颈动脉分叉区域的神经血管解剖及其对颈动脉内膜剥脱术的临床意义

doi:10.13418/j.issn.1001-165x.2018.02.002

中国临床解剖学杂志 ›› 2018, Vol. 36 ›› Issue (2): 127-131.doi: 10.13418/j.issn.1001-165x.2018.02.002

颈动脉分叉区域的神经血管解剖及其对颈动脉内膜剥脱术的临床意义

谭庆晶¹，秦超²，　杨俊威¹，　王天保¹，　林浩海¹，　张德敏³，　江志滨³

1. 广西中医药大学第一附属医院脑病科，南宁 530023； 2. 广西医科大学第一附属医院神经内科，南宁 530022；
3. 中国人民解放军三〇三医院神经内科，南宁 530021

收稿日期:2017-08-01 出版日期:2018-03-25 发布日期:2018-05-04
通讯作者: 秦超，主任医师，博士研究生导师，E-mail:mdqc6639@163.com
作者简介:谭庆晶（1982-），主治医师，硕士，研究方向：脑血管病，Tel:0771-5848507, E-mail:784307436@qq.com
基金资助:
广西壮族自治区卫生厅自筹经费科研课题项目（Z2015302）

The study of the nerve and vascular anatomy in the bifurcation region of the carotid artery and its clinical significance in carotid artery intimal dissection

TAN Qing-jing¹, QIN Chao², YANG Jun-wei¹,WANG Tian-bao¹, LIN Hao-hai¹,ZHANG De-min³, JIANG Zhi-bin³

1. Department of Neurology，the First Affiliated Hospital of Guangxi University of Chinese Medicine，Nanning 530023, China；2. Department of Neurology，the First Affiliated Hospital of Guangxi Medical University, Nanning 530022, China；3. Departmentof Neurology，the 303rd hospital of Chinese People's Liberation Army， Nanning 530021, China

Received:2017-08-01 Online:2018-03-25 Published:2018-05-04

摘要/Abstract

摘要：

目的　通过对尸体标本的颈动脉分叉区域内的神经、血管进行解剖研究，为安全有效地开展颈动脉内膜剥脱术提供形态学依据及解剖学基础。方法选取20例（40侧）无明确心、脑血管疾患的尸体解剖标本（男11例、女9例），采取颈动脉内膜剥脱术式入路对颈动脉分叉区域内的神经、血管进行解剖研究，明确血管和神经的形态学及结构特点。结果颈总动脉分叉部形态可分为Ⅰ、Ⅱ、Ⅲ型，分别占比为10%、52.5%、37.5%。分叉位置以甲状软骨为界，左侧颈总动脉分叉部高度在其上缘以上、平上缘和上缘以下的占比分别为55%、37.5%、7.5%；相较之下右侧分别为62.5%、27.5%、10%。男性颈总、颈内、颈外动脉内径均大于女性（P<0.05）；男性颈动脉分叉角度大于女性（P<0.05 ）。双侧颈总、颈内、颈外动脉内径相比无统计学意义（P>0.0 5）；左侧颈动脉分叉角度大于右侧（P<0.05）。结论　通过对颈动脉分叉区域内的神经、血管进行解剖研究，对颈动脉内膜剥脱术术中血管与神经的保护具有重要的临床意义。

关键词: 颈总动脉, 　颈动脉分叉区域, 　颈动脉内膜剥脱术, 　应用解剖

Abstract:

Objective　To study the nerve and blood vessels in the carotid bifurcation area in cadavers so that the morphological diagnostic basis and anatomic basis could be provided for safe and effective performance of carotid endarterectomy.　Methods　20 cases (40 sides) of autopsy specimens with no clear heart and cerebrovascular diseases before death were selected in our school (male 11 cases, female 9 cases). The anatomic study on the nerve and blood vessels in the carotid bifurcation area was performed using the surgical approach of carotid endarterectomy, and morphological and structural features of blood vessels and the relationship between the nerve and the blood vessels were explored.　Results　The types of common carotid artery bifurcation: type I accounted for 10%; type II accounted for 52.5%; type III accounted for 37.5%. The height of the bifurcation of the common carotid artery: above the top of the thyroid cartilage: 55% on the left side and 62.5% on the right; parallel to upper edge of thyroid cartilage on the upper edge: 37.5% on the left side of the, and the 27.5% on right side of the; below the upper edge of the thyroid cartilage: 7.5% on the left side, and 10% on the right side. The internal diameter of common, internal and external carotid arteries of males were wider than that of females（P＜0.05）, so was the bilateral carotid bifurcation angle（P＜0.05）. No statistically significant correlation was found between the internal diameters of common, internal and external carotid arteries of left side and right side. The bilateral carotid bifurcation angle of males was larger than that of female(P＜0.05）.　Conclusion　The anatomical measurement data of nerves and vessels on the carotid bifurcation region can not only define the relationship between neck blood vessels and nerves, but also provide morphological evidence and anatomic basis for safe and effective implementation of carotid endarterectomy.

Key words: Common carotid artery;　Carotid bifurcation region;　Carotid artery intimal dissection, Research significance;　Anatomy

谭庆晶,秦超,杨俊威,王天保,林浩海,张德敏,江志滨. 颈动脉分叉区域的神经血管解剖及其对颈动脉内膜剥脱术的临床意义[J]. 中国临床解剖学杂志, 2018, 36(2): 127-131.

TAN Qing-jing, QIN Chao, YANG Jun-wei,WANG Tian-bao, LIN Hao-hai,ZHANG De-min, JIANG Zhi-bin. The study of the nerve and vascular anatomy in the bifurcation region of the carotid artery and its clinical significance in carotid artery intimal dissection[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(2): 127-131.

参考文献

[1] 王涛.专题综述:颈动脉狭窄与卒中[J].中国卒中杂志, 2013, 28(1) : 39-40.
[2] 高峰, 杜彬, 秦海强, 等. 2007年颈动脉支架成形术专家共识[J]. 中国卒中杂志, 2007, 2(5): 430-454.
[3] Dumont TM, Rughani AI. National trends in carotid artery revascularization surgery[J]. J Neurosurg, 2012,116 (6) :1251-1257.
[4] 杨华, 刘健, 王景传, 等. 颅底动脉解剖影像特征的量化研究及其临床意义[J].中华医学杂志, 2003, 83(1):13-17.
[5] 王学廷, 潘为领, 王涛. MSCTA评价颈总动脉分叉正常解剖[J].医学影像学杂志, 2009, 19(9): 1106-1108.
[6] 徐群渊. 格氏解剖学—临床实践的解剖学基础[M].北京大学医学出版社, 2008: 649.
[7] Zachrisson H, Fouladiun M, Blomstrand C, et al. Functional assessment of high-grade ICA stenosis with duplex ultrasound and transcranial Doppler[J]. Clin Physiol Funct Imaging, 2012, 32(3)：241-246.
[8] Leseche G, Alsac JM, Houbbalah R, et al. Carotid endartereclomy in the acute phase of stroke-in-evolution is safe and effective in selected patients[J]. J Vasc Surg, 2012，55(3)：701-707.
[9] Assadian A, Senekowitsch C, Pfaffelmeyer N, et al. Incidence of cranial nerve injuries after carotid eversion endarterectomy with a transverse skin incision underregional anaesthesia [J]. Eur J Vasc Endovasc Surg, 2004, 28(4) : 421-424.
[10] Kochilas X, Bibas A, Xenellis J, et al. Surgical anatomy of the external branch of the superior laryngeal nerve and its clinical significance in head and neck surgery [J]. Clin Anat, 2008, 21(2): 99-105.
[11] AbuRahma AF, Choueiri MA. Cranial and cervical nerve injuries after repeat carotid endarterectomy [J]. J Vasc Surg, 2000, 32(4): 649-654.
[12]RogersW, Root HD. Cranial nerve injuries after carotid arte ryendarterectomy[J]. South Med J, 1998, 81(8): 1006-1009.
[13]Beasley WD, Gibbons CP. Cranial nerve injuries and the retrojugular approach in carotid endarterectomy [J]. Ann R Coll Surg Engl, 2008, 90(8): 685-688.
[14]Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trail Collaborators [J]. N Engl J Med, 1998, 339(20): 1415-1425.
[15]Ferguson GG, Eliasziw M, Barr HW, et al. The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients [J]. Stroke, 1999, 30(9): 1751-1758.
[16]闵红星, 何仲义, 韦晓勇, 等. 经胸锁乳突肌外侧缘颈内静脉穿刺置管的解剖学基础研究[J].宁夏医科大学学报, 2015, 37(9) :1017-1021.
[17]玄太权. 颈内动脉穿刺结合静脉溶栓治疗颈内动脉系统脑梗死的疗效分析[J].中外医疗, 2010, 7: 68-69.
[18]Saleh TM, Connell BJ, Legge C, et a1. Estrogen attenuates neuronal excitability in the insular cortex followirlg middle cerebral artery conclusion[J].Brain Res, 2004, 1018(1): 119-129.
[19]薛蕴菁, 高培毅, 林燕, 等. 应用图像后处理技术测量和分析人体颈动脉分叉血管几何学指标[J].中华放射学杂志, 2008, 42(8): 849-853.
[20]Johnston SC, Mendis S, Mathers CD. Global variation in strokeburden and mortality: estimates from monitoring, surveillance, and modeling[J].Lancet Neurol, 2009, 8:345-354.
[21] Murray CJ, Lopez AD. Measuring the global burden of disease[J]. N EnglJ Med, 2013 , 369(5): 448-457.
[22]沈松鹤, 蒋雄京, 董徽, 等. 主动脉弓解剖分型对颈动脉支架置入术技术指标的影响[J]. 中国循环杂志, 2015, 30(1): 34-37.
[23]郑夏, 樊雪强, 陈洁, 等. 颈动脉内膜剥脱术的危险因素分析[J].中日友好医院学报, 2016, 30(4): 210-212.
[24]Taboada CR, Duran Mariño JL, Garcia Colodro JM, et al. Clinical outcomes after carotid endarterectomy in patients with contralateral carotid occlusion[J]. Ann Vasc Surg, 2016, 32: 83- 87.
[25] 张萌, 郝继恒, 张利勇, 等. 颈动脉内膜剥脱术治疗高龄颈动脉狭窄患者效果分析[J]. 山东医药, 2016, 56(14): 18-20.
[26] 田磊, 关朝聚, 陈学东, 等. 颈动脉内膜剥脱术治疗老年症状性颈动脉狭窄的研究[J]. 中华老年心脑血管病杂志, 2013, 15(2): 126-128.
[27] 牛宏珍, 勇强, 张蕾, 等. 彩色多普勒超声在颈动脉内膜剥脱术中的应用[J]. 中国介入影像与治疗学, 2012, 9(12): 865-868.
[28] 吕旭光, 辜赶超, 杨宏伟, 等. 64层螺旋CT血管造影技术与多普勒超声在颈动脉内膜剥脱术中的应用价值[J].中国CT和MRI杂志, 2017, 15(11): 67-69,105.
[29] 王立娟, 勇强. DSA、常规超声与实时三维超声在颈动脉内膜剥脱术术前的诊断价值[J]. 血管与腔内血管外科杂志, 2016, 2(1): 36-40.

颈动脉分叉区域的神经血管解剖及其对颈动脉内膜剥脱术的临床意义

The study of the nerve and vascular anatomy in the bifurcation region of the carotid artery and its clinical significance in carotid artery intimal dissection

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	陈仁, 杨胜波. 咬肌的解剖与临床应用研究进展[J]. 中国临床解剖学杂志, 2024, 42(1): 115-117.
[2]	吴文斌, 胡雨田, 代琳曦, 吕旺轩, 吕丰均, 尹袁杰, 杨红梦, 畅君达, 李文奇, 郭义威. 椎神经节麻醉的应用解剖学研究[J]. 中国临床解剖学杂志, 2023, 41(6): 640-646.
[3]	白继岳, 徐永清. 周围神经选择性部分切断术治疗脑性瘫痪的解剖学研究进展[J]. 中国临床解剖学杂志, 2023, 41(6): 754-756.
[4]	何晓清, 杨曦, 石岩, 徐月仙, 方翔, 范新宇, 吴亚玲, 徐永清. 腓肠外侧浅动脉穿支皮瓣术中解剖学观察及临床意义[J]. 中国临床解剖学杂志, 2023, 41(2): 132-136.
[5]	陈帅, 易陈鹏, 王杰, 宫大伟, 焦峰, 黄华扬, 郑小飞, 王海彬. 胫侧副韧带与内侧半月板的关系解剖研究及临床意义[J]. 中国临床解剖学杂志, 2022, 40(5): 519-522.
[6]	朱明昇, 王增涛, 陈京国, 郝丽文, 陈超, 侯致典. 第1掌心动脉掌骨颈尺侧穿支的解剖研究及临床意义[J]. 中国临床解剖学杂志, 2022, 40(3): 249-254.
[7]	周家宇, 周国燕, 杨胜波. 成人前臂前群肌的神经入肌点定位及意义[J]. 中国临床解剖学杂志, 2022, 40(2): 126-131.
[8]	王少和, 范红斌, 史关祺, 陈杨澍, 高娣, 金哲悟, 王真, 杜斌, 胡一波, 吴柯. 近节指骨滑车损伤对近指间关节侧方稳定性影响的应用解剖学研究[J]. 中国临床解剖学杂志, 2021, 39(6): 635-637.
[9]	刘兴利, 杜自宏, 张湘敏, 尹俊琨, 付杜娟, 李治, 吕梁. 基于血管显像仪的右上肢肘窝区浅静脉应用解剖研究[J]. 中国临床解剖学杂志, 2021, 39(3): 269-275.
[10]	赵文韬, 赵民. 手指伸肌腱Ⅰ区肌腱末节指骨止点与毗邻组织的应用解剖学研究[J]. 中国临床解剖学杂志, 2021, 39(2): 126-129.
[11]	孙诗竹, 　于胜波, 　隋鸿锦. P45断层塑化技术在应用解剖学研究中的应用[J]. 中国临床解剖学杂志, 2021, 39(2): 240-243.
[12]	田维东, 彭龙锋, 祝绍磊, 王孝文. 小脑动脉与三叉神经根毗邻关系的应用解剖[J]. 中国临床解剖学杂志, 2020, 38(6): 625-628.
[13]	陈韦东, 钱蕾, 瞿东滨, 贺善礼, 李泽宇, 谭炜浩, 钟锦涛, 杨航, 欧阳钧, 郑明辉. 胸椎旁神经阻滞术穿刺深度的解剖学研究[J]. 中国临床解剖学杂志, 2020, 38(5): 545-548.
[14]	姜铧财, 龙雳, 李森. 高位髂腹股沟入路治疗Tile C型骨盆骨折的应用解剖及临床疗效[J]. 中国临床解剖学杂志, 2020, 38(4): 471-475.
[15]	曹禹文, 刘由军, 袁佳, 江凯燕, 徐聪. 后路经皮内窥镜下颈椎椎间盘切除术的解剖学研究及临床意义[J]. 中国临床解剖学杂志, 2020, 38(3): 246-249.