發(fā)布時(shí)間：2018-10-10 13:20

【摘要】： 目的:研究胸外側(cè)動(dòng)脈走行的解剖特性,明確其與胸長(zhǎng)神經(jīng)的關(guān)系及供血對(duì)象,為相關(guān)臨床科室治療乳腺癌及豐胸等提供解剖學(xué)依據(jù)。 實(shí)驗(yàn)方法:10具(20側(cè))10%甲醛固定的女性成人尸體標(biāo)本。分別測(cè)量和觀察胸外側(cè)動(dòng)脈、胸長(zhǎng)神經(jīng)的外徑和全長(zhǎng),并用統(tǒng)計(jì)軟件對(duì)測(cè)量數(shù)據(jù)進(jìn)行處理,對(duì)重要部位進(jìn)行拍照。 實(shí)驗(yàn)結(jié)果:我們通過研究發(fā)現(xiàn)胸外側(cè)動(dòng)脈起點(diǎn)分散,可直接起自腋動(dòng)脈第1-3段,也可與胸肩峰動(dòng)脈、肩胛下動(dòng)脈共干或由胸背動(dòng)脈分出。胸外側(cè)動(dòng)脈主支向內(nèi)向下進(jìn)入乳腺實(shí)質(zhì),于小葉間走行進(jìn)一步發(fā)出分支供應(yīng)腺體,并向表面發(fā)出垂直分支穿出腺體供應(yīng)乳房皮膚。胸長(zhǎng)神經(jīng)起自臂叢,在臂叢和腋動(dòng)脈后方入腋窩,沿前鋸肌表面下行,支配此肌。損傷此神經(jīng)引起前鋸肌癱瘓,可發(fā)生翼狀肩胛。前鋸肌是重要的胸上肢肌,位于胸壁的外側(cè)面,前上部被胸大、小肌所覆蓋,其肌腹逐漸增厚,各肌齒起始部分有明顯間隙并為脂肪組織所填充,各肌腹沿腹外側(cè)壁行至腋中線處相互呈疊瓦狀并攏。胸部的淺筋膜包裹整個(gè)乳房,構(gòu)成乳腺囊,乳腺囊伸入到各小葉之間形成小葉間隔,對(duì)乳腺組織和脂肪組織起支持作用。乳房?jī)?nèi)有豐富的血管分布,它們對(duì)乳房的營養(yǎng)和新陳代謝維持起著主要作用。乳房的動(dòng)脈血供十分豐富,主要源于以下動(dòng)脈:(1)胸廓內(nèi)動(dòng)脈的肋間穿支,穿過胸大肌深入到乳房?jī)?nèi)側(cè)部分。(2)腋動(dòng)脈發(fā)出的胸外側(cè)動(dòng)脈、胸最上動(dòng)脈、胸肩峰動(dòng)脈、胸背動(dòng)脈主要供應(yīng)乳腺外側(cè)部。(3)源于胸主動(dòng)脈的肋間動(dòng)脈穿支,分布到乳房的深部和外側(cè)1/4。 結(jié)論:1、以胸長(zhǎng)神經(jīng)和胸外側(cè)動(dòng)脈為蒂的前鋸肌肌瓣轉(zhuǎn)移體有豐富的血供和神經(jīng)支配,所以適宜作豐乳術(shù)及乳腺象限切除術(shù)后的填充物。 2、乳腺癌供血?jiǎng)用}灌注化療是一種兼局部灌注優(yōu)點(diǎn)的全身化療方法。術(shù)前有針對(duì)性乳腺癌供血?jiǎng)用}灌注化療,可使患者乳腺區(qū)腫塊有不同程度縮小。 3、乳頭乳暈主要靠來自于腺體深層的動(dòng)脈供血。 4、胸長(zhǎng)神經(jīng)與胸外側(cè)動(dòng)脈可伴行,所以行乳癌根治術(shù)及行側(cè)胸部小切口時(shí),要注意保護(hù),防止出現(xiàn)并發(fā)癥。
[Abstract]:Objective: to study the anatomical characteristics of the lateral thoracic artery and to determine the relationship between the artery and the long thoracic nerve and to provide anatomic basis for the treatment of breast cancer and breast enlargement in clinical departments. Methods: 10 female adult cadavers (20 sides) were fixed with 10% formaldehyde. The external diameter and length of lateral thoracic artery and long thoracic nerve were measured and observed respectively. Results: we found that the starting point of the lateral thoracic artery was scattered directly from the 1-3 segments of the axillary artery, and could also be separated from the thoracic and acromitic artery, the subscapular artery or the thoracic dorsal artery. The main branch of the lateral thoracic artery enters the breast parenchyma downward and further issues branches between the lobules to supply the glands and the vertical branches to the surface to supply the skin. The long thoracic nerve originates from the brachial plexus and enters the armpit behind the brachial plexus and axillary artery. Injury of the nerve causes paralysis of the anterior serratus and the winglike scapula. The anterior serratus is an important muscle of the upper thoracic limb, which is located on the outer side of the chest wall. The anterior and upper part of the muscle is covered by the larger chest and the smaller muscle. The muscle abdomen is gradually thickened, and the initial part of each muscle has a clear gap and is filled with adipose tissue. The ventral muscles along the ventrolateral wall to the axillary midline were imbricate with each other. The superficial fascia of the chest encapsulates the whole breast and forms the mammary gland sac which extends into the interlobular space between the lobules and plays a supporting role in the breast tissue and adipose tissue. There is a rich distribution of blood vessels in the breast, they play a major role in the maintenance of breast nutrition and metabolism. The arterial blood supply of the breast is very abundant, mainly from the following arteries: (1) the intercostal perforating branch of the internal thoracic artery through the medial part of the breast, (2) the lateral thoracic artery from the axillary artery, the superior thoracic artery, the thoracic and acromitic artery, The thoracic dorsal artery mainly supplies the lateral part of the mammary gland. (3) the perforating branch of the intercostal artery originating from the thoracic aorta is distributed to the deep and lateral parts of the breast. Conclusion: 1. The transfer body of serratus anterior muscle flap pedicled with long thoracic nerve and lateral thoracic artery has abundant blood supply and nerve innervation. Therefore, it is suitable for breast augmentation surgery and breast quadrant resection. 2. Arterial infusion chemotherapy for breast cancer is a systemic chemotherapy with advantages of local perfusion. Preoperative arterial infusion chemotherapy for breast cancer, 3. Nipple areola mainly depends on arterial blood supply from deep gland. (4) the long thoracic nerve and the lateral thoracic artery can be accompanied, Therefore, breast cancer radical surgery and small lateral chest incision, should pay attention to protection, to prevent complications.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2007
【分類號(hào)】：R322

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 彭勇，鄒利光，席道友;乳腺癌的介入治療8例報(bào)告[J];第三軍醫(yī)大學(xué)學(xué)報(bào);1994年04期

2 林浩東;陳德松;方有生;;胸長(zhǎng)神經(jīng)卡壓的診斷和治療[J];解剖與臨床;2006年01期

3 楊接輝;CTF方案在乳腺癌新輔助化療近期的療效觀察[J];中國綜合臨床;2004年07期

4 許慶文,梁立華,朱荷根;乳腺癌的位置與血液供應(yīng)及其與術(shù)前介入化學(xué)藥物治療效果的關(guān)系[J];中華普通外科雜志;1999年01期

5 劉強(qiáng),陳德松,方有生;肩胛背神經(jīng)合并胸長(zhǎng)神經(jīng)卡壓的解剖學(xué)和臨床研究[J];中華手外科雜志;2002年02期

6 華新民，盧衛(wèi)平，張玉清，段貴新，王啟文，，劉建陽;經(jīng)腋窩L形切口進(jìn)行胸內(nèi)手術(shù)[J];中華胸心血管外科雜志;1994年04期

7 徐萬里;Ⅲ期乳腺癌術(shù)前超選擇性動(dòng)脈灌注化療的臨床應(yīng)用[J];中國基層醫(yī)藥;2004年07期

8 邱水波;周汝明;劉閩華;莊少育;楊慧君;;術(shù)前動(dòng)脈灌注化療治療乳腺癌56例[J];中國基層醫(yī)藥;2006年04期

9 李慧有;桂國成;馬裕兵;常加志;;前鋸肌筋膜瓣的應(yīng)用解剖學(xué)研究[J];臨床應(yīng)用解剖學(xué)雜志;1985年04期

10 韓震,鐘世鎮(zhèn),孫博,劉牧之,何蘊(yùn)韶,彭義森,孟石合,顧玉東;前鋸肌及其神經(jīng)支配的解剖學(xué)研究[J];臨床解剖學(xué)雜志;1986年03期

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