大隐静脉旁淋巴管的应用解剖
收稿日期: 2013-12-05
网络出版日期: 2014-06-04
基金资助
徐州医学院院长专项基金（53051116）；徐州医学院课题（2012KJ11)
The applied anatomy of lymphatics around the great saphenous vein
Received date: 2013-12-05
Online published: 2014-06-04
目的 研究大隐静脉周围淋巴管的解剖学特征，为治疗下肢继发性阻塞性淋巴水肿提供解剖学基础。 方法 择成年新鲜尸体3具，截取3对下肢。在内踝后皮内，注入少量双氧水，于真皮下找到淋巴管，将显影剂经30G注射针注入淋巴管。在下肢内侧沿显影之淋巴管进行追踪解剖、照像及X线记录。 结果 从内踝后区至腹股沟可见不同数量、大小的淋巴管，呈向心性、蜿蜒起伏地与大隐静脉伴行于下肢内侧的皮下组织内。管径在0.2 ~1.8 mm之间。在行程中淋巴管分叉或合流、或与附近淋巴管交叉通过。汇入腹股沟淋巴结前分成许多小分支。解剖过程中，发现了淋巴管壁的营养血管。 结论 详细描叙了从内踝后区到腹股沟淋巴结的淋巴通路。为治疗继发性淋巴水肿和其他与下肢淋巴系有关的疾病时提供形态学基础。
潘伟人 , 王德广 , 陈渊 , 曾凡强 . 大隐静脉旁淋巴管的应用解剖[J]. 中国临床解剖学杂志, 2014 , 32(3) : 269 -274 . DOI: 10.13418/j.issn.1001-165x.2014
Objective To determine the lymphatic anatomy around the great saphenous vein (GSV) for the treatment of secondary lymphoedema in the lower extremity. Methods A total of six lower extremities from three unembalmed human cadavers were studied. Under a surgical microscope, 6% hydrogen peroxide was used to detect the lymphatic vessels commencing on the skin between the medial malleolus and the Achilles tendon. A 30-gauge needle was inserted into the vessels and injected with a radio-opaque barium sulphate or lead oxide mixture. The vessels were traced, photographed and radiographed to demonstrate the lymphatic pathways around GSV in the lower extremity. Results Numerous lymphatic vessels were identified in the subcutaneous tissue around GSV travelling in the medial side of the lower extremity. They originated underneath the dermis between the medial malleolus and the Achilles tendon, travelling towards the superficial inguinal lymph nodes. The diameters of the vessels varied from 0.2 to 1.8 mm. During their tortuous course some vessels branched, diverged and converged, and sometimes anastomosed with neighboring vessels or crossed them. Most vessels converged to form larger collectors and then diverged into small branches before entering the lymph nodes. The nutrient vessels of the lymphatic vessels were found in 1 case. Conclusion Actual and accurate lymphatic routes from the skin between the medial malleolus and the Achilles tendon to the inguinal lymph nodes have been described. This information upgrades our anatomical knowledge and the results will be of bene?t for the clinical management of lymphedema and the other lymph-related diseases of the lower extremity.
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