肺段的冠状断层解剖:断层标本与多层螺旋CT图像对照研究

Coronal sectional anatomy of pulmonary segments correlated with multislice spiral CT image

目的:研究肺段在冠状断面上的划分及分布。方法:利用20例胸部连续冠状断层标本、2例多层螺旋CT图像、5侧游离肺剥离标本和7侧肺管道铸型,追踪观察了肺叶和肺段的支气管、肺动脉和肺静脉,并据此在冠状断面上划分了肺段。结果:肺段主要分布于从胸骨角至脊柱的10个断面里,气管杈层面是在冠状断面上划分肺段的最佳开始层面。在冠状断面上有6个划分肺段的关键层面:①升主动脉层面,划分肺段的标志性结构尖段静脉、外侧段静脉、尖后段静脉、左前段静脉和上舌段静脉均出现;②肺动脉杈层面,于肺动脉权下方可见到左、右上肺静脉,在11例(55％)标本中出现尖后段静脉、前段静脉和舌静脉干同时汇入左上肺静脉的情形;③气管杈层面,左、右肺上叶支气管及其分支显示清晰,于气管杈下方可见到左、右下肺静脉汇入左心房;④中间支气管层面,可见到两肺下叶肺段支气管、肺动脉和肺静脉的起源;⑤胸主动脉层面,主要为两肺上段和外后底段的支气管和血管;⑥脊柱层面,两肺下叶主要表现为上段、外侧底段和后底段的支气管和血管。结论:通过仔细辨认肺段支气管、肺动脉和肺静脉,可在冠状断面上精确划分肺段。

Objective: To investigate the division and distribution of pulmonary segments on the coronal section. Methods: Through serial coronal sections of thorax of 20 adult cadavers, multislice spiral CT images of 2 healthy volunteers, 5 tripped specimens of lung and 7 corrosion casts of lung, the lobar and segmental bronchi, arteries and veins were observed and pulmonary segments were divided on the coronal section. Results: The pulmonary segments mainly distributed on 10 sections from sternal angle to vertebral column. The section through the bifurcation of trachea was the best beginning section for the division of pulmonary segments on the coronal section. There were 6 key sections for the division of pulmonary segments on the coronal section: ① On the section through ascending aorta, the apical segmental vein, lateral segmental vein, apicoposterior segmental vein, left anterior segmental vein, and superior lingular vein appeared. Those veins were the landmarks for the division of pulmonary segments. ② On the section through pulmonary bifurcation, the left and right superior pulmonary veins could be seen under the pulmonary bifurcation. It appeared on the coronal sections of 11 cadavers (55%) that apicoposterior segmental vein, anterior segmental vein, and lingular venous trunk drained into left superior puimonary vein simultaneously. ③ On the section through bifurcation of trachea, left and right superior lobar bronchi and their branches demonstrated clearly. Under the bifurcation of trachea, it showed that left and right inferior pulmonary veins converged into left atrium. ④ On the section through intermediate bronchus, the origin of segmental bronchi, arteries and veins of bilateral lungs could be found.⑤The superior segmental and lateroposterior basai segmental bronchovasculature mainly appeared on the section through thoracic aorta. ⑥ On the section through spinal column, the inferior lobes of bilateral lungs mainly showed the bronchi, arteries and veins of superior, lateral basai and posterior basai segments. Conclusions: The pulmonary segments can be divided exactly on the coronal section by recognizing the lobar and segmental bronchi, arteries and veins of the lungs carefully.