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目的为带血管蒂膈肌瓣重建食管提供解剖学依据。方法在12具经动脉灌注红色乳胶的成人防腐标本上,解剖观测膈肌神经血管的起源、走行、外径、分布、长度及其交通情况。结果膈肌的营养血管主要有膈下动脉,肌膈动脉、心包膈动脉膈肌支、膈上动脉和下位肋间后动脉的部分分支。膈下动脉是膈肌的主要供血血管,主要起始于腹腔动脉干或腹主动脉,起始点外径分别为:(1.52±0.06)mm,(1.61±0.04)mm。经左右膈脚的两侧上行进入膈肌,分别分成前、后两支。前支行向前外,支配中心腱中间部、中心腱两侧叶前部、部分膈肌前肋部,后支行向后外,分布中心腱两侧叶后部、部分膈肌后肋部、部分膈肌腰部。结论以膈下动脉为血管蒂的膈肌瓣完全具有重建食管的解剖学可行性。
Objective To provide an anatomical basis for reconstructing the esophagus with vascularized diaphragmatic muscle flap. Methods The origin, path, diameter, distribution, length and traffic of the neurovascular of diaphragm were observed anatomically on 12 adult anticorrosion specimens infused with red latex through artery. Results The vegetative vessels in the diaphragm mainly included subphrenic artery, phrenic artery, phrenic branch of the pericardial phrenic artery, supra-phrenic artery and posterior intercostal artery. The subphrenic artery is the main blood supply to the diaphragm, which mainly starts from the celiac artery or the abdominal aorta. The initial diameter is (1.52 ± 0.06) mm and (1.61 ± 0.04) mm, respectively. After the left and right phrenic feet on both sides into the diaphragm, were divided into before and after the two. Before the branch forward, the control center of the tendon in the middle of the central tendon on both sides of the leaf in front of the anterior part of the diaphragm, the posterior branch of the back, the distribution of the central tendon on both sides of the posterior leaf, part of the posterior wall of the diaphragm, part of the diaphragm waist . Conclusion The diaphragm pedicled with the pedicle of the inferior phrenic artery has the anatomical feasibility of reconstructing the esophagus completely.