颈动脉分叉区域的神经血管解剖及其对颈动脉内膜剥脱术的临床意义

The study of the nerve and vascular anatomy in the bifurcation region of the carotid artery and its clinical significance in carotid artery intimal dissection

目的通过对尸体标本的颈动脉分叉区域内的神经、血管进行解剖研究,为安全有效地开展颈动脉内膜剥脱术提供形态学依据及解剖学基础。方法选取20例（40侧）无明确心、脑血管疾患的尸体解剖标本（男11例、女9例）,采取颈动脉内膜剥脱术式入路对颈动脉分叉区域内的神经、血管进行解剖研究,明确血管和神经的形态学及结构特点。结果颈总动脉分叉部形态可分为Ⅰ、Ⅱ、Ⅲ型,分别占比为10%、52.5%、37.5%。分叉位置以甲状软骨为界,左侧颈总动脉分叉部高度在其上缘以上、平上缘和上缘以下的占比分别为55%、37.5%、7.5%;相较之下右侧分别为62.5%、27.5%、10%。男性颈总、颈内、颈外动脉内径均大于女性（P〈0.05）;男性颈动脉分叉角度大于女性（P〈0.05）。双侧颈总、颈内、颈外动脉内径相比无统计学意义（P〉0.0 5）;左侧颈动脉分叉角度大于右侧（P〈0.05）。结论通过对颈动脉分叉区域内的神经、血管进行解剖研究,对颈动脉内膜剥脱术术中血管与神经的保护具有重要的临床意义。

Objective To study the nerve and blood vessels in the carotid bifurcation area in cadavers so that the morphological diagnostic basis and anatomic basis could be provided for safe and effective performance of carotid endarterectomy. Methods 20 cases（40 sides） of autopsy specimens with no clear heart and cerebrovascular diseases before death were selected in our school（male 11 cases, female 9 cases）. The anatomic study on the nerve and blood vessels in the carotid bifurcation area was performed using the surgical approach of carotid endarterectomy, and morphological and structural features of blood vessels and the relationship between the nerve and the blood vessels were explored. Results The types of common carotid artery bifurcation： type I accounted for 10%; type II accounted for 52.5%; type III accounted for37.5%. The height of the bifurcation of the common carotid artery： above the top of the thyroid cartilage： 55%on the left side and 62.5% on the right; parallel to upper edge of thyroid cartilage on the upper edge： 37.5% on the left side of the, and the 27.5% on right side of the; below the upper edge of the thyroid cartilage： 7.5% on the left side, and 10% on the right side. The internal diameter of common, internal and external carotid arteries of males were wider than that of females（P〈0.05）, so was the bilateral carotid bifurcation angle（P〈0.05）.No statistically significant correlation was found between the internal diameters of common, internal and external carotid arteries of left side and right side. The bilateral carotid bifurcation angle of males was larger than that of female（P〈0.05）. Conclusion The anatomical measurement data of nerves and vessels on the carotid bifurcation region can not only define the relationship between neck blood vessels and nerves, but also provide morphological evidence and anatomic basis for safe and effective implementation of carotid endarterectomy.