中国人哨兵静脉和颞中静脉的解剖学特征

Sentinel vein and middle temporal vein in Chinese:an anatomic study

目的哨兵静脉和颞中静脉对颞区的手术和注射操作有重要影响,通过标本解剖揭示其特征。方法2018年1月至2019年8月,收集捐献的新鲜冰冻头颅标本20例,男12例,女8例;年龄21~88岁,平均47.2岁。对29侧颞区进行精细解剖,观察并测量哨兵静脉和颞中静脉的出现率、走行路径和层次、几何参数、属支情况及相互关系。结果哨兵静脉出现率96.6%(28/29),属支数2.5±1.0,有6种汇合模式。水平段长(5.8±3.8)mm,外径(1.0±0.1)mm,行于颞浅筋膜和皮下脂肪层之间,垂直段长(8.2±4.3)mm,外径(1.2±0.4)mm,向深部穿过颞浅筋膜、颞中筋膜和颞深筋膜浅层,延续为颞中静脉。哨兵静脉与面神经颞支最短距离(6.0±2.7)mm。颞中静脉出现率96.6%(28/29),前半段与颧弓平行,后半段弧形下转约90°后与颧弓垂直,沿途收集(5.9±2.7)支属支。颞中静脉长度(82.3±8.6)mm,最粗处外径(3.6±0.7)mm。结论哨兵静脉垂直穿越数层软组织后直接延续为颞中静脉,其位置恒定,是颞区手术时重要的定位标志。颞中静脉口径粗大且固定于颞浅脂肪垫内,收集颞区深浅两个层次静脉回流,可能是颞部脂肪移植引起肺梗死的主要血管,应避免损伤。

Objective To study the characteristics of sentinel vein(SV)and middle temporal vein(MTV)and influence in surgery of periorbital and temporal areas.Methods From January 2018 to August 2019,20 donated fresh/frozen head specimens(12 males and 8 females)were collected in various regions of China,with an average age of 47.2(21 to 88)years.Temporal region of 29 hemi-facial area was dissected in layers,and the occurrence rate,route,geometric parameters,branchesand correlation of SV and MTV were observed and measured.Results Occurrence rate of SV was 96.6%(28/29),the subcutaneous subordinate branches of SV were 2.5±1.0 in average,with both joining together in 6 kinds of mode.The horizontal section length was(5.8±3.8)mm,and outside diameter was(1.0±0.1)mm.The vertical section length was(8.2±4.3)mm,and outside diameter was(1.2±0.4)mm,steering vertically to the deep through the superficial temporal fascia,middle temporal fascia(MTF)and superficial layer of deep temporal fascia(SDTF),continuing to the MTV.The minimal average distance between the SV and TFN was(6.0±2.7)mm.Occurrence rate of MTV was 96.6%(28/29).The first half of MTV was parallel to the zygomatic arch and ran across the superficial temporal fat pad,then turned down near the upper pole of the external ear wheel,and run vertically in front of the ear,and 5.9±2.7 peripheral branches were collected along the way.The length of temporal middle vein was(82.3±8.6)mm,and outer diameter of the thickest point was(3.6±0.7)mm.Conclusions Sentinel vein is the main branch of middle temporal vein.It passes through several layers of soft tissue vertically and directly into the MTV.Position of sentinel vein is relatively constant,which is an important localization marker in the operation of the temporal region.The middle temporal vein has large diameter,fixing in the superficial temporal fat pad,collecting the venous reflux of the temporal area at both superficial and deep,which may be the main cause of pulmonary infarction produced by the temporal fat transplantation,and injury should be avoided.