喉部应用解剖及临床意义

发布时间：2018-05-13 17:47

本文选题：喉 + 喉上神经　；参考：《山西医科大学》2011年硕士论文

【摘要】：目的：对国人成人尸头喉部进行大体解剖和显微解剖研究,明确喉部主要解剖结构的位置、形态、毗邻关系及变异,并对手术相关的重要解剖标志进行测量,探讨各结构在喉部临床诸多手术中的解剖学意义,为喉切除、移植、修复、重建等手术提供显微解剖数据和形态学资料,并为制作一套完整、精细的喉部临床解剖学图谱提供素材。方法：模拟头颈部手术入路,解剖10%甲醛溶液常规固定的国人成人头颈标本34例68侧(其中红色乳胶灌注标本10例),按颈部解剖层次先进行喉外大体解剖,再用手术放大镜进行喉内显微解剖研究,观测喉部重要解剖结构及相关区域结构的位置、形态、毗邻关系及变异,同时用尼康数码单镜反光相机D80及AF-S微距尼克尔60mmf/2.8G ED镜头在专业的静物台上多角度、多参数采集图片。结果：1.甲状腺上动脉52%起自颈外动脉,44%起自颈动脉分叉处,4%起自颈总动脉。喉上动脉94%起自甲状腺上动脉；4.5%起自颈外动脉；1.5%起自面舌干动脉；入喉处距甲状软骨上角14.43±2.1mm；距舌骨下缘5.16±0.69mm,距甲状软骨上缘5.16±0.69mm；7.4%喉上动脉穿甲状软骨翼孔入喉。2.喉上动脉喉内分前上支、后上支、前中支、后中支、前下支、后下支,分布较恒定,吻合支多。3.喉上神经内支分前上支(分前支和上支)和后下支；后下支终末支与喉下神经后支吻合形成Galen's吻合支。4.喉上神经与颈交感干形成喉上神经袢：无袢形(21%),单袢形(78%),双袢形(1%)。5.甲状腺下动脉与喉返神经关系分：Ⅰ型神经在动脉及分支前方(13%)；Ⅱ型神经在动脉及分支后方(47%)；Ⅲ型神经在动脉分支间(18%)；Ⅳ型动脉在神经分支间(7%)；Ⅴ型神经、动脉分支相互夹持(15%)。6.喉下神经入喉处距甲状软骨下角尖5.32±0.77mm；距环甲关节水平距离3.71±0.58mm；内收肌支入肌点距甲状软骨下结节5.15±0.45mm,距环甲关节垂直距离7.57±0.45mm，距环甲关节水平距离9.98±0.70mm。7.会厌软骨形态分：平坦型(44%)；卷曲型(36%)；半卷曲型(20%)。8.变异发现：甲状颈干缺失1例；喉上动脉、面动脉、舌动脉共干1例；喉上神经外支穿甲状软骨翼孔入喉1例；喉上神经内支与喉下神经后支直接吻合3例。结论：1.喉部手术中,喉上动脉可在甲状软骨上角前下方14mm,舌骨下缘和甲状软骨上缘5mm处寻找并结扎,本研究有助于手术中喉上动脉定位和结扎。2.喉内动脉分支多,吻合支多,是喉重建、喉部分切除术成功的保证。3.环甲动脉可代替喉上动脉成为喉内主要滋养动脉,行甲状腺切除术和喉修复、重建、移植术时应注意。4.甲状腺上动脉、喉上动脉与喉上神经以及甲状腺下动脉与喉返神经的关系复杂多变。术中应将各结构暴露清楚,直视下结扎动脉,避免喉部神经的损伤。5.喉上神经内支可能含有运动神经纤维。6.甲状软骨下结节、环甲关节、环杓后肌外侧缘可作为解剖标志,定位喉下神经的甲杓肌支和环杓后肌支。7.喉部分切除术时,在杓会厌皱襞下缘5～10mm解剖并保留喉上神经内支的后下支,有助于保留声门后联合区、声门下区后部粘膜的感觉功能,提高患者术后生活质量。
[Abstract]:Objective: To study the gross anatomy and microanatomy of the adult cadaver head larynx of the Chinese adults, to clarify the position, morphology, adjacent relationship and variation of the main anatomical structures of the larynx, and to measure the important anatomical signs related to the operation, and to explore the anatomical significance of the various structures in the many surgical operations of the larynx, for laryngectomy, transplantation, repair and reconstruction. The operation provides microanatomical data and morphological data, and provides material for making a complete set of detailed laryngeal clinical anatomy atlas.
Methods: the head and neck surgical approach was simulated to dissected 34 cases of Chinese adult head and neck specimens of 10% Formaldehyde Solution routinely (10 cases of red latex perfusion). The gross anatomy of the larynx was first carried out at the anatomical level of the neck, and the microanatomy of the larynx was carried out by the surgical magnifying glass to observe the important anatomical structure and related regional structure of the larynx. The position, shape, adjacent relationship and variation, and the multi angle and multi parameter collection of pictures with Nikon digital single mirror reflector D80 and AF-S micro distance nicer 60mmf/2.8G ED lens on the professional static object platform.
Results 1. the superior thyroid artery was 52% from the external carotid artery, 44% from the cervical artery branch and 4% from the common carotid artery. The upper laryngeal artery was 94% from the superior thyroid artery; 4.5% from the external carotid artery; 1.5% self lingual dry artery; the larynx was 14.43 + 2.1mm from the upper angle of the thyroid cartilage; it was 5.16 + 0.69mm from the hyoid edge, 5.16 + 0.69 from the upper margin of the thyroid cartilage. Mm; 7.4% the upper branch of the upper larynx of the upper larynx was divided into the upper branch of the superior laryngeal artery and the upper branch of the larynx of the larynx, the posterior superior branch, the posterior middle branch, the posterior inferior branch, the posterior inferior branch, and the constant distribution of the superior branch of the superior branch of the larynx of the larynx (the anterior branch and the upper branch) and the posterior inferior branch of the superior branch of the larynx in the anastomosis branch, and the posterior inferior branch of the posterior inferior branch and the posterior branch of the inferior larynx formed a.4. anastomosis branch of the larynx and formed the.4. branch of the Galen's anastomosis to form.4..4.. The superior laryngeal nerve loop formed by the sympathetic trunk of the larynx and the neck: no loop (21%), single loop (78%), double loop (1%).5. inferior thyroid artery and recurrent laryngeal nerve: type I nerve in the anterior artery and branch (13%); type II nerve in the artery and the rear (47%); type III nerve in the artery (18%); type IV artery in the branch of nerve. 7%): type V nerve, artery branches holding (15%).6. sublaryngeal nerve into the larynx at 5.32 + 0.77mm from the inferior horns of the thyroid cartilage, 3.71 + 0.58mm from the horizontal distance to the ring nail, 5.15 + 0.45mm from the adductor to the inferior thyroid nodule, 7.57 + 0.45mm from the ring armour joint, and 9.98 + 0.70mm.7. epiglottis from the horizontal distance from the ring nail joint. Cartilage morphology: flat (44%); curly type (36%); semi curl type (20%).8. variation found in 1 cases of cervical trunk deletion; 1 cases of upper laryngeal artery, facial artery and tongue artery; 1 cases of superior laryngeal nerve external branch through thyroid cartilage wing hole into the larynx; 3 cases of superior laryngeal nerve and inferior laryngeal Sutra posterior branch of the larynx.
Conclusion: during the 1. larynx operation, the superior laryngeal artery can be found and ligation at the lower edge of the superior horn of the thyroid cartilage, the lower edge of the hyoid bone and the upper edge of the thyroid cartilage. This study is helpful to locate and ligate the upper laryngeal artery in the operation and to ligation of the.2. internal laryngeal artery branches, the anastomosis branch is more, the larynx reconstruction is a successful alternative to the laryngectomy instead of the larynx in the laryngectomy. The upper artery becomes the main trophoblastic artery in the larynx. In the operation of thyroidectomy and larynx repair, reconstruction and transplantation, the upper thyroid artery should be paid attention to.4.. The relationship between the superior laryngeal artery and the superior laryngeal nerve and the inferior thyroid artery and the recurrent laryngeal nerve is complicated and changeable. In the operation, the structures should be exposed clearly, and the ligation artery is directly under the operation to avoid the injury of the laryngeal nerve in.5.. The internal branch of the superior laryngeal nerve may contain a motor nerve fiber.6. subchondral nodule, and the ring nail joint and the lateral rim of the posterior CRICO can be used as an anatomical sign to locate the subarytenoid and posterior subarytenoid branches in the.7. larynx for the subdivision of the subarytenoid muscle and the posterior inferior branch of the superior branch of the laryngeal nerve at the lower edge of the aryepiglottic fold 5 to 10mm, which is helpful to retain the inferior laryngeal nerve. The sensory function of the posterior mucous membrane of the subglottic region improves the quality of life after operation.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322

【参考文献】