大网膜移植的应用解剖

Applied anatomy of the greater omentum in transplantation

目的观测大网膜的形态及血管分布，探讨大网膜的设计剪裁，为临床提供可靠的解剖学资料。方法选用12例防腐固定处理的成人尸体，3例成人新鲜尸体。分别巨微解剖观测大网膜的形态及血管分布、进行明胶一氧化铅血管造影及三维重建。结果大网膜的长度为（24．7±6．9）cm，宽度为（28．3±2．8）cm，分为薄、中、厚三型，薄型占33．3％，中型占46．7％，厚型占20．0％。大网膜的血供来源于胃网膜左、右动脉沿胃大弯连接而构成胃网膜血管弓，从胃网膜血管弓向大网膜发出血管分支。大网膜的主要动脉有4条：①大网膜右动脉：起始处外径为（1．0±0．4）mm。②大网膜中动脉：起始处外径为（0．7±0．3）mm。③大网膜左动脉：起始处外径为（1．2±0．4）mm。④大网膜副动脉：起始处外径为（0．5±0．1）mm。结论根据大网膜前、后弓血管的解剖特点、大网膜中动脉分又位置的高低及与延长方法，将大网膜分为5种不同的类型。在临床裁剪使用大网膜时，应根据5型的不同特点做不同的裁剪。

Objective To observe the shape, size, position and vessels of greater omentum. To ex- plore the design of greater omentum and clarify its clinical significance. Methods Three fresh and 12 formalin-fixed cadaveres were dissected. All of them had no damage nor injury. 1. Macro-micro-dissection： The shape, size and position of greater omentum were observed. The vessels of the greater omentum were studied. 2. Lead oxide-gelatin injection technique and three-dimensional reconstruction. Results The length of greater omentum was（24.7±6.9）cm,the width was（28.3±2.8）cm. It could be divided into 3 types： thin type, middle type and thick type, the occurrence rate was 33.3%, 46.7% and 20.0% respectively. The blood sup- ply of greater omentum mainly came from the gastroepiploic arch composed of the left gastroepiploic artery and the right gastroepiploic artery. There were 4 main arteries of the greater omentum： （1）The right epiploic artery： The external diameter at origination was（1.0±0.4）mm.（2） The middle epiploic artery： The exterual diameter at origination was （0.7 ± 0.3）mm. （3）The left epiploic artery：The external diameter at origination was （1.2±0.4）mm. （4） The accessary epiploic artery： The external diameter at origination was （0.5 ± 0.1）mm. Conclusion According to the characteristic of the anterior arch and posterior arch, the position of the mid- dle epiploic artery divarication and the method of spread, the greater omentum is divided into 5 types. It should be according to the characteristic, when the greater omentum is designed and clipped.