本文選題：腎上腺 + 斷層解剖學(xué)��； 參考：《山東大學(xué)》2008年博士論文

【摘要】： 腎上腺位于腹膜后隙內(nèi),其病變種類繁多,臨床表現(xiàn)復(fù)雜,故而是臨床尤其是醫(yī)學(xué)影像學(xué)和外科學(xué)研究的熱點(diǎn)之一。但由于其位置深在,體積細(xì)小,形態(tài)各異且毗鄰關(guān)系復(fù)雜,因此其影像學(xué)探測(cè)尚有一定地難度。近年來臨床普遍開展的腹腔鏡腎上腺切除術(shù)對(duì)腎上腺的毗鄰關(guān)系,特別是和其周圍大血管的關(guān)系又提出了更高的要求。早期有學(xué)者采用CT在橫斷層上研究了腎上腺的位置、大小和常見疾病的影像學(xué)表現(xiàn),這些研究單純采用影像學(xué)手段,沒有斷層標(biāo)本的對(duì)照,由于受CT密度分辨力的影響,腎上腺的微小病變難以精確定位和顯示。近年來隨著多層螺旋CT及其圖像后處理功能的快速發(fā)展以及MRI快速掃描序列的應(yīng)用,影像學(xué)技術(shù)可在橫、矢、冠和斜狀斷層上顯示腎上腺的正常解剖和其病變。目前,腎上腺的橫斷層解剖研究較多,但這些研究方法多采用1例或幾例斷層標(biāo)本,僅結(jié)合正常的CT或MRI圖像,并且缺乏腎上腺微小病變圖像的對(duì)照研究;本課題組曾對(duì)腎上腺的矢狀斷層解剖進(jìn)行了初步探討,只是單純采用矢狀斷層標(biāo)本,沒有結(jié)合正常腎上腺圖像及腎上腺典型微小病變圖像對(duì)照研究;迄今為止,有關(guān)腎上腺的冠狀斷層解剖尚未見報(bào)道,而冠狀斷層解剖在同時(shí)顯示雙側(cè)腎上腺方面有其獨(dú)特的優(yōu)勢(shì)。 用斷層解剖方法研究腎上腺的位置、形態(tài)和毗鄰關(guān)系,可充分保證腎上腺的在體方位,不僅便于和斷層影像直接對(duì)照研究,更有利于泌尿外科確定腎上腺病變的準(zhǔn)確位置,進(jìn)而有利于各種腎上腺手術(shù)的實(shí)施。但這方面的研究使用的斷層標(biāo)本數(shù)量較少,并且僅限于橫斷層或矢狀斷層。 多層螺旋CT及其三維重建技術(shù)的臨床應(yīng)用,可重建出腎上腺及其周圍器官的三維圖像,能充分顯示在體方位的。腎上腺及其和周圍結(jié)構(gòu)的毗鄰關(guān)系。近年來MRI快速掃描序列的應(yīng)用,以及壓脂技術(shù),可清晰顯示腎上腺及其周圍結(jié)構(gòu)的細(xì)微解剖,使腎上腺微小病變的精確定位成為可能。然而單純地采用CT或MRI,由于部分容積效應(yīng)的存在和密度分辨力的限制,其顯示的腎上腺與標(biāo)本上的真實(shí)結(jié)構(gòu)之間尚存有差異,尚需將斷層標(biāo)本和CT及MRI圖像結(jié)合起來探討腎上腺的三維斷層解剖。 另外采用橫、矢和冠狀斷層標(biāo)本,并結(jié)合腎上腺微小病變的典型表現(xiàn),來系統(tǒng)探討正常腎上腺及其病變的影像學(xué)表現(xiàn),這方面的研究報(bào)道較少。 本課題使用上腹部橫、矢、冠狀斷層標(biāo)本,并結(jié)合多層螺旋CT(MSCT)圖像和三維(3D)圖像,MRI斷層圖像,以及腎上腺微小病變的CT和MRI圖像,系統(tǒng)研究腎上腺的三維斷層解剖特點(diǎn)和腎上腺微小病變的影像學(xué)表現(xiàn),以期為腎上腺病變的影像診斷和外科治療提供準(zhǔn)確而實(shí)用的斷層解剖學(xué)基礎(chǔ)。 本課題共分為5部分: 第一部分腎上腺橫斷層解剖及CT、MRI 目的為腎上腺病變的橫斷層影像診斷和外科治療提供實(shí)用的斷層解剖和影像診斷學(xué)依據(jù)。 材料和方法使用20例成人上腹部連續(xù)橫斷層標(biāo)本、10例健康成人MRI橫斷層圖像及20例無腎上腺病變的臨床病人MSCT橫斷層圖像,連續(xù)追蹤觀測(cè)了腎上腺在橫斷面上的形態(tài)、位置、毗鄰和大小。 結(jié)果在連續(xù)橫斷面上,第一肝門層面往往是腎上腺首次出現(xiàn)的層面,左右腎血管出現(xiàn)層面是雙側(cè)腎上腺消失的層面。左、右腎上極出現(xiàn)層面是橫斷層上尋找雙側(cè)腎上腺的理想層面。經(jīng)肝門下方的橫斷面上,右腎上腺位于下腔靜脈后方、肝裸區(qū)和右膈腳圍成的右腎上腺三角內(nèi),左腎上腺位于胃裸區(qū)、脾和左膈腳圍成的左腎上腺三角內(nèi)。經(jīng)左腎上極或右腎上極的橫斷面上,左腎上腺位于左腎上極前內(nèi)、胰體后面、脾的內(nèi)側(cè)和左膈腳圍成的四邊形區(qū)域內(nèi),右腎上腺位于右腎上極前內(nèi)、下腔靜脈后壁、肝裸區(qū)和右膈腳圍成的四邊形區(qū)域內(nèi)。 結(jié)論連續(xù)橫斷層上左、右。腎上極層面是尋找雙側(cè)腎上腺的可靠層面。下腔靜脈后壁是識(shí)別右腎上腺前界的標(biāo)志;脾動(dòng)、靜脈則是識(shí)別左腎上腺前界的標(biāo)志。在連續(xù)橫斷層上腎上腺的形態(tài)變化較大,腎上腺前方的毗鄰結(jié)構(gòu)尤其左腎上腺復(fù)雜,故腎上腺病變向前生長(zhǎng)時(shí)有不同的優(yōu)勢(shì)途徑。 第二部分腎上腺矢狀斷層解剖及CT、MRI 目的為腎上腺病變的矢狀斷層影像診斷和外科治療提供實(shí)用的斷層解剖學(xué)依據(jù)。 材料和方法使用30例成人上腹部連續(xù)矢狀斷層標(biāo)本、10例健康成人MRI矢狀圖像及20例無腎上腺病變的臨床病人MSCT矢狀重建圖像,觀測(cè)了左、右腎上腺的出現(xiàn)斷面、形態(tài)、大小和毗鄰關(guān)系。 結(jié)果在連續(xù)矢狀斷面上,左腎上腺集中出現(xiàn)在腹主動(dòng)脈左緣至左腎門之間,而右腎上腺集中出現(xiàn)在下腔靜脈左緣至右腎門之間。左、右腎上極內(nèi)側(cè)緣出現(xiàn)的矢狀斷面是左、右腎上腺恒定出現(xiàn)的斷面,即從正中矢狀面開始尋找腎的首次出現(xiàn)斷面是快速找到腎上腺的一個(gè)簡(jiǎn)便方法。左、右腎上極內(nèi)側(cè)緣出現(xiàn)層面是左、右腎上腺呈現(xiàn)最大面積的層面。該層面上左腎上腺呈Y或I形,而右腎上腺形狀不規(guī)則,可呈多種形狀。左腎上腺一般位于左膈腳或左腎與胰體之間。右腎上腺的前方為下腔靜脈,后方緊鄰右腎或膈,下方有右腎動(dòng)、靜脈走行,上方為膈和肝裸區(qū)。 結(jié)論在連續(xù)矢狀斷層上,左、右腎上極出現(xiàn)的層面是腎上腺恒定出現(xiàn)的斷面,且該層面上雙側(cè)腎上腺呈現(xiàn)最大面積。脾動(dòng)、靜脈是識(shí)別左腎上腺前界的標(biāo)志,下腔靜脈是識(shí)別右腎上腺前界的標(biāo)志,左、右腎動(dòng)、靜脈分別是識(shí)別左、右腎上腺下界的標(biāo)志。矢狀面上右腎上腺的形態(tài)變化較大,而左腎上腺的形態(tài)相對(duì)恒定。 第三部分腎上腺冠狀斷層解剖及CT、MRI 目的為腎上腺病變的冠狀斷層影像診斷和外科治療提供實(shí)用的斷層解剖學(xué)依據(jù)。 材料和方法使用31例成人上腹部連續(xù)冠狀斷層標(biāo)本、10例健康成人MRI冠狀圖像及5例無腎上腺病變的臨床病人MSCT冠狀重建圖像,連續(xù)追蹤觀測(cè)了腎上腺在冠狀面上的形態(tài)、位置、毗鄰和大小。 結(jié)果在連續(xù)冠狀斷面上,腎上腺集中出現(xiàn)于下腔靜脈后緣前18mm和其后的24mm范圍內(nèi)。左腎上腺的出現(xiàn)一般早于右腎上腺2個(gè)層面。在經(jīng)下腔靜脈前份和左腎靜脈的冠狀面(A_(15))上,左腎上腺位于腹主動(dòng)脈外側(cè)、左腎靜脈上方和左腎前極的內(nèi)上且呈現(xiàn)多種形態(tài)。在經(jīng)左、右腎門前份的冠狀面(A_(18))上,雙側(cè)腎上腺的出現(xiàn)率均為100%,并且左、右腎上腺出現(xiàn)最大徑線,右腎上腺的長(zhǎng)、寬、體厚、內(nèi)側(cè)肢厚、外側(cè)肢厚分別是32.02±4.12mm,10.91±1.89mm,5.82±0.26mm,2.78±0.08mm,2.62±0.06mm,而左腎上腺的大小分別是28.31±3.46mm,18.40±1.56mm,6.84±0.24mm,3.02±0.08mm,2.86±0.10mm。在經(jīng)左、右腎竇后份和脾門的冠狀面(A_(20))上,右腎上腺位于肝右后葉的裸區(qū)和右膈腳之間,而左腎上腺位于胃裸區(qū)和左膈腳之間。在經(jīng)脊髓圓錐和馬尾的冠狀面(A_(22))上,左腎上腺已消失,而右腎上腺仍位于肝、右腎上極和右膈腳圍成的三角內(nèi),但形態(tài)明顯變小。 結(jié)論冠狀面是顯示雙側(cè)腎上腺的優(yōu)勢(shì)斷面。腎上腺的形態(tài)變化較大,而腎上腺的厚度較恒定。腎上腺的內(nèi)、外側(cè)肢厚,尤其外側(cè)肢厚度的變化更能反映腎上腺皮質(zhì)的改變。 第四部分腎上腺多層螺旋CT圖像的三維重建 目的對(duì)正常腎上腺進(jìn)行MSCT三維重建,為腎上腺病變的影像學(xué)診斷和外科治療提供實(shí)用的影像斷層解剖學(xué)依據(jù)。 材料和方法使用20例無腎上腺病變的臨床病人64層螺旋CT斷層圖像探討了腎上腺的三維重建方法,重點(diǎn)研究了腎上腺的整體形態(tài)特點(diǎn)及其在正常人體中的位置和毗鄰等。 結(jié)果1.25mm層厚64層螺旋CT橫斷層圖像上,雙側(cè)腎上腺的邊界清晰,易于進(jìn)行腎上腺邊界的提取。用VR依次分步重建出的腎上腺及其毗鄰結(jié)構(gòu),邊界清楚,立體感強(qiáng),能動(dòng)態(tài)多角度顯示正常腎上腺的形態(tài)和位置,以及和周圍器官的毗鄰關(guān)系。 結(jié)論正常腎上腺M(fèi)SCT三維重建圖像能動(dòng)態(tài)立體顯示腎上腺及其周圍結(jié)構(gòu)的毗鄰關(guān)系,充分體現(xiàn)腎上腺的在體方位,與手術(shù)視野中的腎上腺有很好的對(duì)應(yīng)關(guān)系,以期為現(xiàn)代泌尿外科施行各種腎上腺手術(shù)提供可行而又實(shí)用的解剖學(xué)基礎(chǔ)。 第五部分腎上腺三維斷層解剖在影像診斷中的應(yīng)用 目的為明確腎上腺微小病變的影像診斷依據(jù),闡明腎上腺腫塊對(duì)毗鄰結(jié)構(gòu)推壓、侵蝕的影像學(xué)表現(xiàn)與斷層解剖基礎(chǔ)的相關(guān)性,并為腎上腺病變的外科治療提供實(shí)用的影像解剖學(xué)依據(jù)。 材料和方法本研究利用上述的橫、矢、冠狀斷層標(biāo)本和30例腎上腺病變(22例腎上腺微小病變,8例腎上腺腫塊)的CT、MRI橫、矢和冠狀圖像,探討腎上腺病變的影像學(xué)特征及斷層解剖學(xué)基礎(chǔ)。 結(jié)果雙側(cè)腎上腺后內(nèi)側(cè)的毗鄰關(guān)系恒定,上份分別和左、右膈腳相鄰,下份則分別和左、右腎上極相毗鄰。雙側(cè)腎上腺前方的毗鄰結(jié)構(gòu)變化較大,右腎上腺前方為下腔靜脈,正常右腎上腺可位于下腔靜脈和右膈腳之間或位于下腔靜脈后外緊貼肝裸區(qū),右腎上腺腫塊可將下腔靜脈推向前方、前外或前內(nèi)。右腎上腺外側(cè)和肝裸區(qū)及右肝下間隙相鄰,右腎上腺的腫塊向外生長(zhǎng),肝右后葉的內(nèi)側(cè)面可出現(xiàn)壓跡,亦可突入右肝下間隙。左腎上腺上份的前外側(cè)和胃裸區(qū)及網(wǎng)膜囊、胃后壁相鄰,左腎上腺上份的病變可突入胃裸區(qū)或網(wǎng)膜囊內(nèi)。左腎上腺下份的前外側(cè)和胰體后界、脾動(dòng)、靜脈相鄰,左腎上腺下份的腫塊可向前推壓脾動(dòng)、靜脈和胰體,出現(xiàn)脾動(dòng)、靜脈受壓的征象。左腎上腺的前內(nèi)側(cè)和腹主動(dòng)脈的上份及其分支腹腔干和腸系膜上動(dòng)脈的起始部相鄰,左腎上腺的腫塊可向右推壓腹主動(dòng)脈及其分支。 結(jié)論腎上腺的三維斷層解剖學(xué)基礎(chǔ)可很好地解釋腎上腺腫塊對(duì)毗鄰結(jié)構(gòu)推壓、侵蝕的影像學(xué)表現(xiàn)。腎上腺斷面形態(tài)多樣化,不能用一種類型反映單個(gè)腎上腺全貌;腎上腺前方的毗鄰結(jié)構(gòu)關(guān)系變化較大,決定腎上腺病變向前生長(zhǎng)、侵蝕有不同的優(yōu)勢(shì)途徑和類型。 結(jié)論和意義 1.本研究首次使用較大樣本的冠狀斷層標(biāo)本和薄層冠狀銑切標(biāo)本并結(jié)合活體MRI及MSCT冠狀圖像,詳細(xì)探討了腎上腺在連續(xù)冠狀斷面上的斷層影像變化規(guī)律。冠狀面是顯示雙側(cè)腎上腺的優(yōu)勢(shì)斷面。冠狀面上腎上腺的形態(tài)變化較大,而腎上腺的厚度較恒定。腎上腺的內(nèi)、外側(cè)肢厚,尤其外側(cè)肢厚度的變化更能反映腎上腺皮質(zhì)的改變。為腎上腺病變的斷層影像診斷和腎上腺的外科手術(shù)治療提供實(shí)用的斷層影像解剖學(xué)基礎(chǔ)。 2.橫、矢和冠狀斷層標(biāo)本和臨床活體腎上腺CT和MRI圖像有很好的對(duì)應(yīng)關(guān)系,便于二者之間對(duì)照研究,這些研究結(jié)果將為腎上腺微小病變的精確影像學(xué)診斷提供實(shí)用的斷層解剖學(xué)依據(jù)。連續(xù)橫斷層上左、右腎上極層面是尋找雙側(cè)腎上腺的可靠層面。下腔靜脈后壁是識(shí)別右。腎上腺前界的標(biāo)志;脾動(dòng)、靜脈則是識(shí)別左腎上腺前界的標(biāo)志。在連續(xù)矢狀斷層上,左、右腎上極內(nèi)側(cè)緣出現(xiàn)的層面是腎上腺恒定出現(xiàn)的斷面,且該層面上雙側(cè)腎上腺呈現(xiàn)最大面積。左、右腎動(dòng)、靜脈分別是識(shí)別左、右腎上腺下界的標(biāo)志。 3.本研究使用臨床活體正常腎上腺多層螺旋CT及三維重建圖像,可多角度立體顯示腎上腺和其周圍結(jié)構(gòu)的毗鄰關(guān)系,充分體現(xiàn)腎上腺的在體方位,與手術(shù)視野中的腎上腺有很好的對(duì)應(yīng)關(guān)系,以期為現(xiàn)代泌尿外科施行各種腎上腺手術(shù)提供可行而又實(shí)用的解剖學(xué)基礎(chǔ)。 4.本研究將腎上腺的三維斷層解剖和腎上腺病變的影像表現(xiàn)結(jié)合起來,用斷層解剖基礎(chǔ)去解釋和闡明腎上腺病變的影像學(xué)表現(xiàn),為腎上腺的影像斷層解剖奠定堅(jiān)實(shí)的基礎(chǔ)。腎上腺的三維斷層解剖學(xué)基礎(chǔ)可很好地解釋腎上腺腫塊對(duì)毗鄰結(jié)構(gòu)推壓、侵蝕的影像學(xué)表現(xiàn)。腎上腺斷面形態(tài)多樣化,不能用一種類型反映單個(gè)腎上腺全貌;腎上腺前方的毗鄰結(jié)構(gòu)關(guān)系變化較大,決定腎上腺病變向前生長(zhǎng)、侵蝕有不同的優(yōu)勢(shì)途徑和類型。
[Abstract]:The adrenal gland is located in the retroperitoneal space. It has a wide range of lesions and complex clinical manifestations, so it is one of the hot spots in clinical medical imaging and external science. However, its imaging detection is still difficult because of its deep location, small size, different morphology and complex adjacent relations. Adrenalectomy has higher requirements for the adjoining relation of the adrenal glands, especially the surrounding large vessels. Early scholars have studied the position, size and imaging manifestations of the adrenal glands on the transection layer by CT. With the effect of CT density resolution, the small lesions of the adrenal gland are difficult to accurately locate and display. In recent years, with the rapid development of multi-slice spiral CT and its image post-processing function and the application of MRI rapid scanning sequence, imaging techniques can display the normal anatomy and pathological changes of the suprarenal gland on the transverse, sagittal, crown and oblique faults. There are more anatomical studies in the transection layer, but these methods used 1 or several fault specimens, only a normal CT or MRI image, and a lack of a control study of the image of the adrenal microscopic lesions. The subject group had a preliminary study of the sagittal sectional anatomy of the adrenal gland, only using a sagittal fault specimen without a normal combination of normal. A contrast study of the adrenal images and the typical adrenal microscopic lesions; up to now, the coronal anatomy of the adrenal gland has not been reported, and the coronary anatomy has its unique advantages in the simultaneous display of bilateral adrenal glands.
The study of the position, morphology and adjacent relationship of the adrenal gland by the method of fault anatomy can guarantee the adrenal location of the adrenal gland. It is not only easy to compare with the image of the fault, but also helps the Department of urology to determine the exact position of the adrenal disease, and it is beneficial to the implementation of various adrenal surgery. The number of specimens is small, and is limited to transverse or sagittal faults.
The clinical application of multi-slice spiral CT and its three-dimensional reconstruction technique can reconstruct the three-dimensional images of the adrenal and its surrounding organs. It can be fully displayed in the body position. The adjoining relationship between the adrenal gland and its surrounding structures. The application of the MRI rapid scanning sequence in recent years, and the technique of pressure fat can clearly show the fine solutions of the adrenal and its surrounding structures. The accurate localization of minor adrenal lesions is possible. However, simple use of CT or MRI, due to the existence of partial volume effect and the limitation of density resolution, shows that there is a difference between the true structure of the adrenal gland and the specimen. It is still necessary to combine the fault specimens with the CT and MRI images to explore the three dimensional faults of the adrenal gland. Anatomy.
In addition, the imaging findings of the normal adrenal gland and its lesions were systematically investigated by using the transverse, sagittal and coronal specimens and combined with the typical manifestations of the adrenal minor lesions.
Using the upper abdominal transverse, sagittal, and coronal specimens, combined with the multi-slice spiral CT (MSCT) image, the three-dimensional (3D) image, the MRI fault image, and the CT and MRI images of the adrenal microscopic lesions, the three-dimensional anatomical features of the adrenal gland and the imaging findings of the adrenal microscopic lesions are systematically studied in order to diagnose the adrenal lesions. It provides accurate and practical sectional anatomy basis for surgical treatment.
This topic is divided into 5 parts:
The first part of the transtransverse dissection of the adrenal gland and CT, MRI
Objective to provide practical sectional anatomy and imaging diagnosis for transverse diagnosis and surgical treatment of adrenal lesions.
Materials and methods 20 cases of adult upper abdominal transverse transection, 10 healthy adult MRI transverse fault images and 20 cases of MSCT transverse fault images without adrenalectomy were used to observe the morphology, position, adjacent and size of adrenal glands on the cross section.
Results on the continuous cross section, the first hepatic portal was usually the first appearance of the adrenal gland. The left and right renal vascular planes were the disappearance of the adrenal glands on the left and right kidney. The upper level of the left and right kidney was the ideal level for the bilateral adrenal glands on the transverse layer. The right adrenal gland was located behind the inferior vena cava on the transverse section of the hepatic portal. In the right adrenal triangle surrounded by the bare and right diaphragmatic feet, the left adrenal is located in the bare area of the stomach and the left adrenal trigonometry enclosed by the spleen and the left diaphragm. The left adrenal gland is located in the anterior left renal pole, behind the body of the pancreas, the inside of the pancreas and the left diaphragm in the quadrilateral area, and the right adrenal in the right kidney. In the anterior part, the posterior wall of the inferior vena cava, the bare area of the liver and the quadrilateral region of the right phrenic foot.
The posterior wall of the inferior vena cava is a sign to identify the right adrenal gland, and the spleen and vein are the markers to identify the left adrenal anterior boundary. The adrenal glands in the continuous transection layer vary greatly, and the adjacent adrenal structures in front of the adrenal gland are especially the left adrenal gland. Therefore, adrenal lesions have different dominant pathways when they grow forward.
The second part of the adrenal sagittal sectional anatomy and CT, MRI
Objective to provide sectional anatomy basis for sagittal sectional imaging diagnosis and surgical treatment of adrenal lesions.
Materials and methods 30 cases of adult upper abdominal sagittal tomography, 10 healthy adult MRI sagittal images and 20 cases of MSCT without adrenalectomy were used to reconstruct the sagittal image of the left and right adrenal gland. The appearance, shape, size and adjacent relationship of the left and right adrenal glands were observed.
Results on the continuous sagittal section, the left adrenal gland was concentrated between the left margin of the abdominal aorta to the left renal portal, and the right adrenal gland appeared between the left margin of the inferior vena cava and the right renal portal. The sagittal section of the left and right medial margin of the right kidney appeared in the left and right adrenal gland, that is to begin with the first appearance of the kidney from the median sagittal plane. The present section is an easy way to quickly find the adrenal gland. The left, right renal proximal edge appears to be left, the right adrenal shows the largest area. At this level, the left adrenal gland is Y or I shaped, while the right adrenal shape is irregular in shape. The left adrenal gland is usually located between the left diaphragm or the left kidney and the pancreas. The right adrenal gland is in the right adrenal gland. The anterior part is inferior vena cava, with the right kidney or diaphragm behind, and the right kidney moves below, and the vein runs along the diaphragm and the bare area of the liver.
Conclusion on the continuous sagittal fault, the upper level of the left and right kidney appears to be a constant section of the adrenal gland, and the bilateral adrenal gland presents the largest area at this level. The splenic movement and vein are the markers to identify the left adrenal anterior boundary, and the inferior vena cava is a marker for the recognition of the right adrenal anterior boundary, and the left, right kidney, and the right adrenal gland are identified respectively. The right adrenal gland on the sagittal plane has a large morphological change, while the left adrenal gland is relatively constant in shape.
The third part of the coronal sectional anatomy of the adrenal gland and CT, MRI
Objective to provide practical sectional anatomy basis for coronal tomography diagnosis and surgical treatment of adrenal lesions.
Materials and methods the morphology, position, location, adjacent and size of the adrenal gland on the coronal plane were continuously traced in 31 consecutive cadaver upper abdominal coronary faults, 10 healthy adult MRI coronal images and 5 cases of MSCT coronary reconstruction without adrenalectomy.
Results on the continuous coronary section, the adrenal glands were concentrated in the anterior 18mm and 24mm of the posterior inferior vena cava. The appearance of the left adrenal gland was generally earlier than the right adrenal 2 levels. The left adrenal gland was located outside the abdominal aorta, the left renal vein and the left renal pole in the anterior ventral vein and the left renal vein (A_ (15)). In the left, right renal anterior portion of the coronal plane (A_ (18)), the incidence of bilateral adrenal gland was 100%, and the left and right adrenal glands had the largest diameter, the right adrenal length, width, body thickness, the thickness of the medial limb, and the lateral limb thickness were 32.02 + 4.12mm, 10.91 + 1.89mm, 5.82 + 0.26mm, 2.78 + 0.08mm, 2.62 + 0.06mm, while the left kidney was on the left kidney. The size of the gland was 28.31 + 3.46mm, 18.40 + 1.56mm, 6.84 + 0.24mm, 3.02 + 0.08mm and 2.86 + 0.10mm. in the left, right renal sinus and the coronal plane of the splenic portal (A_ (20)). The right adrenal gland was located between the naked area of the right posterior lobe of the liver and the right diaphragm, while the left adrenal was located between the bare area of the stomach and the left diaphragm. (A_ (22) in the conus of the spinal cord and the cauda equina. The left adrenal gland has disappeared, while the right adrenal gland is still located in the trigone of the liver, the upper pole of the right kidney and the right phrenic foot, but the morphology is obviously smaller.
Conclusion the coronal plane is the dominant cross section of the adrenal gland. The adrenal gland has a larger change in morphology and a constant adrenal thickness. The changes in the adrenal cortex can be reflected by the changes in the adrenal gland, the lateral limb thickness, and the lateral limb thickness.
The fourth part is three-dimensional reconstruction of adrenal multislice spiral CT images.
Objective to perform MSCT three-dimensional reconstruction of normal adrenal glands, and provide a practical sectional anatomical basis for imaging diagnosis and surgical treatment of adrenal lesions.
Materials and methods the three-dimensional reconstruction of adrenal gland was studied by the 64 slice spiral CT tomography of 20 cases of clinical patients without adrenal lesions. The overall morphological characteristics of adrenal glands and their location and adjacency in the normal human body were studied.
Results the boundary of adrenal gland was clear and easy to extract the adrenal boundary on the 64 slice spiral CT transverse fault images of 1.25mm layer thick. The adrenal gland and its adjacent structure were reconstructed step by step by VR. The boundary was clear and the stereoscopic sense was strong. The shape and position of normal adrenal gland and adjacent relations with the surrounding organs could be displayed dynamically and multiple angles.
Conclusion the three-dimensional reconstruction image of normal adrenal MSCT can dynamically display adjoining relation of adrenal and its surrounding structure, fully embody the azimuth of adrenal gland, and have a good correspondence with the adrenal gland in the visual field, so as to provide a feasible and practical anatomical basis for various adrenal operations in the modern department of urology.
The fifth part is the application of three dimensional sectional anatomy of adrenal gland in imaging diagnosis.
Objective to clarify the imaging diagnostic basis of adrenal microscopic lesions, to clarify the correlation between the imaging findings of the adrenal masses and the anatomical basis of the adjacent structures, and to provide a practical imaging anatomical basis for the surgical treatment of adrenal lesions.
Materials and methods in this study, the imaging features and sectional anatomical basis of adrenal lesions were investigated using the above transversal, sagittal, coronal specimens and 30 cases of adrenal lesions (22 cases of adrenal minor lesions, 8 adrenal masses) with CT, MRI, sagittal and coronal images.
Results the adjoining relationship between the two sides of the adrenal gland is constant, the upper part is adjacent to the left and right diaphragm respectively, the lower part is adjacent to the left and right kidney respectively. The adjacent structure of the bilateral adrenal glands is larger, the right anterior adrenal gland is the inferior vena cava, and the normal right adrenal can be located between the inferior vena cava and the right diaphragm or behind the inferior vena cava. The right adrenal mass can push the inferior vena cava forward to the front, the anterior and the anterior or anterior. The right adrenal lateral and the naked area of the liver and the right subhepatic space adjacent to the right adrenal gland and right subhepatic space, the right adrenal masses grow outwards, the medial surface of the right posterior lobe of the liver can appear pressure, or the right subhepatic space. The anterolateral and nude stomach and omentum sac of the upper part of the left renal gland and the posterior stomach Adjacent to the wall, the lesion of the upper part of the left adrenal gland can penetrate into the bare area of the stomach or the omentum. The lower part of the lower part of the left adrenal gland, the posterior boundary of the pancreas, the splenic movement and the vein, and the lump of the lower part of the left adrenal gland can push the splenic movement, the veins and the body of the pancreas, the signs of the spleen and vein. The upper and abdominal aorta of the left adrenal and the upper part of the abdominal aorta and its branches The trunk of the celiac trunk is adjacent to the origin of the superior mesenteric artery. The mass of the left adrenal gland can push the abdominal aorta and its branches to the right.
Conclusion the three-dimensional sectional anatomy of the adrenal gland can be well explained.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2008
【分類號(hào)】：R322.5

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前2條

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2 王立峰;雙能量CT對(duì)腎上腺轉(zhuǎn)移瘤及原發(fā)腺瘤鑒別診斷的應(yīng)用研究[D];鄭州大學(xué);2013年

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本文編號(hào)：1884227