膈肌代食管手术可行性的动物解剖学研究

The feasibility of esophagus repair using diaphragm:animal anatomy

目的研究猪膈肌的结构和动脉血供,探讨对猪行膈肌代食管手术实验的解剖学可行性并为其提供理论依据。方法杂种长白猪6头经动脉灌注明胶-氧化铅混悬液,CT扫描后将图像导入计算机行三维重建,并观察膈肌各条供血动脉的起源、走形、和分支;完整切取膈肌组织行X线摄片,观察各动脉在膈肌上分支、供血范围及相互的吻合;同时对膈肌进行大体解剖和测量。结果猪膈肌位置及结构与人类存在部分差异,其血供主要来自肌膈动脉、后肋间动脉、心包膈动脉及膈动脉,其主干和主要分支在重建图像上基本可显示,在X线图上可见其在膈肌上的分支丰富,相互吻合广泛。结论从猪膈肌的结构、动脉血供来看,具备作为带蒂组织瓣行食管替代的解剖可行性;而以膈动脉为血管蒂取组织瓣应为该手术最佳选择。

Objective To investigate the architecture and arterial blood supply of porcine diaphragm,and explore the feasibility of esophagus repair using diaphragm.Methods 6 anesthetized mongrel Landrace were perfused with gelatin-lead oxide mixture and underwent CT scanning.The acquired images were input into the computer to perform 3-dimensional reconstruction.The origin,course and branches of the diaphragmatic arteries were analyzed.After that,diaphragms were incised and underwent X-ray for exploring the phrenic distribution of different arteries and their anastomosis with each other,and compared with that of anatomic measurement of diaphragm.Results The location and structure of the porcine diaphragm was different with that of human being.It＇s blood supply was mainly from the musculophrenic artery,posterior intercostal artery,pericardiacophrenic artery and phrenic artery.Their trunks and major branches can be clearly disclosed by the 3D images.X-ray images disclosed their abundant diaphragmic distribution and anastomosis.Conclusions Considering the architecture and blood supply of porcine diaphragm,it is possible to take diaphragm tissue flap pedicled with phrenic artery to repair esophagus.