多层螺旋CT三维成像行国人气道径线分析

目的探讨国人气管和主支气管各种解剖径线的长度与角度.方法用多层螺旋CT三维成像法测定300例成年健康体检者锁骨胸骨端水平气管内径、锁骨胸骨端水平到隆突的气管长度,左、右主支气管和右中间支气管内径与长度,以及左、右主支气管长轴与矢状面的夹角.结果男性气管、左、右主支气管、右中间支气管内径与长度,以及右上肺叶支气管开口内径均大于女性,而女性左、右主支气管长轴与矢状面夹角均大于男性(p<0.05或0.01).成年人与老年人上述各解剖径线值差异无显著(p>0.05).左主支气管内径值与右主支气管内径值呈高度相关,且分别与气管内径值和身高呈高度相关(p<0.01).结论通过多层螺旋CT三维成像法测定国人气管、左和右主支气管径线值,获左、右主支气管内径值与患者身高和气管内径测量值的回归方程,可预测其左、右主支气管内径值.     

右主支气管与右上叶支气管交汇区的MSCT影像学研究

目的　对正常成年人右主支气管与右上叶支气管交汇区的径线进行测量，分析右主支气管、右上叶支气管、中间支气管径线的相关性。 方法　分析300例正常成年男性与300例正常成年女性的胸部MSCT图像，利用多平面重建技术（Multiplanar reconstruction，MPR）测量右主支气管、右上叶支气管、中间支气管的内径、长度、横截面积和夹角，并进行相关性分析。 结果　男性和女性右主支气管长径（Z）与右上叶支气管长径（X）、中间支气管的长径（Y）相关性分别为Z=0.379X+0.955Y-0.691（r=0.763，P<0.05）和Z=0.386X+0.358Y+6.340（r=0.745，P<0.05）。 结论　正常成年人右主支气管内径、右上叶支气管内径、中间支气管内径存在较高的相关性，可以为右主支气管与右上叶支气管交汇区域内径的准确测量和估算提供参考。     

气管及左右支气管的测量

在140具成人尸体上,分别观察了气管的起迄高度,测量了气管与支气管的长度与管(内)径以及气管支气管的夹角等。气管的起迄高度(78例),上端以平C_6中1/3—C_7,上1/3之间者较多(69.23±5.23％),下端以平T_4下1/3—T_5中1/3之间者较多(67.95±5.28％)。141例气管的平均长度是110.77±9.94毫米,以在101—125毫米之间者较多.占83.0±3.16％。140例气管中部的左右内径的平均值为16.17±2.61毫米,前后内径的平均值为14.73±2.68毫米,故左右内径比前后内径大。120例气管支气管夹角的平均值是68.09°±11.82°,以在66°—80°之间者较多(55.9±4.53％);男性的夹角度数平均比女性的小5°左右。 114例左支气管的平均长度是51.89±4.18毫米;136例左支气管中部左右内径的平均值为11.06±2.10毫米,前后内径的平均值为9.08±1.80毫米。91例右支气管的平均长度为26.18±4.05毫米;109例右支气管中部左右内径的平均值为14.85±2.61毫米,前后内径的平均值为11.20±2.23毫米。由此可见,左支气管的长度约为右支气管的一倍,左支气管中部的内径比右支气管的为小,两者的比例约为4:5。     

儿童气管镜应用解剖学

目的：研究气管镜操作术的成功率和安全性。方法：观测儿童尸体气管的解剖长度、临床长度和气管的横径、矢状径，并与儿童身高和上部量进行相关分析，另外分析临床资料85例，其中58例在使用支气管镜前做了气管横径、矢状和长度的预测。结果：两性儿童的身高和上部量与气管的解剖长度、临床长度、气管内径之间密切相关。结论：测量儿童的身高和上部量就可根据他们之间的回归方程计算出气管的长度和内径大小，为临床准确选用气管镜型号和插管的深度提供可靠的依据。以保证一次性成功率和安全性。     

儿童气管的解剖学观测和临床应用

目的研究支气管镜操作术的成功率和安全性。方法通过44例儿童尸体观测气管的解剖长度、临床长度和气管的横径、矢状径,并与儿童身高和上部量进行相关分析,另外分析临床资料85例,其中58例在使用支气管镜前做了气管横径、矢状和长度的预测。结果两性儿童的身高和上部量与气管的解剖长度、临床长度、气管内径之间密切相关。结论只要先测量儿童的身高和上部量就可根据他们之间的回归方程计算出气管的长度和内径大小,为临床准确选用气管镜型号和插管的深度提供可靠的依据,从而保证了气管插管的一次性成功率和安全性。     

中央气道吸气相-呼气相的多层螺旋CT研究

目的 探讨呼吸运动对中央气道径线值的影响及其临床意义。方法 2016年3—7月郑州大学第一附属医院放射介入科招募60名健康成人志愿者进行前瞻性研究。其中男32例,女28例,年龄25~54(34.0±9.1)岁。志愿者均行胸部多层螺旋CT(MSCT)检查,于深吸气末、深呼气末分别扫描全肺,薄层图像结合多平面重建技术(MPR),使用特殊纵隔窗(窗宽500 HU,窗位-100 HU) 在吸气末、呼气末时测量中央气道横截面积,计算塌陷指数,测量左主支气管-右主支气管夹角(隆突角,∠C)、右上叶-中间支气管夹角(∠RI)、右中叶-右下叶支气管夹角(∠RMI)及左上叶-左下叶支气管夹角(∠LUI),并观察吸气末、呼气末时中央气道的形态改变。结果 深呼气末,中央气道横截面积均少于吸气末相,差异均有统计学意义(P值均<0.01)。气管塌陷指数为19.7%±8.6%;右主支气管、中间支气管、右上叶支气管、右中叶支气管和右下叶支气管塌陷指数分别为21.4%±9.6%、14.7%±6.2%、15.5%±5.7%、10.1%±3.6%、24.5%±9.1%;左主支气管、左上叶支气管、左下叶支气管塌陷指数分别为24.0%±9.4%、15.1%±5.0%、27.6%±10.7%。左侧中央气道中,各级支气管塌陷指数比较,差异有统计学意义(F=32.696, P<0.05);其中左主支气管、左下叶支气管的塌陷指数较大,与左上叶支气管塌陷指数比较,差异均有统计学意义(P值均<0.05)。右侧中央气道中,各级支气管塌陷指数比较,差异有统计学意义(F=38.154, P<0.05);其中右主支气管、右下叶支气管的塌陷指数较大,分别与右上叶支气管、中间支气管、右中叶支气管塌陷指数比较,差异均有统计学意义(P值均<0.05)。呼气末与吸气末时比较,∠C增大,∠RI、∠RMI、∠LUI均减小,差异均有统计学意义(P值均<0.01),其中∠LUI吸气-呼气差值最大。深吸气末时,中央气道的轴位横断面多为类圆形或卵圆形。深呼气末时,气管85%(51/60)、左主支气管70%(42/60)、右主支气管82%(49/60)呈后膜变平或轻度前弓形态。叶支气管断面形态改变不明显。结论 MSCT为观察和测量中央气道径线的有效手段,根据不同呼吸时相的气管及各级支气管的横截面积和夹角变化程度不同,有利于指导临床选择合适型号的气道支架,也有助于探讨和研发更具有生理适应性的气道支架。     

经外周静脉置入中心静脉导管头端定位相关解剖参数的CT研究

目的 探讨经外周静脉置入中心静脉导管(PICC)头端定位的相关解剖参数,以指导PICC头端影像学定位。方法 选取2013年6月—2015年1月中南大学湘雅医学院附属肿瘤医院334例患者胸部薄层增强CT扫描的影像资料进行回顾性分析,分别测量患者右主支气管起点、右锁骨内侧头最上缘、气管隆突与心包返折及房腔交界之间的间距(解剖参数绝对值)。测量T₆椎体上缘平面至T₇椎体上缘平面之间距(T₆单元高度),将各解剖参数绝对值除以T₆单元高度,计算出解剖参数相对值。记录房腔交界和心包返折所对应椎体位置。结果 82%(274/334)的患者房腔交界位于T_6~7水平、79.3%(265/334)的患者心包返折位于T_5~6水平。气管隆突—房腔交界间距、气管隆突—心包返折间距、右主支气管起点—房腔交界间距、右主支气管起点—心包返折间距、右侧锁骨内侧头上缘—房腔交界间距及右侧锁骨内侧头上缘—心包返折间距的绝对值分别为(38.4±8.8)、(21.9±9.2)、(50.7±9.1)、(34.2±9.4)、(110.2±15.9)、(93.7±16.3)mm,相对值分别为(1.85±0.43)、(1.05±0.44)、(2.44±0.45)、(1.64±0.45)、(5.30±0.75)、(4.50±0.75)。相关性分析显示各解剖参数绝对值与患者身高有相关关系(P值均<0.01);而相对值与身高相关性明显减弱,并且部分解剖参数相对值与身高无相关性(P值均>0.05)。结论 气管隆突及右主支气管起点用于PICC头端定位的可靠性相对较好;而心包返折的位置变异较大,利用影像学标志推断心包返折的位置可能存在一定难度。     

锁骨上神经穿锁骨伴斜方肌止点异常一例

在解剖1具成年男尸过程中见其右侧斜方肌止点异常伴锁骨上神经穿锁骨骨孔.报道如下. 男尸身长159.0 cm,其右侧斜方肌一部分异常肌束止于锁骨中部.抵止部长6.47 cm,内侧端距锁骨胸骨端内侧缘5.75 cm,外侧端距肩峰端外侧缘5.32 cm.在距锁骨胸骨端内侧缘9.02 cm处,该肌束与锁骨上缘形成一卵圆形空隙,其长轴1.09 cm,短轴0.47 cm,颈外静脉及锁骨上中间神经从中穿出.该肌束后缘与斜方肌中部前缘及锁骨上缘形成1个三角形间隙,内有锁骨上外侧神经穿出.     

气管、支气管体层X线摄影的测量

为适应气管与支气管体层摄影的需要，以几何法对３２３例正常成人胸部Ｘ线平片进行了测量。在正位片测量胸横径、气管杈平面气管中轴至胸左侧壁与右侧壁的水平距离、气管横径、气管中轴至通过左右肺门的垂线的水平距离和左右主支气管与气管中轴延长线的夹角；在侧位片测量胸矢径、气管杈平面至胸前壁与胸后壁的水平距离、气管矢径。结果发现气管中轴至胸左侧壁距大于至胸右侧壁距，两者的比值男性为１．１７±０．００６６；女性为１．１６±０．００８９；气管中轴至胸后壁距大于至胸前壁距，两者的比值男性为１．２４±０．０１０２，女性…     

右锁骨下动脉起始变异一例报告

<正> 在主动脉弓末端发出右锁骨下动脉(称迷走右锁骨下动脉)的变异,国内外有不少文献报导。作者最近在解剖72个尸体中发现一例,现报告如下: 男性,15岁,发育良好,身高140厘米,心脏大小和位置正常。主动脉弓近矢状位,从升主动脉起始后转向左后至第4胸椎体移行于胸主动脉。主动脉弓的分支从右至左依次为右颈总动脉、左颈总动脉、左锁骨下动脉及右锁骨下动脉,前三者相靠近从主动脉     

Thoracic vagus section distal to the recurrent laryngeal nerve reduces substance

The vagal nerve trunk in the mediastinum of mammals divides into two main branches, the thoracic vagus nerve and the recurrent laryngeal nerve, in which the sensory nerve axons are largely involved in neurogenic inflammation in the tracheobronchial airways. A previous study demonstrated that cutting the right-side thoracic vagus nerve but not the recurrent laryngeal nerve inhibited capsaicin-induced neurogenic inflammation in the right bronchial tree of the rat. The effect of left thoracic vagus nerve section is still not known. The main purpose of the present study was to investigate the effect of sectioning the right or left thoracic vagus nerve on the innervation density of substance P-immunoreactive axons in bilateral bronchial trees. Following nerve degeneration, the whole mounts of airway tissues were processed with substance P immunohistochemistry. Denervation of either thoracic vagus nerve reduced the innervation density of axons by 38-71% in different parts of the ipsilateral bronchial tree. The effect of right recurrent laryngeal nerve section was less specific; the innervation density was reduced by 21-39% in the trachea and bronchi of both sides. Capsaicin-induced neurogenic plasma leakage was decreased in the left mainstem bronchus and lobar bronchi after left thoracic vagus nerve section. It is concluded that the thoracic vagus nerve largely contributed to the sensory innervation in the ipsilateral bronchial airways and modulated their functions.     

多层螺旋CT对小儿不典型气管、支气管非金属异物的诊断价值

目的评价多层螺旋CT在小儿不典型气管、支气管非金属异物诊断中的价值。方法回顾性分析30例（男性19例，女性11例，年龄1～5岁，平均年龄3．5岁）经纤维支气管镜检查证实的小儿不典型气管、支气管非金属异物患儿资料,每一患儿均进行多层螺旋CT扫描（层厚2mm，间隔1～2mm，螺距1～2，电压120kV，电流200mA），重建处理包括多平面重建（MPR）、最小密度投影（Min P）和CT仿真内窥镜（CTVE）技术（重建层厚1mm，间隔0．5mm）。使气管、支气管清晰显示，观察非金属异物的有无、位置及其并发症。结果气管异物3例；右侧支气管异物23例，其中右主支气管异物10例．右中间段支气管异物9例，右下叶支气管异物3例，右中叶支气管异物1例；左主支气管异物3例，左下叶支气管异物1例。4种显示方法对小儿不典型气管、支气管非金属异物诊断的敏感性分别为86．7％（26／30）、83.3％（25／30）、70．0％（21／30）、53．3％（16／30）。结论多层螺旋CT是一种非侵入性、无痛苦、安全、易为小儿所接受的检查方法，对小儿不典型气管、支气管非金属异物的诊断、术前筛选、定位、了解手术路径及术后复查等有很大的价值。     

The bronchial tree of the human embryo: an analysis of variations in the bronchial segments

A classical study has revealed the general growth of the bronchial tree and its variations up to Carnegie stage (CS) 19. In the present study, we extended the morphological analysis CS by CS until the end of the embryonic period (CS23). A total of 48 samples between CS15 and CS23 belonging to the Kyoto Collection were used to acquire imaging data by performing phase-contrast X-ray computed tomography. Three-dimensionally reconstructed bronchial trees revealed the timeline of morphogenesis during the embryonic period. Structures of the trachea and lobar bronchus showed no individual difference during the analyzed stages. The right superior lobar bronchus was formed after the generation of both the right middle lobar bronchus and the left superior lobar bronchus. The speed of formation of the segmental bronchi, sub-segmental bronchi, and further generation seemed to vary among individual samples. The distribution of the end-branch generation among five lobes was significantly different. The median branching generation value in the right middle lobe was significantly low compared with that of the other four lobes, whereas that of the right inferior lobe was significantly larger than that of both the right and left superior lobes. Variations found between CS20 and CS23 were all described in the human adult lung, indicating that variation in the bronchial tree may well arise during the embryonic period and continue throughout life. The data provided may contribute to a better understanding of bronchial tree formation during the human embryonic period.     

国人气管、支气管、肺段支气管长度、矢径、横径、直径的测量及典型相关和回归分析

本文测量了50例成人(男25例、女25例)和20例幼儿的气管、支气管和肺段支气管的长度和直径。结果表明,左肺下叶各段支气管的长度大干上叶各段支气管,右肺各段支气管的长度为下叶各段支大于中叶各段支,中叶各段支大于上叶各段支,而直径无一定规律。同时用成人50例的气管、支气管、部分肺段支气管的长度、横径共20个指标,以及身长、胸围、胸廓矢径、胸廓横径、胸廓长5个外部指标,以了解内部指标与外部指标的相关程度,建立了由外部指标推算内部指标的回归方程,其中有13个具有显著意义,可用来推算预测人体气管、支气管树的形态。     

Tracheobronchial epithelium in the adult rhesus monkey: A quantitative histochemical and ultrastructural study

Previous studies of the intrapulmo-nary conducting airways of sheep and rabbit have demonstrated marked diversity in the epithelial populations lining them. Because studies of trachea and centriaci-nar regions of macaque monkeys suggested that primates may be even more diverse, the present study was designed to characterize the epithelial population throughout the airway tree of one primate species, the rhesus monkey. Trachea and intrapulmonary airways of the right cranial and middle lobes of glutaraldehyde/ paraformaldehyde-infused lungs of five adult rhesus monkeys were microdissected following the axial pathway. Each branch was assigned a binary number indicating its specific location within the tree. The trachea and six generations of intrapulmonary airway from the right cranial lobe were evaluated for ultrastructure and quantitative histology as were those of the right middle lobe for quantitative carbohydrate histochemistry. Four cell types were identified throughout the tree: ciliated, mucous goblet, small mucous granule, and basal. The tallest epithelium lined the trachea; the shortest, the respiratory bronchiole. The most cells per unit length of basement membrane were in proximal intrapulmonary bronchi; the least, in the respiratory bronchiole. The nonciliated bronchiolar epithelial or Clara cell was restricted to respiratory bronchioles. Sulfomucins were present in the vast majority of surface goblet cells in the trachea and proximal bronchi. In proximal bronchi, neutral glycoconjugates predominated in glands and acidic glycoconjugates in surface epithelium. In terminal and respiratory bronchioles the ratio of acidic gly-coconjugate to neutral glycoconjugate equaled that in proximal bronchi, although glands were not present. Sulfomucins were minimal in terminal airways. We conclude that the characteristics of the epithelial lining of the mammalian tracheobronchial airway tree are very species-specific. The lining of the rhesus monkey does not have the diversity in cell types in different airway generations observed in sheep and rabbit. Also, the populations lining these airways in the rhesus are very different from either the sheep or rabbit in number, proportions of different cell types, glycoconjugate content, and distribution of specific cell types.     

左肺支气管64层螺旋CT的解剖学研究

目的 综合应用64层螺旋CT 3种图像对左肺段级支气管的分支形式进行分类,并探讨CT横断面图像辨认主要分支类型的规律. 方法 216例门诊患者胸部CT常规扫描资料,重组左肺支气管树、仿真内镜及薄层CT横断而图像,综合应用3种图像对216例左肺段支气管资料分型,探讨CT横断面图像辨认主要分支类型的规律. 结果 左肺上叶依据上干支气管分支的不同分为3种主要类型,Ⅰ型130例(64%):上干分为尖后段支气管和前段支气管;Ⅱ型45例(23%):上干分为尖、后、前段支气管;Ⅲ型21例(10%);上干分为尖前段及后段支气管.左肺上叶3种主要分支类型可以通过薄层CT横断面图像2个典型层面辨认;左肺下叶依据基底于支气管分支的不同分为2种主要类型,Ⅰ型163例(75%):基底干支气管两分支,即内前底段支气管、外后底段支气管;Ⅱ型39例(18%):基底干支气管3分支,即内前底段、外侧底段、后底段支气管.下叶两种主要分支类型町以通过薄层CT横断面图像2个典型层面辨认. 结论 64层螺旋CT多种重组图像综合应用可以真实直观地显示左肺段级支气管分支形式并对其准确分型.     

Sling left pulmonary artery, bridging bronchus, and associated anomalies.

Sling left pulmonary artery (SLPA) is often associated with tracheobronchial abnormalities, including bridging bronchus (BB). We report on 3 patients with SLPA: One patient had a narrow trachea, absent right upper lobe and right main bronchus, and BB. The second patient had a long and narrow trachea, with normal segmentation of bronchial tree, abnormal cerebral gyri, and minor facial abnormalities. The third patient, with a normal trachea and main bronchi with BB, had imperforate anus, hemivertebrae, and atrial septal defect (VATER association). Patients with SLPA, those with BB, or those with both SLPA and BB as well as multiple congenital anomalies represent a spectrum of anomalies.     

Sling left pulmonary artery,bridging bronchus,and associated anomalies

Sling left pulmonary artery (SLPA) is often associated with tracheobronchial abnormalities, including bridging bronchus (BB). We report on 3 patients with SLPA: One patient had a narrow trachea, absent right upper lobe and right main bronchus, and BB. The second patient had a long and narrow trachea, with normal segmentation of bronchial tree, abnormal cerebral gyri, and minor facial abnormalities. The third patient, with a normal trachea and main bronchi with BB, had imperforate anus, hemivertebrae, and atrial septal defect (VATER association). Patients with SLPA, those with BB, or those with both SLPA and BB as well as multiple congenital anomalies represent a spectrum of anomalies. © Wiley-Liss, Inc.     

右肺肺段和亚肺段支气管和血管的矢状断层解剖学研究

目的：研究右肺肺段和亚肺段支气管和血管在矢状断面上的配布规律.方法：利用15例胸部连续矢状断层标本和2例多层螺旋CT图像,追踪观察了右肺肺段和亚肺段支气管和血管,并据此寻找在矢状断面上划分右肺肺段的方法.结果：在右主支气管杈层面上,右肺上叶动脉发出尖段动脉和前段动脉,右肺下叶支气管向后发出上段支气管、向下发出内侧底段支气管.在叶间动脉层面上,右肺上叶支气管发出尖、后、前段支气管,基底干支气管发出前、外侧和后底段支气管.在叶间动脉分叉层面上,后段静脉居前、后段支气管之间,尖段静脉与前段静脉合成尖前静脉,中叶支气管分为外、内侧段支气管,下叶动脉发出的段级动脉居相应支气管的上方.在右心房右侧第二层面上,右肺上、中叶的支气管和血管已为亚段级,在右肺下叶内,肺段支气管居中,其上、下方分别为相应的肺动脉和肺静脉.结论：在矢状断面上,右侧肺段内支气管和血管相对集中,且容易显示其发出处和长轴,故矢状断面是显示右肺肺段和亚肺段支气管和血管的优势断面.