胸腔镜下切取膈神经的应用解剖

Applied anatomy of cutting the phrenic nerve under VATS

目的 :对胸段膈神经的解剖关系进行了研究。为电视胸腔镜下切取全长膈神经进行移位治疗臂丛损伤奠定解剖学基础。方法 :选用新鲜尸体 6具 12侧 ,对膈神经及其周围器官进行解剖观察。结果 :胸腔内覆盖膈神经的胸膜较疏松 ,易于分离 ;膈神经从锁骨下缘到入肌点的长度为 :右侧 (16 .5 0± 2 .17)cm ,左侧 (2 3 .0 0± 2 .5 0 )cm ;膈神经的血供主要来源于心包膈动脉 ,心包膈动脉的直径为 (1.30± 0 .15 )mm ;在胸廓入口处膈神经、心包膈动脉及胸廓内动脉之间的解剖关系不恒定。结论 :膈神经在胸腔内的解剖特点适合进行电视胸腔镜下的全长游离。但在胸廓入口处 ,膈神经、胸廓内动脉及由胸廓内动脉发出的心包膈动脉解剖位置不恒定。在临床操作时 ,该区域的处理是整个手术的关键。

Objective:To provide anatomical basis for cutting the whole long phrenic nerve with which to repair the defect of brachial plexus under VATS.Methods:The phrenic nerves and neighboring organs on 12 sides of 6 fresh cadavers were carefully observed.Results:The pleura covered the phrenic nerve was loose and easy to be separated.The mean lengths of phrenic nerve from the lower edge of clavicle to its enter point of diaphragm were 16.50±2.17 cm on the right side and 23.00±2.50 cm on the left side.The blood supply of the phrenic nerve mainly came from the perocardiacophrenic artery whose mean diameter was 1.30±0.15 mm.The relationship of the phrenic nerve,the perocardiacophrenic artery and the internal thoracic artery wasn't constant on the region of thoracic inlet.Conclusion:The anatomical character of phrenic nerve made itself suitable to be cut under VATS.However,since the relationship of the phrenic nerve,the perocardiacophrenic artery and the internal thoracic artery wasn't constant on the region of thoracic inlet,the operation on this region was key part in the whole clinical operation.