经皮穿刺胸腺介入治疗重症肌无力的应用解剖  

Applied anatomy of intervention treatment of myasthenia gravis by thymic percutaneous paracentesis

作　　者：纪荣明[1] 程林发[1] 姜宗来[1] 曲莉[1] 冯皓[1] 汪晓军[1] 涂来慧[2] 张仁琴[2] 蒋建明[2] 吴涛[2] 

机构地区：[1]上海市第二军医大学解剖学教研室,200433 [2]第二军医大学长海医院神经内科

出　　处：《中国临床解剖学杂志》2000年第2期157-158,共2页Chinese Journal of Clinical Anatomy

摘　　要：目的 :为经皮穿刺胸腺介入治疗重症肌无力提供应用解剖基础。方法 :童尸 15具 (男 12 ,女 3 )解剖观测胸腺的形态、血供和毗邻关系以及胸骨的前突角度。结果 :胸腺左叶和右叶长、宽、厚度分别为 :60 .7、16.7、5 .5mm和 80 .3、18.6、4.9mm ,胸腺上极伸至颈部的占 93 % ( 14例 ) ,左叶上极伸至颈部的长为 2 9.5mm ;右叶长度为 2 5 .1mm。胸腺上极与甲状腺下极的关系为 :左侧两者相距平均为 2 1.5mm ;右侧相距为 2 3 .8mm。胸腺在左头臂静脉的前面长度 :左叶为 14 .4mm ,右叶为 13 .7mm。胸骨前突的角度为10 .9°。结论 :经皮穿刺胸腺时为防止伤及左头臂静脉、上腔静脉以及胸膜腔 ,在颈部可在第 3～ 4气管软骨环 (甲状腺的峡部 )的下方进针 ;在胸部 ,沿胸骨后方上翘 10°左右的角度穿入胸腺 ,距正中线左右不超过 2 0mm处进针 ,穿刺深度左侧 40mm ,右侧 5 0mm为宜。Objective:To provide morphological data of thymic percutaneous paracentesis for intervention treatment of myasthenia gravis.Methods: The shape, blood supply and syntopy of thymus and protruding angle of sternum were observed and measured on 15 children′s cadaver specimens (12 boys, 3 girls). Results: The average length, width and thickness of the left lobes of thymuses were 60.7 mm, 16.7 mm and 5.5 mm respectively, and those of the right lobes were 80.3 mm, 18.3 mm and 4.9 mm respectively. The length of left lobe and right lobe in front of brachiocephalic vein were 14.4 mm and 13.7 mm separately. The average protruding angle of sternum was 10.9°. Conclusion: To avoid injury of blood vessels and pleura during thymic percutaneous paracentesis, the following suggestion should be followed.In cervical region, the puncture point should be selected under the third and forth brachial ring where the isthmus of thyroid gland located.In choracic region, the distance from the puncture point to the median line should not exceed 20 mm, the appropriate angle between the needle and sternum is about 10 degree.The appropriate puncture depth from left and from right is 40 mm and 50 mm separtely.

关 键 词：胸腺 经皮穿刺 重症肌无力 应用解剖 

分 类 号：R746.1[医药卫生—神经病学与精神病学] R322.53[医药卫生—临床医学]