上颌动脉-大脑中动脉血管搭桥的解剖学研究

Bypass of the maxillary to proximal middle cerebral artery: an anatomical and technical study

目的探讨上颌动脉与大脑中动脉第二段近端之间进行血管搭桥的可行性。方法解剖观察10具尸头标本(20侧)的颞浅动脉、上颌动脉及颞深动脉、大脑中动脉分叉部、颈总动脉分叉部及颈外、颈内动脉起始部,分别测量其外径,颈外、颈内动脉起始部及上颌动脉至大脑中动脉分叉部移植血管的走行距离。多普勒超声检查10例健康成人(20侧)的上颌动脉、颈总、颈外、颈内动脉及颞浅动脉主干、额支、顶支的内径和相关血流动力学参数。结果尸头解剖上颌动脉外径为(2.60±0.20)mm,大于颞浅动脉分叉部外径(1.70±0.30)mm,两者差异具有统计学意义(P<0.05);上颌动脉至大脑中动脉分叉部移植血管的行程为(61.70±1.50)mm,而颈外、颈内动脉至大脑中动脉分叉部移植血管的行程分别为(162.40±2.60)mm、(171.00±2.70)mm。超声多普勒检查上颌动脉第二段血流量为(62.70±13.30)mL/min,而颞浅动脉额支、顶支血流量仅(15.90±3.70)mL/min、(17.70±4.10)mL/min,均具有统计学差异(P<0.05)。结论上颌动脉与大脑中动脉第二段近端进行血管搭桥是切实可行的,具有血流量大、移植血管短、路径直等优点,是一种有效的颅内外血管搭桥方法。

Objective To investigate the feasibility of bypass between the maxillary artery （MA） and proximity of the second segment of middle cerebral artery （MCA）. Methods The superficial temporal artery and its branches, MA and deep temporal artery, the bifurcation of MCA, the bifurcation of common carotid artery, the beginning of external and internal carotid artery were dissected in ten perfused adult cadaver heads （20 sides）, and the outer diameters were measured respectively. The lengths of grafts vessels between the external carotid artery, internal carotid artery, MA and proximal MCA were measured respectively. Ten healthy adults （20 sides） were also included in the study. The inner diameter and blood flow dynamic parameters of the MA, common carotid artery, external carotid artery, internal carotid artery, superficial temporal artery and its two branches were measured with ultrasound examination. Results The outer diameter of MA was （2.60±0.20） mm, which was larger than that of the temporal artery trunk （1.70±0.30） mm. The lengths of grafts vessels between the external carotid artery, internal carotid artery and MCA bifurcate department were （162.40±2.60） mm and （171.00±2.70） mm, respectively, which were longer than that between MA and MCA bifurcate department （61.70±1.50） ram. The blood flow of the second segment of MA was （62.70±13.30） ml/min, which was more than that of the two branches of the superficial temporal artery （15.90±3.70） and （17.70±4.10） ml/min, respectively. Conclusion Bypass between the maxillary artery and proximity of the second segment of middle cerebral artery is feasible. It is a kind of effective high flow bypass, with which the graft vessel is shorter and straighter.