腓肠内外侧血管解剖特点及其在小腿创伤修复中的意义

目的：为小腿创伤皮瓣移植修复与腓肠内、外侧血管吻合提供解剖学基础。方法：在７０侧成人下肢标本上解剖观测了腓肠内、外侧血管的长度、外径、血管神经的毗邻关系及其形态特点。结果：①腓肠内、外侧动脉起于动脉，伴行静脉注入静脉；②动脉起点至入肌段的长度内、外侧分别为４．１±０．７（１．８～６．４）ｃｍ、３．７±０．５（２．０～６．５）ｃｍ；③肌门处内、外侧动脉的外径分别为２．２±０．１（１．１～３．４）ｍｍ、２．０±０．１（０．９～３．１）ｍｍ；④肌门处伴行静脉有１～２条，内、外侧静脉外径为２．５±０．３（１．８～４．５）ｍｍ，２．３±０．３（１．５～４．１）ｍｍ。结论：腓肠内、外侧血管恒定、径粗、较长，是小腿创伤皮瓣移植修复受区可供应用的吻合血管     

睾丸神经切除术的应用解剖

目的：为睾丸神经切除术提供解剖学基础。方法：在３０侧成年男性尸体标本上对精索腹股沟管腹环至皮下环段进行了解部学观测。结果：输精管位于精索后内方,睾丸动脉位于中央,被蔓状静脉丛包绕,输精管动脉位于精索内生殖股神经生殖支与输精管静脉之间稍后方,髂腹股沟神经位于精索的外侧、生殖股神经生殖支位于精索的内侧,与精索伴行。结论：在显微外科睾丸神经切除术中应注意寻找保护睾丸动脉和输精管动脉,切断睾丸神经,根除交感神经的支配,即可阻断睾丸神经的痛觉传导。     

活体肾上腺血管的解剖观测及临床意义

目的：研究活体肾上腺血管的应用解剖。方法：对１８例２４侧肾上腺手术时分离出血管，测量血管外径及长度，对６个完整肾上腺灌注染色。结果：右膈下动脉从下腔静脉右缘至末支肾上腺上动脉长８．５（７．５～１１．０）ｃｍ，外径２．５～３．０ｍｍ；左膈下动脉从腹主动脉左缘至末支肾上腺上动脉长８．０（７．０～９．０）ｃｍ，外径２．５～３．１ｍｍ；肾上腺上动脉１～６支，均源于膈下动脉。肾上腺中动脉右侧长１．７～２．２ｃｍ，外径１．０～１．５ｍｍ；左侧长１．５～２．０ｃｍ，外径１．０～１．５ｍｍ。肾上腺下动脉两侧基本相同，长１．５～２．０ｃｍ，外径１．０～２．０ｍｍ。肾上腺中心静脉右侧长０．４～０．８ｃｍ，左侧长３．０～４．０ｃｍ，外径３．０～４．０ｍｍ。结论：肾上腺血管加部分膈下血管的长度可供带血管蒂肾上腺转位治疗柯兴氏病；活体切取供移植的肾上腺；选择性肾上腺血管造影等。     

股部皮神经营养血管皮瓣的应用解剖

目的：为股部皮神经及其营养血管为蒂的岛状皮瓣提供解剖学基础。方法：８侧经动脉灌注红色乳胶成人新鲜下肢标本，解剖观测股部主要皮神经血供及其筋膜皮支的分布范围；２侧成人新鲜下肢标本经墨汁灌注，皮肤脱水透明后观测各皮神经营养血管的分支分布及吻合。结果：①股外侧皮神经有营养动脉２～６支，超始外径１．０±０．４ｍｍ，其筋膜皮支分布达神经内侧４．１ｃｍ，外侧５．９ｃｍ；②股前皮神经有营养动脉１～５支，外径１．０±０．３ｍｍ，其筋膜皮支分布达神经内侧２．４ｃｍ，外侧３．４ｃｍ；③股后皮神经有营养动脉１～３支，外径０．９±０．３ｍｍ，其筋膜皮支分布达神经内侧３．９ｃｍ，外侧３．２ｃｍ。结论：以股部各主要皮神经及其营养血管为蒂可沿其皮神经走行设计切取顺行或逆行岛状皮瓣     

睾丸静脉与腹壁浅静脉分流治疗小儿精索静脉曲张的应用解剖

目的：为临床行睾丸静脉分流术治疗小儿精索静脉曲张症提供应用解剖学资料。方法：在３４侧小儿标本上，解剖观测了睾丸静脉、腹壁浅静脉的起始、位置、外径及分离长度。结果：腹壁浅静脉由脐下浅静脉汇成，以腹股沟为标志线，静脉在距前正中线３．５±０．８ｃｍ处，位于浅筋膜内几乎垂直下行注入大隐静脉，分离长度６．０±１．７ｃｍ，中１／３外径２．０±０．３ｍｍ。结论：腹壁浅静脉是治疗小儿精索静脉曲张症较为理想的分流血管。     

股神经嵌压症的应用解剖

目的：为肌腔隙内的股神经嵌压症机理和治疗提供解剖学资料。方法：解剖４０侧成人肌腔隙（男性２８侧、女性１２侧），对肌腔隙内相关结构进行观察、测量。结果：腹股沟韧带长平均为１１３．３±１．１ｍｍ；肌腔隙浅边长为４６．１±０．９ｍｍ；深边长为６９．２±１．２ｍｍ；肌腔隙的深度为１７．１±１．１ｍｍ；髂耻弓长度为３１±０．６ｍｍ。肌腔隙内股神经横径为７．１±０．３ｍｍ；股神经距腹股沟韧带的深度为１１．７±０．４ｍｍ；股神经横径中点到髂前上嵴距离为６２．０±０．８ｍｍ。结论：肌腔隙内压力增高可导致股神经嵌压症，治疗的关键是及时沿腹股沟韧带由内向外切开髂耻弓减压。     

一个新的甲状腺手术麻醉点的解剖学基础及临床应用

目的：为甲状腺手术提供新的麻醉方法。方法：用３０侧成人标本，在手术显微镜下观察了颈前部神经的来源、分支分布及其吻合。结果：颈皮神经分单干，上、下干和上、中、下干三种类型。上、中、下干的起始宽度分别为１．６±０．６ｍｍ，１．８±０．６ｍｍ和１．８±０．７ｍｍ；干长１７．７±７．８ｍｍ，３１．７±１２．３ｍｍ和２５．４±９．０ｍｍ。锁骨上内侧神经分布至胸锁关节和胸骨柄上方的皮肤。面神经颈支的降支均与颈皮神经吻合。明确了通过胸锁乳突肌前缘，甲状软骨上缘下方１．５ｃｍ与颈前正中线外侧４ｃｍ的交点处（麻醉点）１ｃｍ和２ｃｍ半径圆形区的神经来源和分布。结论：经临床１００例应用验证新麻醉点具有安全可靠、效果理想、并发症少等特点，有推广前途     

内窥镜鼻窦手术相关解剖结构测量及临床意义

目的：为功能性鼻内窥镜术中确定手术部位，减少并发症提供解剖学基础。方法：２０具（４０例）头部标本，以鼻小柱基部为基点，分别测量各解剖结构与基点间的距离的该连线与鼻底的夹角。结果：鼻小柱基点及基线与各解剖结构的平均距离和夹角分别为：泪囊３．９±０．４ｃｍ，５２°±７．０°；中甲前缘３．９±０．３ｃｍ，４５．０°±５．０°；额窦开口５．１±０．４ｃｍ，５８．０°±４．０°；额隐窝４．９±０．５ｃｍ，５６．０°±５．０°；钩突前缘４．４±０．４ｃｍ，４９．０°±６．０°；上颌窦开口４．３±０．２ｃｍ，４５．０°±４．０°；筛前动脉５．６±０．４ｃｍ，５０．０°±５．０°；视神经６．９±０．５ｃｍ，４１．０°±６．０°；蝶窦开口６．６±０．４ｃｍ，４５．０°±４．０°。结论：①鼻小柱是一直观的参照标志，以其为基点测出各解剖数据，对ＦＥＳＳ具有实用意义；②尸体标本所测数据与正常人基本一致     

巨大盲肠并位置左移1例

巨大盲肠并位置左移１例何尚宽在一约１３岁男性标本上，见其盲肠增大，与升结肠呈葫芦状，位置左移，整个盲肠部分游离，与周围组织无粘连。以回盲部上缘为界，测得盲肠外径为７．０ｃｍ×６．５ｃｍ×６．０ｃｍ，３／５位于腹正中线右侧，２／５位于腹正中线左侧，其下...     

上颌骨腭突圆孔状缺如一例报告

作者在处理一成年男性出土骨骼标本时，发现其上颌骨腭突的左前部有圆孔状的缺失区（见附图）。圆孔周边整齐，约２／３偏向中线的右侧，通向右下鼻道前部。圆孔的周径为５．６ｃｍ，前后直径为１．８ｃｍ，左右横径为１．９ｃｍ，前缘距切牙０．７ｃｍ，后缘距腭横线０．...     

胎儿睾丸及输精管解剖

通过对１３６例１８～４２周龄男性胎儿尸体睾丸,输精管,精索血管解剖,在直视下测量了睾丸长度,前后径及输精管,附睾,精索血管的长度,观察了睾丸的位置,计算了睾丸的体积,结果：发现胎儿睾丸,附睾,输精管的发育与胎龄呈正相关,同一胎龄组内双侧睾丸长度,前后径及输精管,精索前管长度无差异（Ｐ〉０．０５）。睾丸开始下降的时间较国内外资料偏导。     

Giant fibrolipoma of the spermatic cord

Fibrolipoma of the spermatic cord is extremely rare. A case of giant fibrolipoma of the right spermatic cord is reported here. A 68‐year‐old man noticed a mass in the right inguinal region, and was admitted to Shizuoka City Shimizu Hospital. Tumorectomy and right orchiectomy were performed. Grossly, the tumor was a well‐defined, yellowish white, solid, firm tumor measuring 13 × 10 × 9 cm. The tumor had a thin capsule. The tumor was attached to the right spermatic cord, and was remote from the right testis and epididymis. Microscopically, the tumor was composed of mature adipose tissue (40% in area) and collagenous fibrous tissue (60% in area). No lipoblasts were recognized, and on immunohistochemistry the tumor was negative for MDM2 and CDK4. Neither smooth muscle nor vascular proliferation was recognized. The tumor was diagnosed as giant fibrolipoma of the right spermatic cord. To the best of the author's knowledge, only two cases of fibrolipoma in the spermatic cord, scrotum, and testis have been reported in the English‐language literature.     

Intermediate inguinal ring

The purpose of this paper is to reintroduce the concept that the cremasteric muscle and fascie (intermediate spermatic covering) arise from an intermediate inguinal ring, similar to the internal spermatic fascia arising from the deep inguinal ring and the external spermatic fascia arising from the superficial inguinal ring. This will help students learn the anatomy of the inguinal region. © 1992 Wiley-Liss, Inc.     

Cystadenoma of spermatic cord resembling ovarian serous epithelial tumour of low malignant potential: immunohistochemical study suggesting Müllerian differentiation

A cystic lesion of the spermatic cord resembling an ovarian serous epithelial tumour of low malignant potential or borderline malignancy is reported. Immunohistochemical staining and electronmicroscropic examination suggested epithelial rather than mesothelial differentiation of the cyst lining cells. There was strong positive immunohistochemical staining of cyst lining cells for CA 125, providing evidence for Müllerian differentiation. A flow cytometric analysis of nuclear DNA content revealed a diploid profile.     

Morphological Changes in Varicocele Veins: Ultrastructural Study

Background: Varicocele consists of dilatation of the pampiniform venous plexus and the internal spermatic veins. It is present in 15% of male population and is a common cause of male infertility. Objective: To describe the normal structure of the internal spermatic vein and the morphological changes in grade 3 varicocele. Methods: The authors dissected and analyzed a 2- to 3-cm tract of the pampiniform venous plexus of 20 patients undergoing varicocelectomy for left varicocele and of 10 consecutive patients undergoing surgery for left inguinal hernia. The histological examination was performed with hematoxylin–eosin and Masson trichrome stains. The ultrastructural evaluation was done using both scanning and transmission electron microscopy. Results: Compared with normal internal spermatic veins, varicocele veins showed narrowing and/or obliteration of the lumens, destruction of the endothelial cells, invagination of the intima, and deposition of collagen bundles in the media (light microscopy). The ultrastructural changes in varicocele veins included elongation of the endothelial cells with features of cellular damage, loss of the internal elastic lamina, and the appearance of ghost bodies and degenerative vacuoles in the subendothelial layer. Conclusions: The authors believe this is the first report analyzing ultrastructual changes in normal human internal spermatic vein samples and in varicocele. The underlying molecular mechanisms of these changes await further studies.     

Hydrodynamic relationship between color Doppler ultrasonography findings and the number of internal spermatic veins in varicoceles

Purpose

The improvement of testicular volume, testosterone levels and sperm concentration was suggested to be significantly associated with the number of internal spermatic veins (ISVs) ligated during varicocelectomy. Herein, we investigated preoperative color Doppler ultrasonography (CDU) findings as potential preoperative predictors of the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy.

Materials and Methods

In a prospective evaluation of 40 patients, maximal vein size and maximal reflux velocity were measured, while the total cross-sectional area of the affected testicular veins during a Valsalva maneuver was calculated using CDU by a single uroradiologist. Microsurgical subinguinal varicocelectomies were performed by one urologist.

Results

Among the semen parameters, semen morphology showed significant improvement (p=0.033), which was much clearer in the patients with a higher number of ISVs ligated than a lower number of ISVs ligated. Among the various preoperative variables, maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated (r=-0.442, p=0.004; r=0.594, p=0.000, respectively). Furthermore, univariate and multivariate linear regression analyses showed that maximal reflux velocity and total cross-sectional area on CDU were independent predictive factors of the number of ISVs ligated.

Conclusion

Maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated. This means that the maximal reflux velocity and total cross-sectional area measured by preoperative CDU can predict the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy, which might be related to significant improvement of semen parameters after varicocelectomy.     

Ultrastructural Changes of Smooth Muscles in Varicocele Veins

Background: Varicocele is a dilatation of the pampiniform venous plexus and internal spermatic veins. It affects about 15–20% of male population and can cause infertility.

Objective: To describe the most significant ultrastructural changes of the smooth muscle cells in grade 3 varicocele veins.

Methods: The authors analyzed 2- to 3-cm tracts of pampiniform venous plexus from 20 patients who underwent varicocelectomy for left varicocele. Light microscopic examination was performed with Van Gieson’s stain. Ultrastructural examination was done using scanning and transmission electron microscopy.

Results: Light microscopic examination revealed irregularity and separation of medial smooth muscle cells by abundant collagen fibers in varicocele veins. On scanning electron microscopy, the medial layer of varicocele veins showed hypertrophy, irregularity, and separation of the outer longitudinal smooth muscle cells and deposition of numerous fatty globules in between muscle fibers. Transmission electron microscopy showed marked indentation and chromatin condensation of the nucleus, presence of clear vacuoles and myelin figures in the cytoplasm and plasmalemmal projections and formation of ghost bodies. Furthermore, smooth muscle cells were found to have pseudopodia-like projections around adjacent elastic and collagen fibers.

Conclusions: The degenerative changes observed in smooth muscle cells and presence of abundant collagen fibers in the medial layer may contribute to the development of the varicocele of pampiniform venous plexus. Further molecular studies are required to shed more light for the underlying mechanism.