动脉导管三角的应用解剖学研究

An application anatomic study of the ductus arteriosus triangle

目的研究动脉导管三角区，为动脉导管未闭手术提供解剖学依据。方法解剖30具（男性22具，女性8具）成人尸体标本，在动脉导管三角区进行解剖、观察和测量。结果①在动脉导管三角内，左膈神经的长度为（7．30±0．85）cm，左迷走神经的长度为（6．08±0．50）cm；左肺动脉的长度为（2.31±0．9）cm；α角为（18±0．6）°；动脉导管三角的面积为（6．8±0．7）cm^2。②动脉韧带长度为（14．0±5．6）mm，宽度为（4．5±0．8）mm。③左喉返神经跨过主动脉弓前方时发出，继而绕此动脉下后方上行，返回颈部，其在迷走神经的返折点平对T3椎体2具（7．0％），T3／4椎间盘9具（30．0％），T4椎体12具（40．0％），T5椎体4具（13．0％），T6椎体3具（10．0％）。左喉返神经跨越动脉韧带主动脉侧1／3段者占58．1％（17例），中1／3段者占22．8％（7例），肺动脉侧1／3段者占19．1％（6例）。结论在动脉导管未闭手术中，手术暴露在T3／4椎间盘、T4椎体高度以上时比较安全，应注意避免损伤左喉返神经。

Objectives To explore the anatomical features of the ductus arteriosus triangle and provide morphologic data for ligation of ductus arteriosus. Methods The anatomic study on 30 （male 22, female 8 ） cadavers was taken. And the aim mainly focused on the originating site of the left bronchial artery from the aorta and the site where the left recurrent laryngeal nerve override the arterial ligament. Results （1）In the area of ductus arteriosus triangle, the length of left phrenic nerve was （7.30±0.85）cm, the length of left vagus nerve was （6.08± 0.50）cm, the length of left pulmonary artery was （2.31±0.90）cm, α was （18±0.6）°, the area of ductus arteriosus triangle was （6.8±0.7）cm^2. （2）The length ofarterial ligament was （14.0±5.6）mm, and the extent was （4.5±0.8） mm. （3）The laryngeal nerve was come from aortic arch, and then descended, returned to corvical part. Two（7.0%） of the break point of cranial nerve equal to the centra of T3, to the disci intervertebrales of T3/4 was 9（30%）. To the centra of T4 was 12（40% ）, and to the centra of T5 was 4 （13%）. The centra of T6 was 3 （10%）. Conclusion In the operation of patent ductus arteriosus （PDA）, it was safer that exposed above the height of disei intervertebrales of T3/4 or the centra of T4. It should be carefully avoid injuring left laryngeal nerve.