右肺肺段和亚肺段支气管和血管的矢状断层解剖学研究

Segmental and subsegmental bronchovascular anatomy of the right lung on the sagittal section

目的:研究右肺肺段和亚肺段支气管和血管在矢状断面上的配布规律。方法:利用15例胸部连续矢状断层标本和2例多层螺旋CT图像,追踪观察了右肺肺段和亚肺段支气管和血管,并据此寻找在矢状断面上划分右肺肺段的方法。结果:在右主支气管杈层面上,右肺上叶动脉发出尖段动脉和前段动脉,右肺下叶支气管向后发出上段支气管、向下发出内侧底段支气管。在叶间动脉层面上,右肺上叶支气管发出尖、后、前段支气管,基底干支气管发出前、外侧和后底段支气管。在叶间动脉分叉层面上,后段静脉居前、后段支气管之间,尖段静脉与前段静脉合成尖前静脉,中叶支气管分为外、内侧段支气管,下叶动脉发出的段级动脉居相应支气管的上方。在右心房右侧第二层面上,右肺上、中叶的支气管和血管已为亚段级,在右肺下叶内,肺段支气管居中,其上、下方分别为相应的肺动脉和肺静脉。结论:在矢状断面上,右侧肺段内支气管和血管相对集中,且容易显示其发出处和长轴,故矢状断面是显示右肺肺段和亚肺段支气管和血管的优势断面。

Objective： To explore the anatomic characteristics of the segmental and subsegmental bronchi, arteries, and veins of the right lung on the sagittal section, Methods： The segmental and subsegmental bronchi, arteries, and veins were observed through serial sagittal sections of thorax of 15 adult cadavers and multislice spiral CT images of 2 healthy right lung. Their anatomic relationships were also evaluated. Results： On the section through the bifurcation of right principal bronchus, right superior lobar artery sent out apical and anterior segmental arteries, and right inferior lobar bronchus sent out superior segmental bronchus backwards and medial basal segmental bronchus downwards. On the section through interlobar artery, right superior lobar bronchus sent out apical, posterior, and anterior segmental bronchi, while basal tnmk bronchus sent out anterior, lateral, and posterior basal segmental bronchi. On the section through the bifurcation of interlobar artery, posterior segmental vein laid between anterior and posterior segmental bronchi, Apical and anterior segmental veins merged into apicoanterior vein. Middle lobar bronchus sent out lateral and medial segmental bronchi. The segmental arteries arising from inferior lobar artery laid superior to their corresponding bronchi. On the second section through the right side of right atrium, the bronchi and blood vessels of the superior and middle lobes of the right lung became subsegmental branches. In the inferior lobe of right lung, the segmental bronchi laid between the corresponding arteries superiorly and the corresponding veins inferiorly. Conclusions： On the sagittal section, the bronchi and blood vessels in the right pulmonary segments are intensive relatively, and their origin and axes are easily shown at the same time. So the sagittal section is the advantaged section which displaying the segmental and subsegmental bronchi and blood vessels of the right lung,