冠状动脉的解剖学观察

发布时间：2018-04-20 03:13

本文选题：射频消融术 + 冠状动脉　；参考：《大连医科大学》2009年硕士论文

【摘要】： 研究背景及目的:国内外许多学者从基础医学到临床医学等不同角度对冠状动脉做了大量研究。目前,导管射频消融术(radiofrequencycatheter ablation,RFCA)成为越来越多的心律失常的标准治疗方法,但其对冠状动脉的影响,尤其是引起心绞痛甚至心肌梗死的发生,已引起临床医师的高度重视,因此,就迫切要求从应用解剖学的角度对冠状动脉做全新了解。方法:用大体解剖学方法将40例教学尸体心脏取出,细致剥离心脏冠状动脉周围的软组织,充分暴露左、右冠状动脉根部及各分支的全貌,记录并归纳冠状动脉的开口位置、分支类型、副冠状动脉存在比例。结果: 1.左、右冠状动脉在主动脉窦的开口部位,以窦内占多数,分别为87.5%和92.5%。若将主动脉窦分为左、中、右三等分,则左、右冠状动脉开口于中1/3者多见,分别为62.5%和70%。 2.左冠状动脉外径比右冠状动脉外径的平均值大。成人左、右冠状动脉外径平均值分别为5.1±1.4mm和3.8±2.1mm。 3.观察了左冠状动脉及其分支和分布。其对角支出现率为40%,前降支和旋支形成角度以90°±10°多见。 4.观察了右冠状动脉及其分支和分布。右冠状动脉的分支在心脏膈面多终止在房室交点和左缘间,占62.5%。其后降支多终止在后纵沟下1/3部位,占52.5%。 5.冠状动脉以右优势型居大多数,其次是均衡型和左优势型,分别60%、35%和5%。 6.副冠状动脉的出现率为47.5%,19例副冠状动脉中,1支者17例,2支者2例,全部发自右主动脉窦,主要分布于肺动脉圆锥(61.9%)及主动脉壁(33.3%)。分布于肺动脉圆锥的副冠状动脉外径平均值为1.4±0.1mm。分布于主动脉壁的副冠状动脉外径平均值为0.6±0.1mm。结论: 1.左右冠状动脉均是以开口于主动脉窦内中1/3者占绝大多数。 2.左冠状动脉外径比右冠状动脉外径的平均值大。 3.观察了左冠状动脉及其分支和分布。 4.观察了右冠状动脉及其分支和分布。 5.冠状动脉以右优势型居大多数。 6.副冠状动脉的出现率为47.5%。 7.建议: (1)消融前应常规行冠状动脉造影以明确冠状动脉开口与消融靶点之间的距离、冠脉分支的走行以及是否存在副冠状动脉。 (2)为减少热损伤,应力求定位准确,接触固定,减少放电时间及次数,从而减少射频消融对冠脉的急性损伤。 (3)可采用低能量、温控、多次消融,也可用盐水灌注导管消融以减少对冠脉的损伤。 (4)在射频消融手术操作过程中避免动作粗糙、误入冠脉造成对冠脉的直接损伤。
[Abstract]:Research background and purpose: many scholars at home and abroad have done a lot of research on coronary artery from different angles of basic medicine to clinical medicine. At present, radiofrequencycatheter ablation (RFCA) has become the standard treatment of more and more arrhythmia, but its effect on coronary artery, especially angina pectoris Even the occurrence of myocardial infarction has attracted the attention of clinicians. Therefore, it is urgent to make a brand-new understanding of coronary artery from the perspective of applied anatomy.
Methods: 40 cases of cadaver heart were removed by gross anatomy. The soft tissues around the coronary artery were carefully stripped and the whole appearance of the left and right coronary roots and the branches were fully exposed. The location of the coronary artery, the type of branch, and the proportion of the accessory coronary arteries were recorded and summed up.
Result:
1. left, right coronary artery in the opening part of the aortic sinus, the majority of the sinus, 87.5% and 92.5%., respectively, if the aortic sinus is divided into the left, middle, right three, then the left, right coronary artery opening in the middle 1/3 are more common, 62.5% and 70%., respectively.
2. the mean diameter of the left coronary artery is larger than that of the right coronary artery. The mean diameter of the left and right coronary arteries in adults is 5.1 + 1.4mm and 3.8 + 2.1mm. respectively.
3. the left coronary artery and its branches and distribution were observed. The incidence of diagonal branches was 40%, and the angle of anterior descending branch and circumflex branch was 90 degrees or 10 degrees.
4. the right coronary artery and its branch and distribution were observed. The branch of the right coronary artery stopped at the atrioventricular intersection and left margin in the heart diaphragm, and the descending branch of 62.5%. ended in the 1/3 part of the posterior longitudinal sulcus, accounting for 52.5%..
5. the majority of the coronary arteries were dominated by right dominance, followed by balanced and left dominant types, 60%, 35% and 5%. respectively.
The incidence of 6. accessory coronary arteries was 47.5%, 19 of the accessory coronary arteries, 17 in 1 and 2 in 2, all from the right aortic sinus, mainly in the conus (61.9%) and the aortic wall (33.3%). The mean value of the outer diameter of the accessory coronary artery distributed in the conus was 1.4 + 0.1mm., the average of the accessory coronary artery diameter of the aortic wall. The value is 0.6 + 0.1mm.
Conclusion:
About 1. of the coronary arteries were mostly 1/3 with the opening of the aortic sinus.
2. the mean diameter of the left coronary artery is larger than that of the right coronary artery.
3. the left coronary artery and its branches and distribution were observed.
4. the right coronary artery and its branches and distribution were observed.
5. the majority of the coronary arteries were in the right dominant type.
The incidence of 6. accessory coronary arteries was 47.5%.
7. suggestions:
(1) before ablation, a routine coronary angiography should be performed to determine the distance between the coronary artery opening and the ablation target, the operation of the branch of the coronary artery and the presence of the accessory coronary artery.
(2) in order to reduce thermal injury, we should strive for accurate positioning, contact fixation, reduction of discharge time and frequency, thereby reducing the acute injury of radiofrequency ablation to the coronary artery.
(3) low energy, temperature control, multiple ablation, and saline perfusion catheter ablation can be used to reduce the damage to the coronary artery.
(4) during radiofrequency ablation operation, it is necessary to avoid rough operation and direct injury to the coronary artery.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R322

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