肺段的冠状断层解剖:断层标本与多层螺旋CT图像对照研究

目的：研究肺段在冠状断面上的划分及分布。方法：利用20例胸部连续冠状断层标本、2例多层螺旋CT图像、5侧游离肺剥离标本和7侧肺管道铸型，追踪观察了肺叶和肺段的支气管、肺动脉和肺静脉，并据此在冠状断面上划分了肺段。结果：肺段主要分布于从胸骨角至脊柱的10个断面里，气管权层面是在冠状断面上划分肺段的最佳开始层面。在冠状断面上有6个划分肺段的关键层面：①升主动脉层面，划分肺段的标志性结构尖段静脉、外侧段静脉、尖后段静脉、左前段静脉和上舌段静脉均出现；②肺动脉权层面，于肺动脉权下方可见到左、右上肺静脉，在Il例(55％)标本中m现尖后段静脉、前段静脉和舌静脉干同Here入左上二肺静脉的情形；③气管权层面，左、右肺上叶支气管及其分支显示清晰，于气管权下方可见到左、右下肺静脉汇入左心房；④中间支气管层面，可见到两肺下叶肺段支气管、肺动脉和肺静脉的起源；⑤胸主动脉层面，主要为两肺上段和外后底段的支气管和血管；⑥脊柱层面，两肺下叶主要表现为上段、外侧底段和后底段的支气管和血管。结论：通过仔细辨认肺段支气管、肺动脉和肺静脉，可在冠状断面上精确划分肺段。     

肺段和亚肺段支气管和血管的冠状断层解剖学研究

目的研究肺段和亚肺段支气管、肺动脉和肺静脉在冠状断面上的配布规律。方法利用加例胸部连续冠状断层标本和4例成人胸部多层螺旋CT图像,追踪观察肺段和亚肺段支气管、肺动脉和肺静脉。结果在冠状断面上有6个识别肺段和亚肺段支气管和血管的关键层面：1．升主动脉层面,切及尖段静脉、后段静脉、外侧段静脉、尖后段静脉、前段静脉和上舌段静脉;2．肺动脉权层面,于肺动脉权或左肺动脉下方可见到左、右上肺静脉注入左心房,在ll例（55％）标本中出现尖后段静脉、前段静脉和舌静脉干同时汇入左上肺静脉的情形;3．气管权层面,于气管权下方可见到左、右下肺静脉汇入左心房;4．中间支气管层面,可见到两肺下叶肺段支气管、肺动脉和肺静脉的起源;5．胸主动脉层面,主要为两肺上段和外后底段的支气管和血管;6．脊柱层面,两肺下叶主要表现为上段、外侧底段和后底段的支气管和血管。结论在胸部冠状断面上,以支气管分支为向导可准确辨认肺段和亚肺段的肺动脉和肺静脉。     

左肺门支气管和血管在横断面上的配布特点

目的：探讨左肺门支气管和血管在横断面上的配布特点。方法：在44例成人胸部连续横断层标本和10例多层螺旋CT图像上，追踪观察了左侧第1、2、3肺门处支气管、肺动脉和肺静脉的分支（或属支）及其毗邻关系。结果：在气管权层面上，尖后段静脉居中，其前方，前段动脉居前段支气管的内前方；其后方，尖后段动脉上行于相应支气管内侧。在肺动脉权层面上，左肺动脉发出尖后段动脉和前段动脉，其外侧可见尖后段支气管和前段支气管。在27例（61、4％）断层标本上，左肺动脉与前段动脉一起呈“鱼钩”状勾绕左上肺静脉。在左肺上叶支气管层面上，左肺上叶支气管居中，其前方，前段静脉汇入左上肺静脉；其后方，上段动脉发自左肺下叶动脉。在左肺下叶支气管层面上，上段支气管发出。于上叶内，下舌段支气管居中，其前方，舌静脉干汇入左上肺静脉；其后方，舌动脉干发自左肺下叶动脉。在底段上、下静脉层面上，内前、外侧和后底段支气管呈顺时针排列，各底段动脉相对同名支气管呈周围性分布，底段上、下静脉呈向心性走行。结论：通过寻找标志性结构，在横断面上可准确识别左肺肺段和亚肺段的支气管、肺动脉和肺静脉。     

左肺肺段和亚肺段支气管和血管的矢状断层解剖学研究

目的研究左肺肺段和亚肺段支气管和血管在矢状断面上的配布特点及左肺肺段在矢状断面上的划分。方法利用15例胸部连续矢状断层标本、2例多层螺旋CT图像,追踪观察左肺肺叶、肺段和亚肺段支气管、肺动脉和肺静脉,并据此寻找在矢状断面上划分肺段的方法。结果左侧肺段内的支气管和血管主要分布于从左主支气管权至心尖左侧的4个矢状断层里：1．在左主支气管权层面上,左肺下叶支气管向后发出上段支气管,其下方,上段静脉与底段总静脉在此合成左下肺静脉。2．在左肺动脉叶间部层面上,尖后段静脉、前段静脉和舌静脉干于左肺上叶支气管前方合成左上肺静脉,下叶基底干支气管发出内前底段支气管、外侧底段支气管和后底段支气管。3．在心尖层面上,左肺上叶支气管发出全部肺段支气管,可用尖后段静脉后段间支、前段静脉下支和舌静脉干区分相邻肺段,左肺下叶动脉分出的肺段动脉居相应支气管上方。4．在心尖左侧层面上,在左肺上叶内,从后上至前下依次可见尖后段静脉后段间支、前段静脉下支和上、下舌段静脉;在左肺下叶内,肺段支气管居中,上方为相应动脉,下方为相应静脉。结论在矢状断面上,肺段内支气管和血管相对集中,且容易显示其起源和长轴,故矢状断面是显示肺段和亚肺段支气管及血管的优势断面。     

右肺门支气管和血管在横断面上的配布特点

目的：探讨有肺门支气管、肺动脉和肺静脉在横断面上的配布特点。方法：在44例成人胸部连续横断层标本和5例螺旋CT图像上，追踪观察了有侧第一、二、三肺门处支气管、肺动脉和肺静脉的分支(或属支)及其毗邻关系。结果：从气管权开始，至底段上、下静脉出现，以7个典型横断面便可清晰显示有肺门管道结构的配布规律：①在气管权层面，尖段动脉、尖段支气管和后段静脉于奇静脉弓右侧由内向外依次排列；②在右肺上叶支气管层面，后段静脉居后段支气管与前段支气管之间；③在中间支气管层面，右肺上叶动脉上行于中间支气管前方，两者的深面为尖段静脉、前段静脉和后段静脉；④在叶间动脉层面，右肺上叶静脉、叶间动脉和中间支气管由前向后依次排列，在33例(75％)标本中可见到下叶上段动脉的起源；⑤于中间支气管权层面，中、下叶动脉走行于中、下叶支气管外侧；⑥于基底干支气管层面，在11例(25％)标本中可见中叶静脉直接汇入左心房，内侧底段支气管常与上段静脉段问支同时出现；⑦于底段上、下静脉层面，以各底段支气管为中心，相应动脉呈周围性分布，底段上、下静脉呈向心性走行。结论：通过寻找标志性结构，在横断面上可准确识别有肺门处肺叶和肺段的支气管、肺动脉和肺静脉。     

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.     

左肺上叶前段静脉的多层螺旋CT研究

目的：探讨活体左肺上叶前段静脉（V3）在多层螺旋CT（MSCT）上的分布特点。方法：利用Volume Wizard图像后处理工作站对160例成年男性肺部MSCT图像进行重建,并分析左肺上叶前段静脉与周围结构的关系。结果：①前段静脉（V3）的属支有上、下两部,上部汇入尖后段静脉（V1＋2）或尖段静脉（V1）,下部直接汇入左上肺静脉或与低位后段静脉（V2）汇合后再注入左上肺静脉;②上部属支多为1条,下部属支一般有1-6条,其中前支较粗大。除尖支和下支外,余均呈水平或近水平位排列。结论：MSCT后处理技术可以很好地显示段和亚段级肺静脉,可为临床医生提供较为确切的影像学资料;左肺前段静脉的属支数目和配布类型与传统观点有较大差异。     

左肺上叶尖后段静脉的多层螺旋CT

目的:探讨活体左肺上叶尖后段静脉在螺旋CT上的配布特点. 方法:利用Volume Wizard图像后处理工作站对160例成年男性肺部多层螺旋CT图像进行重建,并分析左肺上叶尖后段静脉及其周围结构.结果:(1) 尖后段静脉的存在率为71.25%,缺如率为28.75%,此时尖段静脉汇入左上肺静脉,而后段静脉则与前段静脉汇合成后前段静脉,再汇入左上肺静脉;(2) 尖段静脉一般有1～6条属支,而后段静脉有1～7条属支.结论:多层螺旋CT是在活体上研究肺段静脉及其属支的理想方法;左肺上叶尖后段静脉的属支数目和走行差异较大;尖段静脉与后段静脉可以共干形成尖后段静脉,尚有尖后段静脉缺如情况,这与传统解剖学的观点有明显不同.     

肺门区横断面CT与解剖对照研究

目的：了解正常肺门断层解剖及CT表现。方法：结合20例胸部边疆横断层标本,研究56例肺门区的CT表现。结果：右侧：右上肺静脉法支位于尖段支气管和动脉与上腔静脉之间,肺门外侧为右上肺静脉后支,后方为后段支气管和同名动脉分支。左侧：左肺静脉尖后支位于尖后段支气管和动脉的前方,或组成肺门外侧。以上观察与CT表现一致。85.7%(48例）左肺静脉尖后支位于尖后段支气管和动脉的前方;14.3%(8例）位于肺门外侧。85%（17例）右上肺静脉后支则位于前、后段支气管二者的夹角内,15%（3例）在此层面远离肺门;CT上,92.9%（52例）右上肺静脉后支则位于前、后段支气管的夹角内,7.1%（4例）在此层面远离肺门。结论：右肺门上、中区的形态与上肺静脉尖支和后支的位置和汇入上肺静脉方式有关。左肺门上区的形态与肺动脉和上肺静脉之间的关系有关;左肺门中区的形态则取决于左肺动脉舌支的发支情况。双肺门下区的形态取决于下叶肺动脉的分支形式。     

肺内血管的影像解剖学在肺段切除术的临床应用

目的 对肺内血管予以三维重建后探讨其解剖结构的走形变异对肺段切除术术式的影响,为临床肺段切除术提供影像解剖学基础。 方法 随机抽取中南大学湘雅医院2019～2020年100例肺部增强CT未见明显异常的成年人样本,分别予以三维重建后进行肺血管主干及分支走行的全方位观察。 结果 左肺动脉主干变异率为1%;尖后段、前段动脉变异率为18%,舌段动脉变异率为10%,背段动脉无变异,基底段动脉变异率为1%。右肺动脉主干变异率为1%,尖后段、前段动脉变异率为17%,舌段动脉变异率为22%,背段动脉无变异,基底段动脉变异率为13%。左肺静脉主干变异率为3%,尖后段、前段静脉变异率为20%,舌段静脉变异率为16%,背段静脉变异率1%,基底段静脉变异率为19%;右肺静脉主干无变异,尖后段、前段静脉变异率为25%,内侧段、外侧段静脉变异率为16%,背段静脉变异率1%,基底段静脉变异率为28%。 结论 肺内血管解剖结构复杂多样,尤以尖后段与前段、各基底段的组合较为多样化,内侧段与外侧段不符解剖位置关系,背段走形较为固定。影像三维重建技术能准确清晰地反映肺内血管走行,为临床影像学定位诊断及肺段切除术前评估血管解剖提供了影像学资料。     

Dissecting aneurysm of the pulmonary artery

Summary Dissecting aneurysm of the aorta is often seen; similar changes in the pulmonary artery are rare. In the German literature they are unknown. 11 previously described cases have been compiled with their clinical and pathological records, and a new added. The patient, a 45 year old woman, suffered from pulmonary hypertension which resulted in medionecrosis and a large aneurysm of the trunk of the pulmonary artery. She died of haemopericardium after rupture of the artery in two stages, with a tear of 8 cm in the trunk which reached to the bifurcation of the vessel.     

Morphometric study of the pulmonary trunk implications for a new approach of the Ross procedure

A pulmonary valve autograft may be proposed to replace diseased aortic valves. The explanted pulmonary valve is replaced with a pulmonary homograft with the inherent risk of calcified degeneration. A monocusp valve using the anterior pulmonary trunk has been proposed to reconstruct the right ventricular outflow tract. The aim of this study was to determine the feasibility of this technique. In hearts from 17 adult cadavers, we measured pulmonary trunk diameter at the leaflet tops (D1). H1 and H2 were respectively from leaflet top to lower and upper levels of the pulmonary trunk bifurcation. D2 = 1.4 D1 was calculated as the monocusp size allowing a 45∘ opening of the valve and thus permitting good valvular efficacy. G = H1-D2 determined the feasibility of the technique G greater than 10 mm, appeared the most favorable, G between 0 and 10 mm, appeared possible, and G less than 0, appeared to be impossible. Mean values of D1, H1 and H2 were respectively 20.19 mm, 37 mm and 57 mm. The technique was possible in 16 cases (94%) and impossible in 1 case (6%). Preoperative determination of these parameters, by echocardiography or magnetic resonance imaging, appears necessary before applying this new surgical technique.     

Baseline Characteristics of the Korean Registry of Pulmonary Arterial Hypertension

Despite recent advances in understanding of the pathobiology and targeted treatments of pulmonary arterial hypertension (PAH), epidemiologic data from large populations have been limited to western countries. The aim of the Korean Registry of Pulmonary Arterial Hypertension (KORPAH) was to examine the epidemiology and prognosis of Korean patients with PAH. KORPAH was designed as a nationwide, multicenter, prospective data collection using an internet webserver from September 2008 to December 2011. A total of 625 patients were enrolled. The patients'' mean age was 47.6 ± 15.7 yr, and 503 (80.5%) were women. The diagnostic methods included right heart catheterization (n = 249, 39.8%) and Doppler echocardiography (n = 376, 60.2%). The etiologies, in order of frequency, were connective tissue disease (CTD), congenital heart disease, and idiopathic PAH (IPAH) (49.8%, 25.4%, and 23.2%, respectively). Patients with WHO functional class III or IV at diagnosis were 43.4%. In total, 380 (60.8%) patients received a single PAH-specific treatment at the time of enrollment, but only 72 (18.9%) patients received combination therapy. Incident cases during the registry represented 297 patients; therefore, the incidence rate of PAH was 1.9 patients/yr/million people. The 1st-, 2nd-, and 3rd-yr estimated survival rates were 90.8%, 87.8%, and 84.4%, respectively. Although Korean PAH patients exhibited similar age, gender, and survival rate compared with western registries, they showed relatively more CTD-PAH in the etiology and also systemic lupus erythematosus among CTD-PAH. The data suggest that earlier diagnosis and more specialized therapies should be needed to improve the survival of PAH patients.

Graphical Abstract

相似文献   

急性肺动脉高压肺血管力学特性的评价

本文通过静脉持续滴注血检素A2类似体U46619复制急性肺动脉高压实验模型，借助右心导管技术和利用压力波形面积确定动脉顺应性的改进方法，评价急性肺动脉高压状态下的肺血管力学特性。实验结果发现，当平均肺动脉压从2.60±0．3kPa上升至3.75±0.45kPa后；心排量（CO）无显著性变化（1．85±0．21vs1．21±0．25l／min；P＞0.05），而肺小动脉血管阻力（PVR）明显升高（31.4±9．4vs148．7±12．3kPa·s／L，P＜0．01）与肺动脉平均压相对应的血管顺应性Cm显著降低（12．43±2．62vs10．30±3．12ml／kPa，P＜0．05），而反映肺血管壁固有结构特性的零压顺应性Co无明显改变（15.22±2.98vs14.31±3.49ml／kPa，P＞0．05。本实验提示，在急性肺高压状态，肺小动脉收缩引起的肺血管阻力变化是关键因素，选择治疗急性肺高压的扩血管药物应偏重于主要作用于小动脉血管的药物。     

旋转磁场对肺水肿,肺出血预防作用的实验研究

本研究采用旋转磁疗机对10只小白鼠进行了实验性肺水肿、肺出血发生前旋磁预处理，以观察旋转磁场对肺水肿、肺出血的预防作用。实验结果发现、经旋磁预处理的小鼠（旋磁组）肺脏大体观察、肺组织病理切片、肺系数以及耳廓微循环与生理盐水组相比无明显差异（P＞0．05），而与对照组相比差异有非常显著性（P＜0.01）。提示旋转磁场对肺水肿、肺出血有一定的预防作用。     

肺段矢状断面的解剖学研究及其临床意义

目的:为了给矢状断层影像在肺段水平上进行肺部疾病的准确定位提供断层解剖学依据。方法:利用28侧肺剥离标本,2侧肺铸型标本和12侧新鲜成年尸肺连续矢状断层标本,研究了肺的矢状断层解剖。结果:确定左右肺在矢状断面上典型层面的标志,并在典型层面上观察左右肺肺段的划分。结论:结果可为肺段在矢状断层影像上的定位提供解剖学依据。     

Structural organization of pulmonary arteries in the rat lung

The structure of the normal pulmonary arteries in the rat was studied with light and electron microscopy after use of a newly devised technique of perfusion fixation and tissue preparation. We distinguished two main types of artery in the rat lung on the basis of the structure of the media, an elastic artery and a muscular artery. The elastic artery was characterized by an abundance of extracellular matrix in the media and by an oblique arrangement of smooth muscle cells to connect neighboring elastic laminae. It was subdivided into two segments, a classical elastic and a transitional elastic segment. The muscular artery was distinguished by a paucity of extracellular matrix in the media and by a circumferential arrangement of smooth muscle cells (or pericytes) enclosing the lumina, and was subdivided into four segments, a thick muscular, an ordinary muscular, a partially muscular and a nonmuscular segment. The smooth muscle cells in the muscular artery contained well-developed microfilament bundles compared with those in the elastic artery. Structural differences in smooth muscle cells and in extracellular matrix in the media between the elastic and muscular arteries may reflect the functional heterogeneity of pulmonary arteries in response to hypoxic pulmonary vasoconstriction and to vasoactive substances such as endothelium-derived relaxing and hyperpolarizing factors, and endothelin.     

Clinical and haemodynamic evaluation of chronic thromboembolic pulmonary hypertension patients scheduled for pulmonary thromboendarterectomy. Is schistosomiasis hypertension an important confounding factor?

INTRODUCTION:

Chronic thromboembolic pulmonary hypertension is a disease affecting approximately 4,000 people per year in the United States. The incidence rate in Brazil, however, is unknown. The estimated survival for patients with chronic thromboembolic pulmonary hypertension without treatment is approximately three years. Pulmonary thromboendarterectomy for select patients is a potentially curative procedure when correctly applied. In Brazil, the clinical and hemodynamic profiles of chronic thromboembolic pulmonary hypertension patients have yet to be described.

OBJECTIVES:

To evaluate the clinical and hemodynamic characteristics of chronic thromboembolic pulmonary hypertension patients scheduled for pulmonary thromboendarterectomy in a referral center for chronic thromboembolic pulmonary hypertension treatment in Brazil.

METHODS:

From December 2006 to November 2009, patients were evaluated and scheduled for pulmonary thromboendarterectomy. The subjects were classified according to gender, age and functional class and were tested for thrombofilia and brain natriuretic peptide levels.

RESULTS:

Thirty‐five consecutive chronic thromboembolic pulmonary hypertension patients were evaluated. Two patients tested positive for schistosomiasis, and 31 were enrolled in the study (19 female, 12 male). The majority of patients were categorized in functional classes III and IV. Hemodynamic data showed a mean pulmonary vascular resistance (PVR) of 970.8 ± 494.36 dynas·s·cm^‐5 and a low cardiac output of 3.378 ± 1.13 L/min. Linear regression revealed a direct relation between cardiac output and pulmonary vascular resistance. Paradoxical septal movement was strongly correlated with pulmonary vascular resistance and cardiac output (p = 0.001). Brain natriuretic peptide serum levels were elevated in 19 of 27 patients.

CONCLUSIONS:

In a referral center for pulmonary hypertension in Brazil, chronic thromboembolic pulmonary hypertension patients evaluated for pulmonary thromboendarterectomy had a hemodynamically severe status and had elevated brain natriuretic peptide serum levels. There was a predominance of females in our cohort, and the prevalence of hematological disorders and schistosomiasis was low (less than 10%).     

Variation in Number and Drainage Pattern of Pulmonary Veins Draining into the Left Atrium

Pulmonary veins carry oxygenated blood from the lungs to the left atrium of the heart. The variation in the number and drainage pattern of pulmonary veins is frequent and this knowledge is valuable for various procedures involving the pulmonary veins. The present study is done on 29 hearts obtained from formalin fixed cadavers from the dissecting room of department of anatomy, MAMC, Agroha, Hisar. The left atrium of these hearts was studied from external aspect for the number of pulmonary veins draining into left atrium and from internal aspect for the drainage pattern. In 13 out of 29 hearts (44.8%), variation in number of pulmonary vein was observed. In the present study the most common variation of right pulmonary veins is three veins with two ostia (10.3%) and the most common variation of left pulmonary veins is a single vein with a single ostium (17.2%).The variations of pulmonary veins are quite common with an equivocal variability in right-sided and left-sided drainage patterns. A classification is proposed to describe these variations to facilitate communication with referring clinicians.