应用解剖

胸腔镜下胸导管结扎术的应用解剖

  • 张小文 ,
  • 杨劼 ,
  • 刘文国 ,
  • 黄峰 ,
  • 王跃建 ,
  • 张斌 ,
  • 吴校连 ,
  • 古卫权 ,
  • 叶俊 ,
  • 王飞
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  • 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
张小文(1987-),男,山西吕梁人,在读硕士,研究方向:胸外科,Tel:(0757)83161319

收稿日期: 2014-01-20

  网络出版日期: 2014-06-04

基金资助

广东省科技计划项目(01593850171507050)

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

  • ZHANG Xiao-Wen ,
  • YANG Jie ,
  • LIU Wen-Guo ,
  • HUANG Feng ,
  • WANG Ti-Jian ,
  • ZHANG Bin ,
  • TUN Jiao-Lian ,
  • GU Wei-Quan ,
  • XIE Dun ,
  • WANG Fei
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  • 1.Department of Thoracic Surgery, The First People’s Hospital of Foshan (The Foshan Affiliated Hospital, Sun Yat-sen University), Foshan 528000, China;  2. Foshan University, Foshan 528000, Guangdong Province, China

Received date: 2014-01-20

  Online published: 2014-06-04

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。

本文引用格式

张小文 , 杨劼 , 刘文国 , 黄峰 , 王跃建 , 张斌 , 吴校连 , 古卫权 , 叶俊 , 王飞 . 胸腔镜下胸导管结扎术的应用解剖[J]. 中国临床解剖学杂志, 2014 , 32(3) : 264 -268 . DOI: 10.13418/j.issn.1001-165x.201

Abstract

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. ② The 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.

参考文献


[1]  王圣应, 王震寰, 张荣新. 颈段胸导管的临床应用解剖研究
[J].淮海医药,2000,18(4):241-242.

[2]  纪荣明, 蒋尔鹏, 申晓军, 等. 腹部手术致乳糜漏解剖学基础的研究
[J].中华外科杂志, 2004, 42(14):857-860.

[3]  张烽, 朱海涛, 陈向东, 等. T4-T12节段椎体与相邻脉管神经系统的应用解剖
[J].中国临床解剖学杂志,2009,27(3):256-262.

[4]  冉茂成, 朱世清, 郭旺, 等. 奇静脉的临床应用解剖
[J]. 局解手术学杂志, 2013, 22(3):241-242.

[5]  傅剑华, 胡袆, 黄伟钊, 等. 预防性胸导管结扎术在食管癌根治术中应用的评价
[J].癌症, 2006, 25(6):728-730.

[6]  Cagol M, Ruol A, Castoro C, et al. Prophylactic thoracic duct mass ligation prevents chylothorax after transthoracic esophagectomy for cancer
[J]. World J Surg, 2009, 33(8):1684-1686.

[7]  Lai FC, Chen L, Tu YR, et al. Prevention of chylothorax complicating extensive esophageal resection by mass ligation of thoracic duct: arandom control study
[J]. Ann Thorac Surg, 2011, 91(6):1770-1774.

[8]  于戈, 鞠进, 高国刚, 等. 胸导管结扎在肺癌手术中应用的临床研究
[J]. 中国实用医药, 2009, 4(24):25-27.

[9]  钟钊, 龚晟, 张永恒. 膈上结扎胸导管对预防食管癌术后乳糜胸的临床研究
[J]. 中国医药指南, 2013, 11(3):164-165.

[10]张玉斌, 李文献, 刘雅彬, 等. 乳糜胸与术中胸导管预防性结扎
[J]. 中国胸心血管外科临床杂志, 1999, 6(1):42-43.

[11]应开军, 黄利荣, 吴广洲, 等. 胸腔镜下hem-o-lok结扎锁治疗食管癌术后乳糜胸
[J]. 江苏医药, 2013, 39(15):1829-1830.

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