本文選題：喉 + 喉上神經　； 參考：《山西醫(yī)科大學》2011年碩士論文

【摘要】：目的：對國人成人尸頭喉部進行大體解剖和顯微解剖研究,明確喉部主要解剖結構的位置、形態(tài)、毗鄰關系及變異,并對手術相關的重要解剖標志進行測量,探討各結構在喉部臨床諸多手術中的解剖學意義,為喉切除、移植、修復、重建等手術提供顯微解剖數據和形態(tài)學資料,并為制作一套完整、精細的喉部臨床解剖學圖譜提供素材。 方法：模擬頭頸部手術入路,解剖10%甲醛溶液常規(guī)固定的國人成人頭頸標本34例68側(其中紅色乳膠灌注標本10例),按頸部解剖層次先進行喉外大體解剖,再用手術放大鏡進行喉內顯微解剖研究,觀測喉部重要解剖結構及相關區(qū)域結構的位置、形態(tài)、毗鄰關系及變異,同時用尼康數碼單鏡反光相機D80及AF-S微距尼克爾60mmf/2.8G ED鏡頭在專業(yè)的靜物臺上多角度、多參數采集圖片。 結果：1.甲狀腺上動脈52%起自頸外動脈,44%起自頸動脈分叉處,4%起自頸總動脈。喉上動脈94%起自甲狀腺上動脈；4.5%起自頸外動脈；1.5%起自面舌干動脈；入喉處距甲狀軟骨上角14.43±2.1mm；距舌骨下緣5.16±0.69mm,距甲狀軟骨上緣5.16±0.69mm；7.4%喉上動脈穿甲狀軟骨翼孔入喉。2.喉上動脈喉內分前上支、后上支、前中支、后中支、前下支、后下支,分布較恒定,吻合支多。3.喉上神經內支分前上支(分前支和上支)和后下支；后下支終末支與喉下神經后支吻合形成Galen's吻合支。4.喉上神經與頸交感干形成喉上神經袢：無袢形(21%),單袢形(78%),雙袢形(1%)。5.甲狀腺下動脈與喉返神經關系分：Ⅰ型神經在動脈及分支前方(13%)；Ⅱ型神經在動脈及分支后方(47%)；Ⅲ型神經在動脈分支間(18%)；Ⅳ型動脈在神經分支間(7%)；Ⅴ型神經、動脈分支相互夾持(15%)。6.喉下神經入喉處距甲狀軟骨下角尖5.32±0.77mm；距環(huán)甲關節(jié)水平距離3.71±0.58mm；內收肌支入肌點距甲狀軟骨下結節(jié)5.15±0.45mm,距環(huán)甲關節(jié)垂直距離7.57±0.45mm，距環(huán)甲關節(jié)水平距離9.98±0.70mm。7.會厭軟骨形態(tài)分：平坦型(44%)；卷曲型(36%)；半卷曲型(20%)。8.變異發(fā)現：甲狀頸干缺失1例；喉上動脈、面動脈、舌動脈共干1例；喉上神經外支穿甲狀軟骨翼孔入喉1例；喉上神經內支與喉下神經后支直接吻合3例。 結論：1.喉部手術中,喉上動脈可在甲狀軟骨上角前下方14mm,舌骨下緣和甲狀軟骨上緣5mm處尋找并結扎,本研究有助于手術中喉上動脈定位和結扎。2.喉內動脈分支多,吻合支多,是喉重建、喉部分切除術成功的保證。3.環(huán)甲動脈可代替喉上動脈成為喉內主要滋養(yǎng)動脈,行甲狀腺切除術和喉修復、重建、移植術時應注意。4.甲狀腺上動脈、喉上動脈與喉上神經以及甲狀腺下動脈與喉返神經的關系復雜多變。術中應將各結構暴露清楚,直視下結扎動脈,避免喉部神經的損傷。5.喉上神經內支可能含有運動神經纖維。6.甲狀軟骨下結節(jié)、環(huán)甲關節(jié)、環(huán)杓后肌外側緣可作為解剖標志,定位喉下神經的甲杓肌支和環(huán)杓后肌支。7.喉部分切除術時,在杓會厭皺襞下緣5～10mm解剖并保留喉上神經內支的后下支,有助于保留聲門后聯合區(qū)、聲門下區(qū)后部粘膜的感覺功能,提高患者術后生活質量。
[Abstract]:Objective: To study the gross anatomy and microanatomy of the adult cadaver head larynx of the Chinese adults, to clarify the position, morphology, adjacent relationship and variation of the main anatomical structures of the larynx, and to measure the important anatomical signs related to the operation, and to explore the anatomical significance of the various structures in the many surgical operations of the larynx, for laryngectomy, transplantation, repair and reconstruction. The operation provides microanatomical data and morphological data, and provides material for making a complete set of detailed laryngeal clinical anatomy atlas.
Methods: the head and neck surgical approach was simulated to dissected 34 cases of Chinese adult head and neck specimens of 10% Formaldehyde Solution routinely (10 cases of red latex perfusion). The gross anatomy of the larynx was first carried out at the anatomical level of the neck, and the microanatomy of the larynx was carried out by the surgical magnifying glass to observe the important anatomical structure and related regional structure of the larynx. The position, shape, adjacent relationship and variation, and the multi angle and multi parameter collection of pictures with Nikon digital single mirror reflector D80 and AF-S micro distance nicer 60mmf/2.8G ED lens on the professional static object platform.
Results 1. the superior thyroid artery was 52% from the external carotid artery, 44% from the cervical artery branch and 4% from the common carotid artery. The upper laryngeal artery was 94% from the superior thyroid artery; 4.5% from the external carotid artery; 1.5% self lingual dry artery; the larynx was 14.43 + 2.1mm from the upper angle of the thyroid cartilage; it was 5.16 + 0.69mm from the hyoid edge, 5.16 + 0.69 from the upper margin of the thyroid cartilage. Mm; 7.4% the upper branch of the upper larynx of the upper larynx was divided into the upper branch of the superior laryngeal artery and the upper branch of the larynx of the larynx, the posterior superior branch, the posterior middle branch, the posterior inferior branch, the posterior inferior branch, and the constant distribution of the superior branch of the superior branch of the larynx of the larynx (the anterior branch and the upper branch) and the posterior inferior branch of the superior branch of the larynx in the anastomosis branch, and the posterior inferior branch of the posterior inferior branch and the posterior branch of the inferior larynx formed a.4. anastomosis branch of the larynx and formed the.4. branch of the Galen's anastomosis to form.4..4.. The superior laryngeal nerve loop formed by the sympathetic trunk of the larynx and the neck: no loop (21%), single loop (78%), double loop (1%).5. inferior thyroid artery and recurrent laryngeal nerve: type I nerve in the anterior artery and branch (13%); type II nerve in the artery and the rear (47%); type III nerve in the artery (18%); type IV artery in the branch of nerve. 7%): type V nerve, artery branches holding (15%).6. sublaryngeal nerve into the larynx at 5.32 + 0.77mm from the inferior horns of the thyroid cartilage, 3.71 + 0.58mm from the horizontal distance to the ring nail, 5.15 + 0.45mm from the adductor to the inferior thyroid nodule, 7.57 + 0.45mm from the ring armour joint, and 9.98 + 0.70mm.7. epiglottis from the horizontal distance from the ring nail joint. Cartilage morphology: flat (44%); curly type (36%); semi curl type (20%).8. variation found in 1 cases of cervical trunk deletion; 1 cases of upper laryngeal artery, facial artery and tongue artery; 1 cases of superior laryngeal nerve external branch through thyroid cartilage wing hole into the larynx; 3 cases of superior laryngeal nerve and inferior laryngeal Sutra posterior branch of the larynx.
Conclusion: during the 1. larynx operation, the superior laryngeal artery can be found and ligation at the lower edge of the superior horn of the thyroid cartilage, the lower edge of the hyoid bone and the upper edge of the thyroid cartilage. This study is helpful to locate and ligate the upper laryngeal artery in the operation and to ligation of the.2. internal laryngeal artery branches, the anastomosis branch is more, the larynx reconstruction is a successful alternative to the laryngectomy instead of the larynx in the laryngectomy. The upper artery becomes the main trophoblastic artery in the larynx. In the operation of thyroidectomy and larynx repair, reconstruction and transplantation, the upper thyroid artery should be paid attention to.4.. The relationship between the superior laryngeal artery and the superior laryngeal nerve and the inferior thyroid artery and the recurrent laryngeal nerve is complicated and changeable. In the operation, the structures should be exposed clearly, and the ligation artery is directly under the operation to avoid the injury of the laryngeal nerve in.5.. The internal branch of the superior laryngeal nerve may contain a motor nerve fiber.6. subchondral nodule, and the ring nail joint and the lateral rim of the posterior CRICO can be used as an anatomical sign to locate the subarytenoid and posterior subarytenoid branches in the.7. larynx for the subdivision of the subarytenoid muscle and the posterior inferior branch of the superior branch of the laryngeal nerve at the lower edge of the aryepiglottic fold 5 to 10mm, which is helpful to retain the inferior laryngeal nerve. The sensory function of the posterior mucous membrane of the subglottic region improves the quality of life after operation.

【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R322

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