肾上腺三维断层解剖及其在影像诊断中的应用

发布时间：2018-05-13 18:00

本文选题：肾上腺 + 断层解剖学　；参考：《山东大学》2008年博士论文

【摘要】： 肾上腺位于腹膜后隙内,其病变种类繁多,临床表现复杂,故而是临床尤其是医学影像学和外科学研究的热点之一。但由于其位置深在,体积细小,形态各异且毗邻关系复杂,因此其影像学探测尚有一定地难度。近年来临床普遍开展的腹腔镜肾上腺切除术对肾上腺的毗邻关系,特别是和其周围大血管的关系又提出了更高的要求。早期有学者采用CT在横断层上研究了肾上腺的位置、大小和常见疾病的影像学表现,这些研究单纯采用影像学手段,没有断层标本的对照,由于受CT密度分辨力的影响,肾上腺的微小病变难以精确定位和显示。近年来随着多层螺旋CT及其图像后处理功能的快速发展以及MRI快速扫描序列的应用,影像学技术可在横、矢、冠和斜状断层上显示肾上腺的正常解剖和其病变。目前,肾上腺的横断层解剖研究较多,但这些研究方法多采用1例或几例断层标本,仅结合正常的CT或MRI图像,并且缺乏肾上腺微小病变图像的对照研究;本课题组曾对肾上腺的矢状断层解剖进行了初步探讨,只是单纯采用矢状断层标本,没有结合正常肾上腺图像及肾上腺典型微小病变图像对照研究;迄今为止,有关肾上腺的冠状断层解剖尚未见报道,而冠状断层解剖在同时显示双侧肾上腺方面有其独特的优势。用断层解剖方法研究肾上腺的位置、形态和毗邻关系,可充分保证肾上腺的在体方位,不仅便于和断层影像直接对照研究,更有利于泌尿外科确定肾上腺病变的准确位置,进而有利于各种肾上腺手术的实施。但这方面的研究使用的断层标本数量较少,并且仅限于横断层或矢状断层。多层螺旋CT及其三维重建技术的临床应用,可重建出肾上腺及其周围器官的三维图像,能充分显示在体方位的。肾上腺及其和周围结构的毗邻关系。近年来MRI快速扫描序列的应用,以及压脂技术,可清晰显示肾上腺及其周围结构的细微解剖,使肾上腺微小病变的精确定位成为可能。然而单纯地采用CT或MRI,由于部分容积效应的存在和密度分辨力的限制,其显示的肾上腺与标本上的真实结构之间尚存有差异,尚需将断层标本和CT及MRI图像结合起来探讨肾上腺的三维断层解剖。另外采用横、矢和冠状断层标本,并结合肾上腺微小病变的典型表现,来系统探讨正常肾上腺及其病变的影像学表现,这方面的研究报道较少。本课题使用上腹部横、矢、冠状断层标本,并结合多层螺旋CT(MSCT)图像和三维(3D)图像,MRI断层图像,以及肾上腺微小病变的CT和MRI图像,系统研究肾上腺的三维断层解剖特点和肾上腺微小病变的影像学表现,以期为肾上腺病变的影像诊断和外科治疗提供准确而实用的断层解剖学基础。本课题共分为5部分: 第一部分肾上腺横断层解剖及CT、MRI 目的为肾上腺病变的横断层影像诊断和外科治疗提供实用的断层解剖和影像诊断学依据。材料和方法使用20例成人上腹部连续横断层标本、10例健康成人MRI横断层图像及20例无肾上腺病变的临床病人MSCT横断层图像,连续追踪观测了肾上腺在横断面上的形态、位置、毗邻和大小。结果在连续横断面上,第一肝门层面往往是肾上腺首次出现的层面,左右肾血管出现层面是双侧肾上腺消失的层面。左、右肾上极出现层面是横断层上寻找双侧肾上腺的理想层面。经肝门下方的横断面上,右肾上腺位于下腔静脉后方、肝裸区和右膈脚围成的右肾上腺三角内,左肾上腺位于胃裸区、脾和左膈脚围成的左肾上腺三角内。经左肾上极或右肾上极的横断面上,左肾上腺位于左肾上极前内、胰体后面、脾的内侧和左膈脚围成的四边形区域内,右肾上腺位于右肾上极前内、下腔静脉后壁、肝裸区和右膈脚围成的四边形区域内。结论连续横断层上左、右。肾上极层面是寻找双侧肾上腺的可靠层面。下腔静脉后壁是识别右肾上腺前界的标志;脾动、静脉则是识别左肾上腺前界的标志。在连续横断层上肾上腺的形态变化较大,肾上腺前方的毗邻结构尤其左肾上腺复杂,故肾上腺病变向前生长时有不同的优势途径。第二部分肾上腺矢状断层解剖及CT、MRI 目的为肾上腺病变的矢状断层影像诊断和外科治疗提供实用的断层解剖学依据。材料和方法使用30例成人上腹部连续矢状断层标本、10例健康成人MRI矢状图像及20例无肾上腺病变的临床病人MSCT矢状重建图像,观测了左、右肾上腺的出现断面、形态、大小和毗邻关系。结果在连续矢状断面上,左肾上腺集中出现在腹主动脉左缘至左肾门之间,而右肾上腺集中出现在下腔静脉左缘至右肾门之间。左、右肾上极内侧缘出现的矢状断面是左、右肾上腺恒定出现的断面,即从正中矢状面开始寻找肾的首次出现断面是快速找到肾上腺的一个简便方法。左、右肾上极内侧缘出现层面是左、右肾上腺呈现最大面积的层面。该层面上左肾上腺呈Y或I形,而右肾上腺形状不规则,可呈多种形状。左肾上腺一般位于左膈脚或左肾与胰体之间。右肾上腺的前方为下腔静脉,后方紧邻右肾或膈,下方有右肾动、静脉走行,上方为膈和肝裸区。结论在连续矢状断层上,左、右肾上极出现的层面是肾上腺恒定出现的断面,且该层面上双侧肾上腺呈现最大面积。脾动、静脉是识别左肾上腺前界的标志,下腔静脉是识别右肾上腺前界的标志,左、右肾动、静脉分别是识别左、右肾上腺下界的标志。矢状面上右肾上腺的形态变化较大,而左肾上腺的形态相对恒定。第三部分肾上腺冠状断层解剖及CT、MRI 目的为肾上腺病变的冠状断层影像诊断和外科治疗提供实用的断层解剖学依据。材料和方法使用31例成人上腹部连续冠状断层标本、10例健康成人MRI冠状图像及5例无肾上腺病变的临床病人MSCT冠状重建图像,连续追踪观测了肾上腺在冠状面上的形态、位置、毗邻和大小。结果在连续冠状断面上,肾上腺集中出现于下腔静脉后缘前18mm和其后的24mm范围内。左肾上腺的出现一般早于右肾上腺2个层面。在经下腔静脉前份和左肾静脉的冠状面(A_(15))上,左肾上腺位于腹主动脉外侧、左肾静脉上方和左肾前极的内上且呈现多种形态。在经左、右肾门前份的冠状面(A_(18))上,双侧肾上腺的出现率均为100%,并且左、右肾上腺出现最大径线,右肾上腺的长、宽、体厚、内侧肢厚、外侧肢厚分别是32.02±4.12mm,10.91±1.89mm,5.82±0.26mm,2.78±0.08mm,2.62±0.06mm,而左肾上腺的大小分别是28.31±3.46mm,18.40±1.56mm,6.84±0.24mm,3.02±0.08mm,2.86±0.10mm。在经左、右肾窦后份和脾门的冠状面(A_(20))上,右肾上腺位于肝右后叶的裸区和右膈脚之间,而左肾上腺位于胃裸区和左膈脚之间。在经脊髓圆锥和马尾的冠状面(A_(22))上,左肾上腺已消失,而右肾上腺仍位于肝、右肾上极和右膈脚围成的三角内,但形态明显变小。结论冠状面是显示双侧肾上腺的优势断面。肾上腺的形态变化较大,而肾上腺的厚度较恒定。肾上腺的内、外侧肢厚,尤其外侧肢厚度的变化更能反映肾上腺皮质的改变。第四部分肾上腺多层螺旋CT图像的三维重建目的对正常肾上腺进行MSCT三维重建,为肾上腺病变的影像学诊断和外科治疗提供实用的影像断层解剖学依据。材料和方法使用20例无肾上腺病变的临床病人64层螺旋CT断层图像探讨了肾上腺的三维重建方法,重点研究了肾上腺的整体形态特点及其在正常人体中的位置和毗邻等。结果1.25mm层厚64层螺旋CT横断层图像上,双侧肾上腺的边界清晰,易于进行肾上腺边界的提取。用VR依次分步重建出的肾上腺及其毗邻结构,边界清楚,立体感强,能动态多角度显示正常肾上腺的形态和位置,以及和周围器官的毗邻关系。结论正常肾上腺MSCT三维重建图像能动态立体显示肾上腺及其周围结构的毗邻关系,充分体现肾上腺的在体方位,与手术视野中的肾上腺有很好的对应关系,以期为现代泌尿外科施行各种肾上腺手术提供可行而又实用的解剖学基础。第五部分肾上腺三维断层解剖在影像诊断中的应用目的为明确肾上腺微小病变的影像诊断依据,阐明肾上腺肿块对毗邻结构推压、侵蚀的影像学表现与断层解剖基础的相关性,并为肾上腺病变的外科治疗提供实用的影像解剖学依据。材料和方法本研究利用上述的横、矢、冠状断层标本和30例肾上腺病变(22例肾上腺微小病变,8例肾上腺肿块)的CT、MRI横、矢和冠状图像,探讨肾上腺病变的影像学特征及断层解剖学基础。结果双侧肾上腺后内侧的毗邻关系恒定,上份分别和左、右膈脚相邻,下份则分别和左、右肾上极相毗邻。双侧肾上腺前方的毗邻结构变化较大,右肾上腺前方为下腔静脉,正常右肾上腺可位于下腔静脉和右膈脚之间或位于下腔静脉后外紧贴肝裸区,右肾上腺肿块可将下腔静脉推向前方、前外或前内。右肾上腺外侧和肝裸区及右肝下间隙相邻,右肾上腺的肿块向外生长,肝右后叶的内侧面可出现压迹,亦可突入右肝下间隙。左肾上腺上份的前外侧和胃裸区及网膜囊、胃后壁相邻,左肾上腺上份的病变可突入胃裸区或网膜囊内。左肾上腺下份的前外侧和胰体后界、脾动、静脉相邻,左肾上腺下份的肿块可向前推压脾动、静脉和胰体,出现脾动、静脉受压的征象。左肾上腺的前内侧和腹主动脉的上份及其分支腹腔干和肠系膜上动脉的起始部相邻,左肾上腺的肿块可向右推压腹主动脉及其分支。结论肾上腺的三维断层解剖学基础可很好地解释肾上腺肿块对毗邻结构推压、侵蚀的影像学表现。肾上腺断面形态多样化,不能用一种类型反映单个肾上腺全貌;肾上腺前方的毗邻结构关系变化较大,决定肾上腺病变向前生长、侵蚀有不同的优势途径和类型。结论和意义 1.本研究首次使用较大样本的冠状断层标本和薄层冠状铣切标本并结合活体MRI及MSCT冠状图像,详细探讨了肾上腺在连续冠状断面上的断层影像变化规律。冠状面是显示双侧肾上腺的优势断面。冠状面上肾上腺的形态变化较大,而肾上腺的厚度较恒定。肾上腺的内、外侧肢厚,尤其外侧肢厚度的变化更能反映肾上腺皮质的改变。为肾上腺病变的断层影像诊断和肾上腺的外科手术治疗提供实用的断层影像解剖学基础。 2.横、矢和冠状断层标本和临床活体肾上腺CT和MRI图像有很好的对应关系,便于二者之间对照研究,这些研究结果将为肾上腺微小病变的精确影像学诊断提供实用的断层解剖学依据。连续横断层上左、右肾上极层面是寻找双侧肾上腺的可靠层面。下腔静脉后壁是识别右。肾上腺前界的标志;脾动、静脉则是识别左肾上腺前界的标志。在连续矢状断层上,左、右肾上极内侧缘出现的层面是肾上腺恒定出现的断面,且该层面上双侧肾上腺呈现最大面积。左、右肾动、静脉分别是识别左、右肾上腺下界的标志。 3.本研究使用临床活体正常肾上腺多层螺旋CT及三维重建图像,可多角度立体显示肾上腺和其周围结构的毗邻关系,充分体现肾上腺的在体方位,与手术视野中的肾上腺有很好的对应关系,以期为现代泌尿外科施行各种肾上腺手术提供可行而又实用的解剖学基础。 4.本研究将肾上腺的三维断层解剖和肾上腺病变的影像表现结合起来,用断层解剖基础去解释和阐明肾上腺病变的影像学表现,为肾上腺的影像断层解剖奠定坚实的基础。肾上腺的三维断层解剖学基础可很好地解释肾上腺肿块对毗邻结构推压、侵蚀的影像学表现。肾上腺断面形态多样化,不能用一种类型反映单个肾上腺全貌;肾上腺前方的毗邻结构关系变化较大,决定肾上腺病变向前生长、侵蚀有不同的优势途径和类型。
[Abstract]:The adrenal gland is located in the retroperitoneal space. It has a wide range of lesions and complex clinical manifestations, so it is one of the hot spots in clinical medical imaging and external science. However, its imaging detection is still difficult because of its deep location, small size, different morphology and complex adjacent relations. Adrenalectomy has higher requirements for the adjoining relation of the adrenal glands, especially the surrounding large vessels. Early scholars have studied the position, size and imaging manifestations of the adrenal glands on the transection layer by CT. With the effect of CT density resolution, the small lesions of the adrenal gland are difficult to accurately locate and display. In recent years, with the rapid development of multi-slice spiral CT and its image post-processing function and the application of MRI rapid scanning sequence, imaging techniques can display the normal anatomy and pathological changes of the suprarenal gland on the transverse, sagittal, crown and oblique faults. There are more anatomical studies in the transection layer, but these methods used 1 or several fault specimens, only a normal CT or MRI image, and a lack of a control study of the image of the adrenal microscopic lesions. The subject group had a preliminary study of the sagittal sectional anatomy of the adrenal gland, only using a sagittal fault specimen without a normal combination of normal. A contrast study of the adrenal images and the typical adrenal microscopic lesions; up to now, the coronal anatomy of the adrenal gland has not been reported, and the coronary anatomy has its unique advantages in the simultaneous display of bilateral adrenal glands.
The study of the position, morphology and adjacent relationship of the adrenal gland by the method of fault anatomy can guarantee the adrenal location of the adrenal gland. It is not only easy to compare with the image of the fault, but also helps the Department of urology to determine the exact position of the adrenal disease, and it is beneficial to the implementation of various adrenal surgery. The number of specimens is small, and is limited to transverse or sagittal faults.
The clinical application of multi-slice spiral CT and its three-dimensional reconstruction technique can reconstruct the three-dimensional images of the adrenal and its surrounding organs. It can be fully displayed in the body position. The adjoining relationship between the adrenal gland and its surrounding structures. The application of the MRI rapid scanning sequence in recent years, and the technique of pressure fat can clearly show the fine solutions of the adrenal and its surrounding structures. The accurate localization of minor adrenal lesions is possible. However, simple use of CT or MRI, due to the existence of partial volume effect and the limitation of density resolution, shows that there is a difference between the true structure of the adrenal gland and the specimen. It is still necessary to combine the fault specimens with the CT and MRI images to explore the three dimensional faults of the adrenal gland. Anatomy.
In addition, the imaging findings of the normal adrenal gland and its lesions were systematically investigated by using the transverse, sagittal and coronal specimens and combined with the typical manifestations of the adrenal minor lesions.
Using the upper abdominal transverse, sagittal, and coronal specimens, combined with the multi-slice spiral CT (MSCT) image, the three-dimensional (3D) image, the MRI fault image, and the CT and MRI images of the adrenal microscopic lesions, the three-dimensional anatomical features of the adrenal gland and the imaging findings of the adrenal microscopic lesions are systematically studied in order to diagnose the adrenal lesions. It provides accurate and practical sectional anatomy basis for surgical treatment.
This topic is divided into 5 parts:
The first part of the transtransverse dissection of the adrenal gland and CT, MRI
Objective to provide practical sectional anatomy and imaging diagnosis for transverse diagnosis and surgical treatment of adrenal lesions.
Materials and methods 20 cases of adult upper abdominal transverse transection, 10 healthy adult MRI transverse fault images and 20 cases of MSCT transverse fault images without adrenalectomy were used to observe the morphology, position, adjacent and size of adrenal glands on the cross section.
Results on the continuous cross section, the first hepatic portal was usually the first appearance of the adrenal gland. The left and right renal vascular planes were the disappearance of the adrenal glands on the left and right kidney. The upper level of the left and right kidney was the ideal level for the bilateral adrenal glands on the transverse layer. The right adrenal gland was located behind the inferior vena cava on the transverse section of the hepatic portal. In the right adrenal triangle surrounded by the bare and right diaphragmatic feet, the left adrenal is located in the bare area of the stomach and the left adrenal trigonometry enclosed by the spleen and the left diaphragm. The left adrenal gland is located in the anterior left renal pole, behind the body of the pancreas, the inside of the pancreas and the left diaphragm in the quadrilateral area, and the right adrenal in the right kidney. In the anterior part, the posterior wall of the inferior vena cava, the bare area of the liver and the quadrilateral region of the right phrenic foot.
The posterior wall of the inferior vena cava is a sign to identify the right adrenal gland, and the spleen and vein are the markers to identify the left adrenal anterior boundary. The adrenal glands in the continuous transection layer vary greatly, and the adjacent adrenal structures in front of the adrenal gland are especially the left adrenal gland. Therefore, adrenal lesions have different dominant pathways when they grow forward.
The second part of the adrenal sagittal sectional anatomy and CT, MRI
Objective to provide sectional anatomy basis for sagittal sectional imaging diagnosis and surgical treatment of adrenal lesions.
Materials and methods 30 cases of adult upper abdominal sagittal tomography, 10 healthy adult MRI sagittal images and 20 cases of MSCT without adrenalectomy were used to reconstruct the sagittal image of the left and right adrenal gland. The appearance, shape, size and adjacent relationship of the left and right adrenal glands were observed.
Results on the continuous sagittal section, the left adrenal gland was concentrated between the left margin of the abdominal aorta to the left renal portal, and the right adrenal gland appeared between the left margin of the inferior vena cava and the right renal portal. The sagittal section of the left and right medial margin of the right kidney appeared in the left and right adrenal gland, that is to begin with the first appearance of the kidney from the median sagittal plane. The present section is an easy way to quickly find the adrenal gland. The left, right renal proximal edge appears to be left, the right adrenal shows the largest area. At this level, the left adrenal gland is Y or I shaped, while the right adrenal shape is irregular in shape. The left adrenal gland is usually located between the left diaphragm or the left kidney and the pancreas. The right adrenal gland is in the right adrenal gland. The anterior part is inferior vena cava, with the right kidney or diaphragm behind, and the right kidney moves below, and the vein runs along the diaphragm and the bare area of the liver.
Conclusion on the continuous sagittal fault, the upper level of the left and right kidney appears to be a constant section of the adrenal gland, and the bilateral adrenal gland presents the largest area at this level. The splenic movement and vein are the markers to identify the left adrenal anterior boundary, and the inferior vena cava is a marker for the recognition of the right adrenal anterior boundary, and the left, right kidney, and the right adrenal gland are identified respectively. The right adrenal gland on the sagittal plane has a large morphological change, while the left adrenal gland is relatively constant in shape.
The third part of the coronal sectional anatomy of the adrenal gland and CT, MRI
Objective to provide practical sectional anatomy basis for coronal tomography diagnosis and surgical treatment of adrenal lesions.
Materials and methods the morphology, position, location, adjacent and size of the adrenal gland on the coronal plane were continuously traced in 31 consecutive cadaver upper abdominal coronary faults, 10 healthy adult MRI coronal images and 5 cases of MSCT coronary reconstruction without adrenalectomy.
Results on the continuous coronary section, the adrenal glands were concentrated in the anterior 18mm and 24mm of the posterior inferior vena cava. The appearance of the left adrenal gland was generally earlier than the right adrenal 2 levels. The left adrenal gland was located outside the abdominal aorta, the left renal vein and the left renal pole in the anterior ventral vein and the left renal vein (A_ (15)). In the left, right renal anterior portion of the coronal plane (A_ (18)), the incidence of bilateral adrenal gland was 100%, and the left and right adrenal glands had the largest diameter, the right adrenal length, width, body thickness, the thickness of the medial limb, and the lateral limb thickness were 32.02 + 4.12mm, 10.91 + 1.89mm, 5.82 + 0.26mm, 2.78 + 0.08mm, 2.62 + 0.06mm, while the left kidney was on the left kidney. The size of the gland was 28.31 + 3.46mm, 18.40 + 1.56mm, 6.84 + 0.24mm, 3.02 + 0.08mm and 2.86 + 0.10mm. in the left, right renal sinus and the coronal plane of the splenic portal (A_ (20)). The right adrenal gland was located between the naked area of the right posterior lobe of the liver and the right diaphragm, while the left adrenal was located between the bare area of the stomach and the left diaphragm. (A_ (22) in the conus of the spinal cord and the cauda equina. The left adrenal gland has disappeared, while the right adrenal gland is still located in the trigone of the liver, the upper pole of the right kidney and the right phrenic foot, but the morphology is obviously smaller.
Conclusion the coronal plane is the dominant cross section of the adrenal gland. The adrenal gland has a larger change in morphology and a constant adrenal thickness. The changes in the adrenal cortex can be reflected by the changes in the adrenal gland, the lateral limb thickness, and the lateral limb thickness.
The fourth part is three-dimensional reconstruction of adrenal multislice spiral CT images.
Objective to perform MSCT three-dimensional reconstruction of normal adrenal glands, and provide a practical sectional anatomical basis for imaging diagnosis and surgical treatment of adrenal lesions.
Materials and methods the three-dimensional reconstruction of adrenal gland was studied by the 64 slice spiral CT tomography of 20 cases of clinical patients without adrenal lesions. The overall morphological characteristics of adrenal glands and their location and adjacency in the normal human body were studied.
Results the boundary of adrenal gland was clear and easy to extract the adrenal boundary on the 64 slice spiral CT transverse fault images of 1.25mm layer thick. The adrenal gland and its adjacent structure were reconstructed step by step by VR. The boundary was clear and the stereoscopic sense was strong. The shape and position of normal adrenal gland and adjacent relations with the surrounding organs could be displayed dynamically and multiple angles.
Conclusion the three-dimensional reconstruction image of normal adrenal MSCT can dynamically display adjoining relation of adrenal and its surrounding structure, fully embody the azimuth of adrenal gland, and have a good correspondence with the adrenal gland in the visual field, so as to provide a feasible and practical anatomical basis for various adrenal operations in the modern department of urology.
The fifth part is the application of three dimensional sectional anatomy of adrenal gland in imaging diagnosis.
Objective to clarify the imaging diagnostic basis of adrenal microscopic lesions, to clarify the correlation between the imaging findings of the adrenal masses and the anatomical basis of the adjacent structures, and to provide a practical imaging anatomical basis for the surgical treatment of adrenal lesions.
Materials and methods in this study, the imaging features and sectional anatomical basis of adrenal lesions were investigated using the above transversal, sagittal, coronal specimens and 30 cases of adrenal lesions (22 cases of adrenal minor lesions, 8 adrenal masses) with CT, MRI, sagittal and coronal images.
Results the adjoining relationship between the two sides of the adrenal gland is constant, the upper part is adjacent to the left and right diaphragm respectively, the lower part is adjacent to the left and right kidney respectively. The adjacent structure of the bilateral adrenal glands is larger, the right anterior adrenal gland is the inferior vena cava, and the normal right adrenal can be located between the inferior vena cava and the right diaphragm or behind the inferior vena cava. The right adrenal mass can push the inferior vena cava forward to the front, the anterior and the anterior or anterior. The right adrenal lateral and the naked area of the liver and the right subhepatic space adjacent to the right adrenal gland and right subhepatic space, the right adrenal masses grow outwards, the medial surface of the right posterior lobe of the liver can appear pressure, or the right subhepatic space. The anterolateral and nude stomach and omentum sac of the upper part of the left renal gland and the posterior stomach Adjacent to the wall, the lesion of the upper part of the left adrenal gland can penetrate into the bare area of the stomach or the omentum. The lower part of the lower part of the left adrenal gland, the posterior boundary of the pancreas, the splenic movement and the vein, and the lump of the lower part of the left adrenal gland can push the splenic movement, the veins and the body of the pancreas, the signs of the spleen and vein. The upper and abdominal aorta of the left adrenal and the upper part of the abdominal aorta and its branches The trunk of the celiac trunk is adjacent to the origin of the superior mesenteric artery. The mass of the left adrenal gland can push the abdominal aorta and its branches to the right.
Conclusion the three-dimensional sectional anatomy of the adrenal gland can be well explained.

【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2008
【分类号】：R322.5

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