咽升动脉分支的解剖分组及其临床意义  

Anatomical classification of the ascending pharyngeal artery branches and its clinical implications

作　　者：左赋兴 万经海 李茗初[2] Zuo Fuxing;Wan Jinghai;Li Mingchu(Department of Neurosurgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Neurosurgery,Capital Medical University Xuanwu Hospital/China International Neuroscience Institute(China-INI),Beijing 100053,China)

机构地区：[1]国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院神经外科,北京100021 [2]首都医科大学宣武医院神经外科中国国际神经科学研究所,北京100053

出　　处：《中华解剖与临床杂志》2022年第5期297-301,共5页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金(81701262);中国医学科学院医学与健康科技创新工程项目(2020-I2M-C&T-B-071)。

摘　　要：目的探讨咽升动脉及其主要分支在颈部颅底区域走行规律及其在血管内外治疗中的临床意义。方法选择以10%甲醛固定并用乳胶灌注的8具(16侧)成人颅颈部标本,自颈总动脉分叉水平向上解剖至颅底骨质,分离显露咽升动脉及周围相关结构,观察咽升动脉的起源部位及主要分支,测量相关解剖学参数。依据咽升动脉主要分支与颈动脉鞘的位置关系分为颈动脉鞘内、外2组,观察2组分支血管的走行规律及解剖分布特点。结果8具16侧标本中:咽升动脉13侧自面动脉起始点平面以下的颈外动脉发出,2侧起源于枕动脉,1侧与枕动脉共干起源于颈外动脉;14侧咽升动脉沿颈内动脉腹侧上行(15.39±3.20)mm后发出主要分支咽干和脑膜干,2侧变异。脑膜干自咽升动脉主干发出(9.32±3.20)mm后均穿入颈动脉鞘,上行分叉后经舌下神经管或颈静脉孔或鼓室小管下口或枕大孔入颅;咽干则在颈动脉鞘外走行并分布于咽旁、椎旁等区域。颈动脉鞘内组包括脑膜干和鼓室下动脉,均穿入颈动脉鞘后沿颈内动脉内侧上行;颈动脉鞘外组包括咽干和肌支,于鞘外走行。结论咽升动脉及其分支变异显著、走行复杂,可按照咽升动脉各主要分支与颈动脉鞘的位置关系对其进行分组描述;该分组描述在头颈部病变患者个体化血管内外治疗方案制定中的临床应用价值有待证实。Objective To explore the anatomical characteristics of the ascending pharyngeal artery(APA)and the major trunks in the skull base and evaluate the implications.Methods The origin,course,and branching patterns of APA were observed in eight human cadaveric specimens(16 sides),which were fixed in a 10%formalin solution and then injected with colored latex.The relationship between the APA and its surrounding structures were observed.Data were measured and analyzed,focusing on the relationship between the APA and the carotid sheath.Results In 13 sides of the specimens,the APA originated from the external carotid artery,lying inferior to the origin of the facial artery.The APA could originate directly from the occipital artery(two sides)or share a common trunk with the occipital artery in one side.Before the bifurcation into the pharyngeal and meningeal trunks,the mean length of the common trunk of the APA was(15.39±3.20)mm(14 sides).The bifurcation of the APA varied in two sides of the specimens.The meningeal trunk entered the carotid sheath(CS)and extended toward intracranial regions through the hypoglossal canal,jugular foramen,inferior tympanic foramen,and foramen magnum.The mean distance from the origin of the meningeal trunk to the CS was(9.32±3.20)mm.The pharyngeal trunk did not enter the CS but gave rise to arterial arcade surrounding the parapharyngeal and paravertebral spaces.The major branches of the APA were classified into two groups.Intra-CS group included the meningeal trunk and inferior tympanic artery,which coursed into the CS medially to the internal carotid artery(ICA).Extra-CS group was composed of the pharyngeal trunk and muscular branches,which did not enter the CS.Conclusions The APA and its branches have significant variation and complicated course.They could be divided into groups according to the positional relationship between the main branches of the APA and the CS.The clinical application value of using CS as an anatomic marker to make individualized intravascular and extravascular treatm

关 键 词：咽升动脉 咽升动脉咽支 颈动脉鞘 解剖学 局部 

分 类 号：R322.121[医药卫生—人体解剖和组织胚胎学]