动脉导管三角的应用解剖  

Applied anatomy of the triangle of ductus arteriousus

作　　者：姚国庆[1] 孙善全[1] 钟源[1] 张沪勤 左尧彬[1] 

机构地区：[1]重庆医科大学实验教学管理中心人体大体形态学实验室,重庆400016

出　　处：《中国临床解剖学杂志》2014年第2期158-161,共4页Chinese Journal of Clinical Anatomy

摘　　要：目的为动脉导管三角区的临床手术提供形态学基础。方法随机选用经福尔马林固定的尸体50具,解剖观测动脉韧带(AL)、左迷走神经、左喉返神经(LRLN)等相关结构,所得结果进行统计学处理。结果 (1)有94%(47例)AL连于主动脉弓和左肺动脉(LPA),即经典的动脉导管三角内,6%(3例)AL连于降主动脉与LPA之间。(2)根据AL与主动脉弓和LPA附着关系的不同,可分为6种类型:Ⅰ.附于主动脉弓下缘和LPA上缘之间(76%);Ⅱ.附于主动脉弓前壁与LPA上缘之间(8%);Ⅲ.附于主动脉弓前壁与LPA前壁之间(8%);Ⅳ.附于降主动脉内侧缘与LPA上缘之间(4%);Ⅴ.附于降主动脉内侧缘与LPA后壁之间(2%);Ⅵ.附于主动脉弓下缘与LPA前壁之间(2%)。(3)LRLN在主动脉弓下缘由左迷走神经发出者占36%;在主动脉弓前壁下1/3、中1/3和上1/3段发出者分别占30%、14%和14%;在降主动脉内侧缘发出者占6%。(4)AL中轴与LPA中轴的夹角平均为(45.08±19.06)°,其中6%(3例)夹角仅为0°,4%(2例)夹角为90°。(5)所有LRLN均贴近动脉韧带主动脉端由左迷走神经发出并向后上方返折。结论 AL的附着关系与经典描述之间存在差异。由于附着关系的不同,使其与LPA、LRLN等周围解剖结构的毗邻关系亦发生了改变。熟悉这些变化,对防止动脉导管结扎术并发症的发生有指导意义。Objective To investigate the anatomical features of the triangle of ductus arteriosus, so as to provide morphologic data for clinical operation in this region. Methods Fifty cadavers fixed by formalin were collected randomly. The arterial ligament（AL）, the left vagus nerve and the left recurrent laryngeal nerve（LRLN） were dissected and observed. The angle between the AL and the left pulmonary artery （LPA） was measured, and the data were statistically analyzed. Results （1） The AL was located between the aortic arch and LPA, namely in a typical triangle of ductus arteriosus in 47 cadavers, and between LPA and descending aorta in remaining 3 cadavers. （2） The attachment sites of AL on the aortic arch and LPA varied greatly. According to the different sites, all of the cases could be divided into 6 types. （3） The LRLN originated from the left vagus nerve at the inferior margin of the aortic arch in 36% cases, at the lower 1/3 of the anterior wall of the arch in 30% cases, at the middle 1/3 of the anterior wall of the arch in 14% cases, at the upper 1/3 of the anterior wall of the arch in 14% cases, and at the medial margin of the descending aorta in 6% cases. （4）The angle between the median axis of the AL and the LPA was （45.08±19.06） ° . In 3 cadavers the angle was 0°, and in 2 cadavers was 90°. （5） The LRLNs hooked around the upper end of the AL and aortic arch in all 50 cadavers. Conclusion The results reveal that the morphology of the AL is different from the classical description. The attachment sites of AL on the aortic arch and LPA vary greatly, which makes the relations of the AL to the surrounding structures more complicated. Surgeons should keep the variations in mind to avoid the occurrence of complications during the operation of ductus arteriosus ligation and other operations in this region.

关 键 词：动脉导管三角 动脉韧带 动脉导管未闭 左喉返神经 

分 类 号：R322.11[医药卫生—人体解剖和组织胚胎学]