左肺肺段和亚肺段支气管和血管的矢状断层解剖学研究

目的研究左肺肺段和亚肺段支气管和血管在矢状断面上的配布特点及左肺肺段在矢状断面上的划分。方法利用15例胸部连续矢状断层标本、2例多层螺旋CT图像，追踪观察左肺肺叶、肺段和亚肺段支气管、肺动脉和肺静脉，并据此寻找在矢状断面上划分肺段的方法。结果左侧肺段内的支气管和血管主要分布于从左主支气管权至心尖左侧的4个矢状断层里：1．在左主支气管权层面上，左肺下叶支气管向后发出上段支气管，其下方，上段静脉与底段总静脉在此合成左下肺静脉。2．在左肺动脉叶间部层面上，尖后段静脉、前段静脉和舌静脉干于左肺上叶支气管前方合成左上肺静脉，下叶基底干支气管发出内前底段支气管、外侧底段支气管和后底段支气管。3．在心尖层面上，左肺上叶支气管发出全部肺段支气管，可用尖后段静脉后段间支、前段静脉下支和舌静脉干区分相邻肺段，左肺下叶动脉分出的肺段动脉居相应支气管上方。4．在心尖左侧层面上，在左肺上叶内，从后上至前下依次可见尖后段静脉后段间支、前段静脉下支和上、下舌段静脉；在左肺下叶内，肺段支气管居中，上方为相应动脉，下方为相应静脉。结论在矢状断面上，肺段内支气管和血管相对集中，且容易显示其起源和长轴，故矢状断面是显示肺段和亚肺段支气管及血管的优势断面。

SEGMENTAL AND SUBSEGMENTAL BRONCHOVASCULAR ANATOMY OF LEFT LUNG ON THE SAGITTAL SECTION

Objective To explore the anatomic characteristics of segmental and subsegmental bronchi, arteries and veins of left lung on the sagittal section and the division of left pulmonary segments on the sagittal section. Methods Using serial sagittal sections of thorax of 15 adult cadavers and multislice spiral CT images of 2 healthy volunteers, the segmental and subsegmental bronchi, arteries, and veins of left lung were traced and observed. It was studied how to divide the left pulmonary segments on the sagittal section. Results The bronchi and blood vessels in left pulmonary segments are mostly distributed on the 4 sagittal sections from the bifurcation of left principal bronchus to left side of cardiac apex.1.On the section through the bifurcation of left principal bronchus, left inferior lobar bronchus sends out superior segmental bronchus backward. Blow it, superior segmental vein and common basal vein are forming left inferior pulmonary vein.2.On the section through the interlobar part of left pulmonary artery, apicoposterior segmental vein, anterior segmental vein and lingular venous trunk form left superior pulmonary vein anterior to left superior lobar bronchus. Basal trunk bronchus of inferior lobe sends out medioanterior, lateral and posterior basal segmental bronchi.3. On the section through cardiac apex, left superior lobar bronchus sends out all segmental bronchi, posterior intersegmental ramus of apicoposterior segmental vein, inferior ramus of anterior segmental vein, and lingular venous trunk can be used to divide adjacent pulmonary segments. The segmental arteries originating from left inferior lobar artery lie superior to the corresponding bronchi.4. On the section through the left side of cardiac apex, intersegmental ramus of apicoposterior segmental vein, inferior ramus of anterior segmental vein and superior, inferior lingular segmental veins are lined successively from posterosuperior to anteroinferior sides in the superior lobe of left lung. In the inferior lobe of left lung, segmental bronchi lie in center. The corresponding arteries lie superior to segmental bronchi. The corresponding veins lie inferior to segmental bronchi.Conclusions On the sagittal sections, the bronchi and blood vessels in pulmonary segments are intensive relatively, at the same time their origin and long axis easily show. So the sagittal section is the advantaged section displaying segmental and subsegmental bronchi and blood vessels of left lung.;