腋弓的常见形态与临床意义  

The common morphology and clinical significance of the axillary arch

作　　者：黄明清 葛菲 候小晨 陈文林[1] Huang Mingqing;Ge Fei;Hou Xiaochen;Chen Wenlin(Third Department of Breast Surgery,the Third Affiliated Hospital of Kunming Medical University,Yunnan Cancer Hospital,Kunming 650118,China;Department of Breast Surgery,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第三附属医院、云南省肿瘤医院乳腺外三科,昆明650118 [2]昆明医科大学第一附属医院乳腺外科,昆明650032

出　　处：《中华外科杂志》2023年第2期168-172,共5页Chinese Journal of Surgery

基　　金：国家自然科学基金(82060538);云南省卫生健康委员会医学学科带头人培养计划(D-2018002);云南省科技计划昆医联合专项(202001AY070001-079)。

摘　　要：腋弓是常见的腋窝肌纤维变异,在中国人群中的发生率约为10.8%。它的形态多样且不固定,有不同起止点,临床医师尚缺乏对它的充分认知。随着前哨淋巴结活检逐渐获得广泛开展,腋弓的临床意义日益凸显。腋弓的存在不仅会遮挡腋窝区域淋巴结,导致腋窝淋巴结清扫解剖层次不清;还会压迫腋窝神经血管束,引起上肢静脉血栓、淋巴水肿及神经卡压等相关症状;体积明显的腋弓还会表现为腋窝异常凸起。除在尸体解剖或手术过程中发现腋弓外,目前已有多种影像学方法可对腋弓进行评估,为前哨淋巴结活检方案的制定提供参考。研究人员虽尝试用胚胎学、比较解剖学来解释腋弓的起源,但多数观点仍为假说,腋弓的起源尚需进一步研究。Axillary arch is the most common type of axillary muscle fiber variation,with about 10.8%incidence in the Chinese population.Its natural forms are varied and fluid,with different starting points and terminations,and clinicians frequently lack recognition.Under commonly applicated sentinel lymph node biopsy,the axillary arch has been endowed with more clinical significance.The fabric of axillary arch will not only block lymphatic drainage in axilla and unclear anatomical level of axillary dissection,but also compress the axillary neurovascular bundle,causing upper limb venous thrombosis,lymphedema and nerve entrapment.The intumescent axillary arch may also show abnormal axillary bulge.In addition to finding axillary arch during cadaveric study and operation,several of imaging methods availably diagnose axillary arch preoperative,which can create new way for detection of axillary arch and extension of the surgical plan of sentinel lymph node biopsy.Although embryology and comparative anatomy have been used to explain the origin of the axillary arch,most of the ideas are still hypotheses and need further study.

关 键 词：神经血管束 前哨淋巴结活检 淋巴水肿 影像学方法 区域淋巴结 腋窝淋巴结清扫 临床医师 解剖层次 

分 类 号：R737.9[医药卫生—肿瘤]