胸外侧动脉与胸长神经的关系及对乳房血液供应的解剖研究

发布时间：2018-10-10 13:20

【摘要】： 目的:研究胸外侧动脉走行的解剖特性,明确其与胸长神经的关系及供血对象,为相关临床科室治疗乳腺癌及丰胸等提供解剖学依据。实验方法:10具(20侧)10%甲醛固定的女性成人尸体标本。分别测量和观察胸外侧动脉、胸长神经的外径和全长,并用统计软件对测量数据进行处理,对重要部位进行拍照。实验结果:我们通过研究发现胸外侧动脉起点分散,可直接起自腋动脉第1-3段,也可与胸肩峰动脉、肩胛下动脉共干或由胸背动脉分出。胸外侧动脉主支向内向下进入乳腺实质,于小叶间走行进一步发出分支供应腺体,并向表面发出垂直分支穿出腺体供应乳房皮肤。胸长神经起自臂丛,在臂丛和腋动脉后方入腋窝,沿前锯肌表面下行,支配此肌。损伤此神经引起前锯肌瘫痪,可发生翼状肩胛。前锯肌是重要的胸上肢肌,位于胸壁的外侧面,前上部被胸大、小肌所覆盖,其肌腹逐渐增厚,各肌齿起始部分有明显间隙并为脂肪组织所填充,各肌腹沿腹外侧壁行至腋中线处相互呈叠瓦状并拢。胸部的浅筋膜包裹整个乳房,构成乳腺囊,乳腺囊伸入到各小叶之间形成小叶间隔,对乳腺组织和脂肪组织起支持作用。乳房内有丰富的血管分布,它们对乳房的营养和新陈代谢维持起着主要作用。乳房的动脉血供十分丰富,主要源于以下动脉:(1)胸廓内动脉的肋间穿支,穿过胸大肌深入到乳房内侧部分。(2)腋动脉发出的胸外侧动脉、胸最上动脉、胸肩峰动脉、胸背动脉主要供应乳腺外侧部。(3)源于胸主动脉的肋间动脉穿支,分布到乳房的深部和外侧1/4。结论:1、以胸长神经和胸外侧动脉为蒂的前锯肌肌瓣转移体有丰富的血供和神经支配,所以适宜作丰乳术及乳腺象限切除术后的填充物。 2、乳腺癌供血动脉灌注化疗是一种兼局部灌注优点的全身化疗方法。术前有针对性乳腺癌供血动脉灌注化疗,可使患者乳腺区肿块有不同程度缩小。 3、乳头乳晕主要靠来自于腺体深层的动脉供血。 4、胸长神经与胸外侧动脉可伴行,所以行乳癌根治术及行侧胸部小切口时,要注意保护,防止出现并发症。
[Abstract]:Objective: to study the anatomical characteristics of the lateral thoracic artery and to determine the relationship between the artery and the long thoracic nerve and to provide anatomic basis for the treatment of breast cancer and breast enlargement in clinical departments. Methods: 10 female adult cadavers (20 sides) were fixed with 10% formaldehyde. The external diameter and length of lateral thoracic artery and long thoracic nerve were measured and observed respectively. Results: we found that the starting point of the lateral thoracic artery was scattered directly from the 1-3 segments of the axillary artery, and could also be separated from the thoracic and acromitic artery, the subscapular artery or the thoracic dorsal artery. The main branch of the lateral thoracic artery enters the breast parenchyma downward and further issues branches between the lobules to supply the glands and the vertical branches to the surface to supply the skin. The long thoracic nerve originates from the brachial plexus and enters the armpit behind the brachial plexus and axillary artery. Injury of the nerve causes paralysis of the anterior serratus and the winglike scapula. The anterior serratus is an important muscle of the upper thoracic limb, which is located on the outer side of the chest wall. The anterior and upper part of the muscle is covered by the larger chest and the smaller muscle. The muscle abdomen is gradually thickened, and the initial part of each muscle has a clear gap and is filled with adipose tissue. The ventral muscles along the ventrolateral wall to the axillary midline were imbricate with each other. The superficial fascia of the chest encapsulates the whole breast and forms the mammary gland sac which extends into the interlobular space between the lobules and plays a supporting role in the breast tissue and adipose tissue. There is a rich distribution of blood vessels in the breast, they play a major role in the maintenance of breast nutrition and metabolism. The arterial blood supply of the breast is very abundant, mainly from the following arteries: (1) the intercostal perforating branch of the internal thoracic artery through the medial part of the breast, (2) the lateral thoracic artery from the axillary artery, the superior thoracic artery, the thoracic and acromitic artery, The thoracic dorsal artery mainly supplies the lateral part of the mammary gland. (3) the perforating branch of the intercostal artery originating from the thoracic aorta is distributed to the deep and lateral parts of the breast. Conclusion: 1. The transfer body of serratus anterior muscle flap pedicled with long thoracic nerve and lateral thoracic artery has abundant blood supply and nerve innervation. Therefore, it is suitable for breast augmentation surgery and breast quadrant resection. 2. Arterial infusion chemotherapy for breast cancer is a systemic chemotherapy with advantages of local perfusion. Preoperative arterial infusion chemotherapy for breast cancer, 3. Nipple areola mainly depends on arterial blood supply from deep gland. (4) the long thoracic nerve and the lateral thoracic artery can be accompanied, Therefore, breast cancer radical surgery and small lateral chest incision, should pay attention to protection, to prevent complications.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

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