparing the present data with available literature, it can be stated that there is a high risk of intraoperative damage to the left AV node artery during manipulation of the mitral valve annulus fibrosus.     

Venous anatomy of the right colon: precise structure of the major veins and gastrocolic trunk in 58 cadavers

PURPOSE: This study was designed to describe the precise venous anatomy of the right colon, which is especially important for laparoscopic right hemicolectomy. METHODS: Fifty-eight adult cadavers were dissected to define the three major venous tributaries of the right colon: the ileocolic vein, right colic vein, and middle colic vein. Two or three middle colic veins were often present, and the biggest one was designated as the main middle colic vein. The middle colic vein and the right colic vein occasionally formed a common trunk with the right gastroepiploic vein and/or the pancreaticoduodenal vein. This common trunk was defined as the gastrocolic trunk. RESULTS: All 58 cadavers had a single ileocolic vein. All of the ileocolic veins drained into the superior mesenteric vein. The right colic vein was absent in 56.9 percent (33/58), and the other 43.1 percent had a single right colic vein. The right colic vein joined the superior mesenteric vein directly in 56 percent (14/25) and the gastrocolic trunk in 44 percent (11/25). The middle colic vein was the most variable. A single middle colic vein was present in 37.9 percent (22/58), 2 middle colic veins were present in 50 percent (29/58), and 3 middle colic veins were present in 12.1 percent (7/58). The main middle colic vein drained into the superior mesenteric vein directly in 84.5 percent (49/58), whereas 12.1 percent (7/58) drained into the gastrocolic trunk. In two cadavers, there was anomalous drainage of the main middle colic vein to the splenic vein and the inferior mesenteric vein. Forty-three accessory middle colic veins were present in total. These drained into the superior mesenteric vein in 17 cadavers and into the gastrocolic trunk in 23. The gastrocolic trunk was present in 69 percent (40/58), being formed with the right colic vein in 27.5 percent (11/40; 1 was together with an accessory middle colic vein) and with the middle colic vein in 75 percent (30/40; 7 with the main middle colic vein, 23 with the accessory middle colic vein). CONCLUSION: Venous anatomy of the right colon is highly variable. It is especially important to recognize the lack of direct drainage of the right colic vein to the superior mesenteric vein and the high frequency of the presence of plural middle colic veins and the gastrocolic trunk.     

Coronary artery anatomy in corrected transposition of the great arteries

Congenitally corrected transposition of the great arteries is an unusual cardiac malformation with discordant atrioventricular and ventriculoarterial alignments. Because knowledge of the coronary artery anatomy is a prerequisite for successful repair of this cardiac anomaly, selective coronary arteriography was performed in 13 children (4 male and 9 female; age range 18 months to 16 years) and 1 adult (aged 59 years) with congenitally corrected transposition of the great arteries and associated intracardiac defects. The typical coronary distribution of corrected transposition (that is, coronary artery-ventricular concordance) was found in 11 patients. In one patient, a single coronary ostium was observed; the right sinus of Valsalva gave rise to a short common branch that divided into three arteries: a left circumflex artery going to the right, a well developed left anterior descending artery running into the anterior interventricular groove and a third vessel that continued on the normal course of the right coronary artery directed posteriorly. In one patient, the left circumflex artery was particularly small. In another patient, with severe hypoplasia of the left anterior descending coronary artery, the anterior ventricular wall of the heart was supplied by three small branches that ended a short distance from their origins. The adult patient had a large anterior ventricular branch arising from the morphologic left coronary ventricular as well as a large acute marginal branch, with a wide distribution, from the morphologic right coronary artery. Presurgical coronary angiographic documentation is helpful because, in congenitally corrected transposition as well as in complex congenital heart disease, coronary anomalies (in origin, course and distribution) are occasionally present and knowledge of their presence can help determine the most appropriate surgical approach.     

Central pulmonary artery anatomy in right ventricular outflow tract obstructions

We reviewed the cine-angiograms of 190 patients with right ventricular outflow tract (RVOT) obstructions for size and anatomy of pulmonary arteries, patent ductus arteriosus (PDA) and major aorto pulmonary collateral arteries (MAPCAs). Patients were grouped into three, Tetralogy of Fallot (TOF) with pulmonary atresia (group 1, N=86), TOF with pulmonary stenosis (group 2, N=97) and 7 cases of pulmonary atresia with intact interventricular septum (group 3). Out of 86 patients in group 1, 49 had PDA alone, 30 had MAPCAs alone, six had both and one had none. In group 2, 31 patients had persistent PDA and one patient had MAPCAS and PDA. A discrete stenosis (DS) of pulmonary artery was seen significantly more in patients with RVOT obstructions associated with PDA compared to patients without PDA (67/84 vs. 5/96). Out of the 84 cases with ducti, 53 had stenosis of the pulmonary artery at the site of ductus insertion. Thus presence of PDA was an important factor in the development of DS. The likely cause of pulmonary artery stenosis in TOF with PDA may be the opposing flows through RVOT and PDA producing a watershed effect at the ductus-pulmonary artery junction. Diffuse hypoplasia of pulmonary arteries (DH) was seen more significantly in RVOT obstructions associated with MAPCAs, compared to other patient groups (19/36 vs. 14/87). These small pulmonary arteries had no discrete stenosis and this diffuse hypoplasia might be the result of inadequate blood flow during intrauterine life [Harikrishnan S, Tharakan J, Titus T, Bhat A, Sivasankaran S, Bimal F, Syam Sunder KR, James, KJ. Central pulmonary artery anatomy in right ventricular outflow tract obstructions. Indian Heart Journal 1997;49:624 (Abstract)[18]].