带蒂膈肌瓣重建食管的临床解剖学可行性研究

Feasibility of the pedicled diaphragmatic flap on esophageal reconstruction

目的为带血管蒂膈肌瓣重建食管提供解剖学依据。方法在12具经动脉灌注红色乳胶的成人防腐标本上,解剖观测膈肌神经血管的起源、走行、外径、分布、长度及其交通情况。结果膈肌的营养血管主要有膈下动脉,肌膈动脉、心包膈动脉膈肌支、膈上动脉和下位肋间后动脉的部分分支。膈下动脉是膈肌的主要供血血管,主要起始于腹腔动脉干或腹主动脉,起始点外径分别为:(1.52±0.06)mm,(1.61±0.04)mm。经左右膈脚的两侧上行进入膈肌,分别分成前、后两支。前支行向前外,支配中心腱中间部、中心腱两侧叶前部、部分膈肌前肋部,后支行向后外,分布中心腱两侧叶后部、部分膈肌后肋部、部分膈肌腰部。结论以膈下动脉为血管蒂的膈肌瓣完全具有重建食管的解剖学可行性。

Objective To explore the feasibility of the pedicled diaphragmatic flap on esophageal reconstruction through anatomic study.Methods To dissect and observe the origin,course,outer diameters,distribution,length and anastomosis of diaphragmatic neuro-vascularity in 12 adult antiseptic specimens perfused with red latex.Results The blood vessels of diaphragm were mainly from inferior phrenic artery,muscle phrenic artery,pericardiacophrenic artery,superior phrenic artery and the branches of the lower posterior intercostal artery.Inferior phrenic artery was the primary one among them,which mainly originated from the trunk of the celiac artery or the abdominal aorta,with the left and right outer diameters at their original site of（1.52±0.06）mm and（1.61±0.04）mm respectively.They passed through the both phrenic angle and reached the diaphragm,and given the anterior and posterior branches to diaphragm.The anterior one coursed anterolaterally,and supplied the center of the central tendon,the anterior part of the both lobes of the central tendon and the anterior costal part of diaphragm.The posterior one coursed posterolaterally,and supplied the posterior part of the both lobes of the central tendon,the posterior costal part and waist of diaphragm.Conclusions It is absolutely anatomically feasible to reconstruct esophagus with pedicled diaphragmatic flap which takes the inferior phrenic artery as the vascular pedicle.