颈胸交界区前入路手术的解剖学研究及临床意义

Anatomical study and clinical significance of anterior surgical approach to the cervicot-horacic junction

目的观察颈胸交界区前入路手术的显露范围并测量相关解剖学参数,以为临床应用提供解剖学依据。方法10具成年国人尸体标本,模拟颈胸交界区前入路手术,劈开部分胸骨,观察显露范围及解剖结构,并测量相关解剖学参数。结果10具标本右侧喉返神经均于C7椎体下缘平面以上进入气管食管沟,位置较高,走行变异较大;左侧喉返神经于T3椎体下缘平面以下进入气管食管沟,位置较低,且全程走行于气管食管沟内,位置恒定。双侧头臂静脉汇合点解剖位置不尽一致,其中4具位于右侧第1胸肋关节后方,4具位于第1肋间隙胸骨柄右缘,2具位于第2胸肋关节后方。7具胸导管于C7-T1椎间盘平面至T2椎体上缘平面之间汇入左侧静脉角。结论颈胸交界区前入路手术可充分显露C3～T3椎体,双侧头臂静脉汇合点位置是决定手术显露范围的关键。采用左侧切口,对喉返神经损伤小,但须注意保护胸导管。

Objective To study the anatomical relationship between the cervico-thoracic junction （CTJ） and adjacent structures in anterior surgical approach, and to measure the related anatomical parameters for clinical application of the anterior surgical approach to the cervico-thoracic junction. Methods Ten Chinese adult cadavers were dissected, simulating the anterior surgical approach. After the manubrium of sternum was split, the exposure area and anatomical structures were studied, and the related anatomical parame-ters were measured. Results The right recurrent laryngeal nerve reached the tracheoesophageal groove at the level up the lower part of C7 in all cadavers, the entry point was high and variable. In all cadavers the left recurrent laryngeal nerve run within the tracheoesophageal groove from the entry point at the level below the lower part of T3, and the position was more constant. The confluence point of bilateral brachiocephalic veins was variable, in 4 cases it was found at the posterior of the right first sternocostal joint, 4 at the first intercostal space near the right margin of sternum, and 2 at the posterior of the second sternocostal joint. In 7 cadavers the thoracic duct converged into the venous system from C7-T1 disc to the upper part of T2. Conclusion An adequate exposure from C3 to T3 can be obtained in the anterior surgical approach. The confluence point of bilateral brachiocephalic veins plays a key role in the surgical exposure. A left anterior surgical approach could cause less injury to the recurrent laryngeal nerve, and attention should be paid to protect the thoracic duct.