手指淋巴管的应用解剖

Applied anatomy of digital lymphatic vessels

目的研究人体指淋巴管的解剖特征为临床提供解剖学基础。方法 2具新鲜成人尸体4例手标本,指尖两侧皮内,注入少量双氧水墨水混合剂。于真皮下找到淋巴管,将显影剂经30G注射针注入。追踪指淋巴管的行程并进行照像和X线记录。1例标本作指截面研究。结果各指两侧皮下各分布淋巴管1支,近指根处偶见多支。它们始于远侧指间关节两侧真皮下、沿指中轴两侧皮下组织蜿蜒起伏地行走。管径0.2~0.8 mm,近端较粗,远端较细。除拇指桡侧和小指尺侧淋巴管各自在掌背尺、桡侧汇入手背淋巴管外,其他指淋巴管在指蹼处与邻近淋巴管吻合,再汇入掌背淋巴管。指横截面显示指淋巴管与周围组织的解剖关系。结论详细描述了各指淋巴管的解剖形态,以及与周围组织、血管神经的关系,为临床和科研提供解剖学基础。

Objective To determine the lymphatic anatomy in human digits. Methods xture of 6% hydrogen peroxide with ink was used to detect lymphatic vessels commencing on bilateral sides of each fingertip. A 30-gauge needle was inserted into the lymphatic vessel and injected with a radio-opaque barium sulphate or lead oxide mixture. Vessels were traced, photographed and radiographed to demonstrate the lymphatic pathways and the relationship with the surrounding tissues in each digit. Transverse sections were made in one specimen. Results Each digit contained two collecting lymphatic vessels, one on each side.The diameter of the vessels varied from 0.2 to 0.8 mm, being larger in the proximal side and smaller in the distal end. They originated underneath the dermis on sides of the distal phalanges and travelled tortuously along the midaxial lines in the subcutaneous tissue on each side of digits. Vessels of adjacent digits converged in web spaces of the hand except vessels on the lateral border of the thumb and the medial border of the little finger. They then traveled radially to merge with lymphatic vessels in the dorsum of the hand. Transverse section of the finger showed locations of the digital lymphatic vessels, arteries, veins, nerves and neighboring tissues. Conclusion Actual and accurate lymphatic anatomy of the human digits has been described. This information upgrades our lymphatic anatomical knowledge and the results will be of benefit for clinical management and further studies in the region.