双侧头臂静脉变异一例

<正>在解剖一具成年男性镜面人标本时,发现其左、右两侧头臂静脉变异较大,左头臂静脉缺如,右头臂静脉直接汇入左心房。为积累解剖学数据,现报道如下。本例标本上腔静脉及奇静脉与正常解解剖标本分布相反,均位于左侧胸腔。上腔静脉(外径30.90 mm)在正中线左侧29.48 mm处,自右心房起始至左颈内静脉与左锁骨下静脉分支处长度为81.84 mm。奇静脉(外径25.56mm)位于正中线位置。左、右两侧头臂静脉与正常解剖标     

非典型奇静脉系的解剖学研究及临床意义

目的观察奇静脉系的形态特征,对非典型奇静脉系进行解剖学分类,为纵隔、胸腔大血管疾患的诊治提供参考依据。方法解剖30具人体标本,分别测量奇静脉、半奇静脉、副半奇静脉起点及终点的直径,观察其终点与胸椎序数的对应关系。结果经典型奇静脉系24例,即该系具有完整的奇静脉、半奇静脉、副半奇静脉。非典型奇静脉系6例,根据其形态进一步分为:a型2例,即倒"Y"字型奇静脉系,奇静脉由左、右腰升静脉及下4位肋间静脉在脊柱前方合成;b型2例,即单柱型奇静脉系,半奇、副半奇静脉发育缺如,仅有1条奇静脉在脊柱前方上行;c型1例,即半奇静脉缺如,副半奇静脉注入左头臂静脉;d型1例,即奇静脉伴双上腔静脉变异。奇静脉终点直径(10.39±1.98)mm,主要平对T_4(83.3%);半奇静脉终点直径(8.51±2.28)mm,主要位于T_7~T_(10)水平;副半奇静脉终点直径(6.29±1.56)mm,位于T_4~T_8水平。结论对非典型奇静脉系的研究,是对该系既往分型的补充,不仅为临床检查过程中识别该系变异提供参考,也为纵隔手术、纵隔镜检查、胸椎外伤的诊治等提供数据支持。     

奇静脉系变异1例

笔者在教学标本制作中,发现1例中年男性尸体(身长165.0cm)标本的奇静脉系变异,此类变异极为罕见,为积累国人解剖学资料,现报道如下. 此例标本左侧第1、2、3肋间静脉,共同汇入副半奇静脉,其主干长7.50 cm,管径4.50 mm,沿脊柱左侧上行,于第2胸椎体水平处向右呈65.50°直接汇入左头臂静脉干.左侧第4、5肋间静脉,管径分别为1.50、1.65 mm,汇成一支,于第5胸椎体水平处向右呈88.50°夹角汇入奇静脉.左侧第6、7肋间静脉,外径分别为1.30、1.25 mm,于第6胸椎体水平处向右呈分别以86.50°、90.00°汇入奇静脉.     

右锁骨下动脉起始及奇静脉系位置变异一例

笔者在解剖一具成年男性尸体标本的颈胸部时,发现头臂干缺失,右锁骨下动脉起自胸主动脉起始处,同时伴有右侧喉返神经缺如,以及"奇静脉"位于脊柱左侧,并注入左头臂静脉等变异,现报道如下.     

主动脉弓后左头臂静脉形态学资料及手术前诊断

主动脉弓后左头臂静脉是一种罕见的解剖结构,正常情况下左头臂静脉由左颈内静脉和左锁骨下静脉于左上方汇合而成后,从主动脉上面经左锁骨下动脉、左颈总动脉,头臂干前面斜向右下汇于上腔静脉;而主动脉弓后左头臂静脉从主动脉弓后于奇静脉入口下方汇入上腔静脉。尽管这种畸形对患者无病理生理方面的影响,但它能使手术人员把它与其它大血管,     

左位奇静脉合并胸导管变异一例

我们在解剖一具成年女性尸体标本时,发现左位奇静脉、左位胸导管变异1例(图1),现报道如下. 解剖后纵隔时,从下往上,于第9～4胸椎(T9～T4)左侧发现异常左位奇静脉.奇静脉在右膈脚处起自右腰升静脉,上段同正常奇静脉,沿食管后方和胸主动脉右侧上行,于T9处,在脊柱前方转向左侧,走行于脊柱胸段左侧,胸主动脉右前方,距前正中线左侧1.5cm.注入左头臂静脉.     

左头臂静脉位于升主动脉后方一例*

正笔者在局部解剖的过程中发现左头臂静脉位于升主动脉后方变异标本1例,老年男性标本(身高161 cm)的左头臂静脉于主动脉弓下方行于升主动脉后方注入上腔静脉。解剖过程与测量参数报道如下。开胸后发现,双肺癌变,脏胸膜与胸壁粘连,心大小测量数值为,右缘95.80 mm,下缘134.90 mm,左缘150.76mm。进一步解剖发现,左头臂静脉与右头臂静脉之间有一交通静脉。上腔静脉长65.50 mm,上腔静脉管径19.80mm,左头臂静脉汇入上腔静脉处距右锁骨中线距离46.56mm。右头臂静脉长58.65mm,左头臂静脉长107.28mm,左头臂静脉汇入上腔静脉处管径12.08mm,左、右头臂静脉间右一交通静脉位于主动脉弓前上方走行,距离左头臂静脉末端17.48 mm汇入右头臂静脉。交通静脉长     

双下腔静脉与奇静脉系的变异一例报告

1 材料为1成年男尸.2 奇静脉 单支型.由左、右腰升静脉在第12胸椎前汇合而成.沿脊柱前方正中线的左侧上行,至第4胸椎平面弯向右前,汇入上腔静脉.左侧第1～4肋间静脉汇成一干,于第4胸椎高度注入奇静脉左侧壁;第5～11肋间后静脉和肋下静脉分别注入奇静脉左侧壁.右侧第1～3肋间后静脉亦汇成一干,注入奇静脉弓右侧壁;第4～11肋间后静脉和助下静脉各自注入奇静脉右侧壁.半奇静脉及副半奇静脉缺如.奇静脉起始端管径0.60cm:平第4胸椎管径0.85cm;奇静脉弓末端管径1.05cm.     

CT诊断左头臂静脉变异1例

1临床资料 男,72岁.因发热,咳嗽查胸部CT. 由图可见:左侧头臂静脉在升主动脉后方注入上腔静脉. 上腔静脉变异并不多见, 主要见于左头臂静脉注入部位的变异和其行程的变异, 注入部位的变异有左头臂静脉注入左心房的变异, 行程的变异有主动脉弓后左头臂静脉的变异[1], 此外还有左头臂静脉与冠状窦异常交通的变异等,目前国内关于头臂静脉变异的报道并不多见, 但头臂静脉的变异对胸外科手术, 尤其是心脏手术具有重要的参考价值,故应引起临床医师的重视[2].     

奇静脉合并胸导管异常一例

1 女尸,约75岁,该例奇静脉由右侧第11肋间后静脉和右腰升静脉在右交感干外侧汇合而成,而后斜过T_(11)前面达脊柱左缘,继在右肋间后动脉的前方沿脊柱左侧上升达T_4高度,然后水平横过T_4前方达右肺根上方,旋即向前注入上腔静脉后壁.下半奇静脉在左胸交感干的右侧起自第11肋间后静脉,先垂直上升至第10胸椎间盘高度,收集左第10肋间后静脉,继斜向右上行至T_9高度注入奇静脉.中半奇静脉在距左胸交感干左侧约2.25mm处起自第9肋间后静脉,垂直上行至T_8高度,收集左第8肋间后静脉,再向右横行注入奇静脉.上半奇静脉起自第6肋间后静脉,垂直上行至T_5高度再折转向右横行注入奇静脉;左第5和第4肋间后静脉分别注入上半奇静脉垂直部和横行部.左第7肋间后静脉直接注入奇静脉.左第1～3肋间后静脉在交感干外侧汇集成最上肋间静脉,后者注入左颈内静脉根部.右侧第5～10肋间后静脉均直接注入奇静脉垂直部右壁;右侧第4肋间后静脉经奇静脉后方注入其左壁;第1、2肋间后静脉汇合后再与第3肋间后静脉汇合成干在T_4左缘注入奇静脉弓上壁.左腰升静脉在T_(12)高度注入椎外静脉丛.2 胸导管由左右两干各起自不同部位.左干起自T_(12)前方的乳糜池;右干由肠干和右腰干在L_1前方汇合而成.     

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。     

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.     

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.     

Phlebectasia of the external jugular vein associated with duplication of the internal jugular vein

The most common cause of a neck mass that increases in size on the Valsalva maneuver is laryngocele. Jugular phlebectasia is a congenital dilation of the jugular vein, which is extremely rare in adults, may present similarly. Duplication of the internal jugular vein (IJV), which is usually encountered coincidentally, is another rare anatomic variation. Isolated cases or cases associated with IJV ectasia have been reported. We report on an adult patient with coexisting external jugular phlebectasia and internal jugular duplication on the same side.     

Leiomyosarcoma of the pulmonary vein

A case of a 74-year-old man with leiomyosarcoma of the pulmonary vein is reported. The patient felt transient chest oppression while playing golf 1 week before he visited a clinic with a common cold. He underwent an ultrasonographic examination of the heart, which showed a mass lesion in the left atrium. The preoperative clinical diagnosis was myxoma of the left atrium. Cardiac surgery revealed the mass to be a leiomyosarcoma, probably extending from the left inferior pulmonary vein. The patient underwent a left lower lobectomy of the lung, and the tumor was confirmed to have originated from the wall of the left inferior pulmonary vein. Although the patient had a metastatic lesion in the right axillary lymph node 11 months later, which was excised, he remained free of disease 14 months after the initial operation. Histologically, the tumors were composed of pleomorphic cells with bizarre nuclei and spindle cells with blunt-ended nuclei with 1-4 mitotic figures in 10 high power fields. Immunohistologically, the tumor cells were positive for alpha-smooth muscle actin and desmin. We reviewed 17 cases of leiomyosarcoma of the pulmonary vein (six males and 11 females with a mean age of 50 years in each group). The present case was the oldest in age and to our knowledge was the first reported case with metastasis in a distant lymph node.