胸腔镜下胸导管结扎术的应用解剖  

Applied anatomic study of video-assisted thoracoscopic ligation of thoracic duct

作　　者：张小文[1] 杨劼[1] 刘文国[2] 黄峰[2] 王跃建[1] 张斌[1] 吴校连[1] 古卫权[1] 叶俊[1] 王飞[1] 

机构地区：[1]佛山市第一人民医院(中山大学附属佛山医院) [2]佛山科学技术学院,广东佛山528000

出　　处：《中国临床解剖学杂志》2014年第3期264-268,共5页Chinese Journal of Clinical Anatomy

基　　金：广东省科技计划项目(01593850171507050)

摘　　要：目的：为胸腔镜下结扎胸导管提供形态学依据。方法观察10例成人尸体标本的乳糜池、肠干、左右腰干及胸导管在胸腔内的走行及毗邻关系，在T4-12各肋骨平面测量胸导管距奇静脉、半奇静脉和副半奇静脉主干的距离。结果①胸导管多起始于T12-L2椎体右前方，但其中1例起于T10。胸导管起点处距右膈脚起始端距离（74.63±38.30）mm。胸导管、各属支间及与奇静脉、半奇静脉等存在广泛交通；②胸导管到奇静脉最小距离（0.94±0.62）mm和到半奇静脉和副半奇静脉主干最大距离（34.92±0.98）mm均在T8水平，向上向下肋水平延伸距离分别逐渐增大、减小。结论胸导管在T5-10间多为单干，走行规律，电视胸腔镜胸导管结扎术经右胸入路，在脊柱前奇静脉下方，降主动脉上方仔细分离出胸导管，经左胸入路，则需在降主动脉下方、脊柱前、奇静脉上方分离出胸导管。Objective To provide morphological basis for ligation of thoracic duct assisted by thoracoscopy. Methods An anatomical study was performed on ten normal adult cadavers to observe the original part of thoracic duct, cisterna chili, intestinal trunk, left and right lumbar trunks, the anatomical characteristics and distribution of the thoracic duct in the chest; and the distance from thoracic duct to the azygos vein, the hemiazygos vein and the accessory hemiazygos vein in the T4-12 segments was measured. Results ①The thoracic duct mostly ascended from the cisterna chili medial to the right diaphragmatic crus at the level of T12~L2 （one exception at T10）. The distance from the origin of thoracic duct to the origin right diaphragmatic crus was （74.63 ± 38.30） mm. There were all kinds of links among the intestinal trunk, left and right lumbar trunks, thoracic duct, the azygos vein and the accessory azygos vein.②The minimum distance from the thoracic duct to the azygos vein and the maximum distance from the thoracic duct to the hemiazygos vein and the accessory hemiazygos vein was at the level of T8, and the distance grew and shrunk with the rib level rising and lowering, respectively. Conclusions In the course of T5~10 the thoracic duct has a fixed and single trunk with fewer variations. It is easy to dissect thoracic duct below the azygos vein, above descending aorta in front of vertebral column through trans-right-thoracic approach during video-assisted thoracoscopic surgery （VATS）, while through trans-left-thoracic approach it should be above the azygos vein and below descending aorta.

关 键 词：胸导管 电视胸腔镜 胸导管结扎术 应用解剖 

分 类 号：R323.22[医药卫生—人体解剖和组织胚胎学]