劈胸骨柄同时锁骨部分离断上胸段胸椎前入路的应用解剖学

Applied .anatomy of the anterior approach to the upper thoracic vertibral bodies with osteotomy of the partial clavicle and median sternotomy

目的为临床经劈胸骨同时锁骨部分离断显露脊柱上胸段提供解剖学依据。方法对30例经福尔马林固定、红色乳胶灌注的成人尸体标本采用劈胸骨柄，同时锁骨部分切断术（左侧径路）进行解剖，观察术中遇到的部分重要解剖结构。结果左头臂静脉属支有颈内静脉、锁骨下静脉、椎静脉、甲状腺下静脉、左第1肋间静脉、左肋间最上静脉、胸廓内静脉。左胸膜顶内侧部借疏松结缔组织、胸内筋膜与胸骨柄相连，易分离。左喉返神经较右喉返神经行程长，与气管食管交角小。胸导管大部分在T4至T6椎体平面越过中线（20例，66．6％），从右侧向左侧斜行跨过椎体。胸交感干和星状神经节位置固定。结论对局部解剖的熟悉程度及术中正确辨认前述解剖结构是手术成功的关键。

Objective To provide clinical anatomic basis for revealing the upper thoracic vertebrae with osteotomy of the partial clavicle and median sternotomy. Methods 30 adult embalmed cadavers were selected. By modeling the anterior approach the upper thoracic vertibral bodies,the partial important structures were observed. Results The tributaries of the left brachiocephalic vein have the left internal jugular vein, the subclavian vein, the left vertebral vein, the left inferior thyroid vein, the first posterior intercostal vein,et al. There are soft connective tissue and endoth0racic fascia between the left cupula of pleura and the sternum manubri- um. It is easy to detach them. At the level of the fourth, fifth and sixth thoracic vertebrae, the most thoracic ducts cross to the left of the vertebral column. The thoracic sympathetic trunk and the stellate ganglion are connected to the spinal nerves by communicating branches and it is difficult to detach them from other structures. Conclusion The key of a successful operation is to be familiar with the regi.nal anatomy and to identify these important anatomic structures.