食管血管的分布特点及其临床意义

Clinic-practical anatomy of the esophageal vessels

目的观察食管各部的血管来源和分支分布特点,为食管微创外科的治疗和食管病变机制的分析提供形态学依据。方法采用50例体积分数为10%福尔马林固定和红色乳胶血管灌注的成人尸体标本进行大体解剖,观测食管的动脉来源、血管口径及其分支分布特点。结果①食管颈、胸和腹部的主要动脉分别来源于甲状腺下动脉、胸主动脉、肋间后动脉以及胃左和膈下动脉的食管支;②分布于食管各部的动脉口径和密度存在差异;③食管的静脉血分别经同名静脉回流至奇静脉和半奇静脉,食管胸部下段的静脉行程迂曲,且口径较粗。结论①食管各部的动脉口径和穿壁分支密度不同,各来源动脉之间存在吻合;②食管切除术中应保留各部来源的动脉主干,将可有利于植入器官的局部血循环重建,避免食管切除后器官吻合端坏死;③食管胸部中、下段静脉迂曲较粗,呈现淤血征象。

Aim ： The vessel origins and the distributive characteristic of the esophageal vessels were observed to provide the morphological basis for clinic so as to reduce the damage in esophagectomy by minimally invasive operation and analyze the mechanism of the esophageal diseases. Methods：The gross dissections were performed on 50 cadavers fixed with 10% formaldehyde and perfused with red emulsion. The origins, the distributive characteristic and the diameter of the esophageal arteries were observed and measured,and the data were analyzed statistically. Results： The esophageal arteries of the cervical, thoracic, abdominal parts originated from the esophageal branches of the inferior thyroid artery, tho- racic aorta, posterior intercostal arteries and inferior phrenic artery; the esophageal arteries and their branches at different part of the esophagus were different in the diameter and density;the vein blood of each part of the esophagus entered the azygos and hemiazygos veins by its veins, and the veins of the middle and inferior thoracic segment of the esophagus travelled tortuously and the diameter of them was larger. Conclusion： The esophageal arteries originate differently and their branches enter the esophageal wall of each part in different density, and the anastomoses exist between the esophageal arteries of each origin ; the main trunk of each origin of esophageal artery should be reserved, which may benefit the transplanting-organ to re-stablish the regional blood circulation and prevent the anastomose terminal necrosis ; the veins of the middle and inferior thoracic segment of the esophagus travel tortuously and the diameter of them is larger with stagnanted blood.