颈部临床应用解剖研究及图集制作

发布时间：2018-01-22 20:13

本文关键词： 临床应用解剖颈部淋巴结清扫　出处：《山西医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的探讨颈部临床应用解剖当中将宏观与微观相结合、临床与基础相结合的可行性,完整、充分、明晰地显示颈部的层次及相关解剖结构,并对常见的手术解剖标志进行测量,为制作系统的颈部临床应用解剖图谱提供素材,为临床教学及颈部疾病的影像诊断、手术定位提供参考。方法由郑州卫教实验用品研制中心提供10具20侧常规固定成人头颈部标本,其中5例动脉罐注红色乳胶。同一标本双侧错层由浅入深按层次解剖标本,初始保留原始筋膜,然后去除筋膜显露相关解剖结构,重点显示进行甲状腺、喉及颈淋巴结清扫术时需解剖或注意的解剖结构,并对手术中部分重要的解剖标志进行测量,使用尼康数码单镜反光相机D80及AF-S微距尼克尔60mm f/2.8G ED镜头多角度多参数采集图片；运用photoshop等软件处理标注图片。结果1.左右对比,依次显示了皮肤、浅筋膜、颈深筋膜浅、中、深三层筋膜及各层间疏松结缔组织形成的颈部间隙,及颈部的肌肉、神经、血管和喉、气管、食管等器官。从不同视角清晰显示了进行甲状腺、喉及颈淋巴结清扫术时需解剖或注意的解剖结构及标志,如颈丛、副神经的走行、颈鞘的内容、喉返神经、颈横动脉、颈总动脉分支行程、分布以及与周围毗邻结构关系。在获得大量实物照片的基础上,经过后期的图像加工处理、标注,形成了比较完整的颈部解剖图集。 2.副神经在出胸锁乳突肌之前的行程基本为斜向后下的直线方向,其在胸锁乳突肌后缘穿出点位于耳大神经穿出点上方(1.154±0.41)cm；甲状腺上动脉与喉上神经伴行,甲状腺下动脉与喉返神经相交叉。喉上动脉入喉处在甲状软骨上角的前下方左侧(14.231±2.45)mm,喉上神经喉内支入喉处在甲状软骨上角前下方左侧(11.95±3.32)mm。喉返神经与颈部食管及颈动脉鞘的位置关系复杂。喉返神经在甲状腺峡平面分支的最为常见；神经位于动脉主干之后的为多见,占54.00%；神经位于动脉前及动脉分支之间的例数相近。结论常规固定动脉乳胶灌注的头颈标本便于解剖、显露相关结构,通过保留颈部各层次的筋膜并拍照,可以系统、完整地显露颈部的层次及结构,形成的系列图谱能够更好地指导手术。通过颈部特殊部位的精细解剖及特定角度的摄影,较好地传达了作者宏观与微观相结合、临床与基础相结合的图示信息。
[Abstract]:Objective to explore the feasibility of combining macroscopic and microcosmic, clinical and basic anatomy in clinical applied anatomy of the neck, and to show the level and related anatomical structure of the neck in a complete, sufficient and clear manner. The common surgical anatomical markers were measured to provide materials for making anatomic atlas of cervical clinical application, and to provide reference for clinical teaching, imaging diagnosis and surgical location of cervical diseases. Methods Ten adult head and neck specimens with 20 sides of routine fixation were provided by Zhengzhou Medical Education Experimental equipment Development Center, of which 5 cases were injected with red latex in arterial canister, and the same specimen was dissected from the superficial to the depth of the bilateral dislocation layer. Initial preservation of the original fascia, then removal of fascia to reveal the related anatomical structure, focusing on the thyroid, larynx and neck lymph node dissection or pay attention to the anatomy of the dissection. Some important anatomic markers were measured. Using Nikon Digital single Mirror Reflector (D80) and AF-S Microdistance Nickel 60mm f / 2.8G Ed lens to capture images with multiple angles and parameters; Use photoshop and other software to process tagged pictures. Results 1.The left and right contrast showed skin, superficial fascia, superficial cervical fascia, middle and deep three layers of fascia and the cervical space formed by loose connective tissue, and the muscles, nerves, blood vessels and larynx of the neck. 2. Trachea, esophagus and other organs. From different perspectives clearly showed the thyroid, larynx and neck lymph node dissection or pay attention to the anatomical structure and signs, such as the cervical plexus, the passage of the accessory nerve, the contents of the cervical sheath. Recurrent laryngeal nerve, transverse carotid artery, common carotid artery branch stroke, distribution and adjacent structure relationship. On the basis of obtaining a large number of physical photos, the image processing and labeling were done in the later stage. A complete atlas of cervical anatomy was formed. 2. The distance of the accessory nerve before exiting the sternocleidomastoid muscle was basically a straight line direction which was oblique to the posterior direction, and the perforating point of the posterior edge of the sternocleidomastoid muscle was 1.154 卤0.41cm above the exiting point of the great auricular nerve. The superior thyroid artery was accompanied by the superior laryngeal nerve, and the inferior thyroid artery crossed with the recurrent laryngeal nerve. The superior laryngeal artery entered the larynx at 14.231 卤2.45 mm. Superior laryngeal nerve, internal laryngeal branch, larynx, anterior and inferior superior angle of thyroid cartilage, left side, 11.95 卤3.32). The relationship between recurrent laryngeal nerve and the position of cervical esophagus and carotid sheath is complex. The most common branch of recurrent laryngeal nerve is in the thyroid isthmus plane. The nerve located after the main artery was more common (54.00%). The number of nerves located in the anterior artery and between the branches of the artery was similar. Conclusion the head and neck specimens infused with conventional fixed arterial latex can be dissected easily and exposed to related structures. By preserving the fascia at all levels of the neck and taking pictures, the layers and structures of the neck can be revealed systematically and completely. Through the fine anatomy of the special part of the neck and the photography of the specific angle, the graphic information of the author's combination of macro and micro, clinical and basic is well conveyed.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322

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