中国人肺的支气管和血管 三、右肺下叶的支气管和血管

AN ANALYSIS OF THE VARIATIONS OF THE BRONCHOVASCULAR PATTERN OF THE RIGHT LOWER LOBE IN FIFTY CHINESE LUNGS

采用考查右肺上叶和中叶的方法考查了50例成年右肺下叶的支气管和血管。右下叶恒定的段支气管有五支,即尖段支气管(B^(6)),内侧基底段支气管(B^(7))^(-),前基底段支气管(B^(8)),外侧基底段支气管(B^(9)),后基底段支气管(B^(10))。尖下段支气管(B^(*))的出现率为46%。B最常见的分支型式是单干类二分支型(B^(6)c,B^(6)a+b),为84%。B^(7)的内侧支(B^(7)b)经右下肺静脉后方(深面)分布于椎旁面的为10%,在施行内侧基底段切除时应予注意,以免损伤右下肺静脉。外侧基底段支气管的后支(即BX^(*)a)在右下叶的出现率为12%。本文讨论了BX^(*)(10)和BX^(*)(9)的命名问题。右下叶动脉的分支数目和分支型式与支气管相同的仅为14%,彼此数目相同分支型式不同的为26%,其余动脉的分支数目和分支型式均不一致。尖段动脉(A^(6))的常见分支型式与尖段支气管一样,是单干类的二分支型(A^(6)c,A^(6)a+b),为58%。前基底段动脉(A^(8))与内侧基底段动脉(A^(7))或内侧基底段动脉外侧支(A^(7)a)共干的占48%,与其它作者的结果之间有显著差别。尖下段动脉(A^(*))的来源不一,它的总支数较B^(*)多,除A^(*)与同数的B^(*)伴行外,还有三支A^(*)伴两支B^(*)的现象。后基底段动脉后支(A^(10)c)(即AX^(*)(10))的起源和支数与尖下段动脉有相似的现象。尖下段动脉和后基底段动脉的后支与它们所伴行的支气管之间,在起源上和分支数目上存在着异源异数或异源同数或同源异数的关系。右肺下叶的静脉与右上叶和中叶一样,行于段间或亚段间,汇集成尖段静脉、上基底静脉和下基底静脉三大支。上、下基底静脉先汇集成总基底静脉,再与尖段静脉组成右下肺静脉。上基底静脉和下基底静脉的组成型式,本文分为正常型、分裂型和异常型。正常型是常见的型式,为66%。右肺下叶的静脉与支气管和动脉间缺少联系。动脉与支气管在分支型式上不尽相同,但在分布上却紧密伴随。

The distribution and arrangement of the segmental bronchi and blood vessels of the lower lobe of right lung have been studied in fifty adult cadavers,by the same methods as those for the right upper and middle lobes reported previously.1.Five segmental bronchi are constantly present in right lower lobe as described in textbook.Subapical bronchus(B^(*))has been identified only 46%in this series of specimens.The prevailing pattern of the branches of the apical bronchus is a bifurcation of B^(6)c,B^(6)a+b.In 10%of the medial basal segmental bronchus,its medial ramus(B^(7)b)is deep to the basal veins.Resection of this type of medial basal segment is considered to be harzardous.Posterior ramus of the lateral basal segmental bronchus(B^(9)c or BX^(*)9)has been found in 12%of the specimens.This has not been reported by E.A.Boyden or by other Chinese writers.2.The number and pattern of origin of the segmental arteries of the right lower lobe are more complex than those of the segmental bronchi.Only in 14%of the speci-mens,the segmental arteries are the same in number and origin as the segmental bronchi,the rest being variable.Same as B^(6),the prevailing pattern(58%)of the branches of the apical segmental artery is a bifurcation of A^(6)c,A^(6)a+b.In 48%of the specimens,the anterior basal segmental artery arises in a common stem with A^(7) or A^(7)a.Comparing with other re-ports,this fact is significant.The total number of subapical segmental arteries(A^(*))in this series of specimens is larger than its accompaning subapical segmental bronchi.Occasionally,the subapical artery arises from the beginning part of the posterior basal segmental artery.The number of the posterior ramus of the posterior basal segmental artery(A^(10)c or accessory subsuperior artery)is not always the same as its accompaning artery.It may arise from A^(9) or the pars basalis of the right pulmonary artery.3.The veins of the right lower lobe are same as the right upper and middle lobes,situated between segments or subsegments.They usually form two main veins which are drained into the right lower pulmonary vein.The basal veins may be classified into three types;the uncomplicated type is the prevailing pattern which occurs in 66%.