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胸骨旁入路胸腔及心包腔穿刺相关的内乳血管CT影像学研究

Parasternal transthoracic and pericaridal puncture related anatomy of internal mammary arteries by multi-slice computed tomography
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摘要 目的 探讨内乳血管的解剖类型及内乳动脉(IMA)与第1~5肋间隙胸骨边缘距离的CT影像学特点,为胸骨旁入路穿刺路径设计提供影像学依据.方法 回顾性分析2016年3—12月在南京医科大学附属无锡第二医院影像中心行胸部64排CT检查244例患者的临床影像学资料.其中,男129例,女95例;年龄27~90岁,平均(63.2±10.4)岁.通过冠状位薄块曲面最大密度投影重建图像观察患者内乳血管在胸骨旁的走行特点,参照修订的Schwabegger分类法记录内乳血管的解剖类型,测量比较不同解剖类型、侧别、性别间两侧IMA与第1~5肋间隙胸骨边缘距离.结果 单根动脉伴单根静脉的Ⅱ型和Ⅳ型是最常见的内乳血管解剖类型(左侧分别为73.7%、19.6%,右侧分别为61.2%、15.6%),其次为Ⅰ型、Ⅲ型和Ⅴ型(左侧分别为2.2%、2.7%和1.8%,右侧分别为12.5%、7.1%和3.6%).不同肋间隙左右两侧IMA距离胸骨边缘的距离比较,差异均无统计学意义(P值均〉0.05);同一侧别不同肋间隙之间IMA与胸骨缘的距离由小到大依次为第1、3、2、4、5肋间隙,差异均有统计学意义(P值均〈0.05).女性左侧第2、3、5肋间隙和右侧第2肋间隙的IMA与胸骨边缘的距离均小于男性,差异均有统计学意义(P值均〈0.05).不同解剖类型各肋间隙之间IMA与胸骨缘的距离差异均无统计学意义(P值均〉0.05).结论 多层螺旋CT可以显示内乳血管的解剖类型,并能够准确测量IMA与胸骨边缘的距离,为胸骨旁胸腔及心包腔穿刺的手术路径设计提供了精确的影像学信息. Objective To explore anatomical variations of the internal mammary arteries (IMA) and measure its distances with the sternum from chest CT imaging , and to provide imaging data for route design of parasternal transthoracic or pericardial interventions .Methods CT data from 224 patients [Male 129, female 95, average age (63.2 ±10.4) years, range 27 -90 years] who underwent enhanced chest multi-slice computed tomography were retrospectively analyzed .The modified Schwabegger classification was used to define the anatomical type of bilateral internal vessels and the distance between IMA and sternum edge from the 1st to the 5th intercostal space (ICS) were also determined on reconstructed coronal thin slab curved multiple planar paralleled with sternum combined with maximum intensity projection images .Results One artery accompanied with one vein was mostly encountered IMA anatomical type (type Ⅱ and type Ⅳ, 73.7% and 19.6% in the left, 61.2% and 15.6% in the right, respectively), followed by type Ⅰ, Ⅲand Ⅴ (left: 2.2%, 2.7% and 1.8%; right 12.5%, 7.1% and 3.6%, respectively).No significant distance difference was observed between left and right IMA (all P values 〉0.05).The distance between IMA and sternal margin increasing sequentially from the 1st, 3rd, 2nd, 4th and 5th ICS, the differences were all statistically significant (all P values 〈0.05).Male-to-female differences were significant at left of the 2nd, 3rd, 5th ICS and right 2nd ICS, with female significantly lower than male (all P values 〈0.05). No statistically distance differences were observed within different IMA anatomical types (all P values 〉0.05).Conclusions Multi-slice computed tomography allows a detailed anatomical evaluation of IMAs and provides precise distances of IMA and sternum which is helpful for route design of parasternal thoracic or pericardial interventions.
出处 《中华解剖与临床杂志》 2017年第6期452-456,共5页 Chinese Journal of Anatomy and Clinics
关键词 穿刺术 内乳动脉 胸腔穿刺 胸骨旁路径 体层摄影术 螺旋计算机 Punctures Internal mammary artery Thoracic puncture Parasternal route Tomography,computed spiral
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