摘要
目的：探讨上胸段交感干及其与肋间神经或胸神经前支之间的神经联系，为经胸腔行上肢交感神经切除术提供解剖学基础。方法：对50侧成人尸体标本的上胸段交感干（神经节及节间支）、上5对肋间神经（或胸神经）及其它们之间的神经联系进行显微解剖。结果：星状神经节出现率为80％，胸2、胸3、胸4神经节多位于相应肋间，出现率分别为92％、68％、50％。第1、2肋间支出现率分别为40％、6%，星状神经节的降支出现率为46％，胸2、胸3、胸4神经节的升支或降支出现率分别为54％、24％、14％。额外交通支与第1胸神经前支的连接点均位于后者发支至臂丛的近侧，与第2～4肋间神经连接点到胸交感干的最远水平距离是29．1mm。只有16％的个体双侧胸2～胸4神经节的交通支配布有类似的解剖学特征，而且胸2神经节的变异较胸3、胸4神经节大。结论：上胸部交感干与肋间神经或胸神经前支间神经联系的变异很大，这些变异可能是手术失败或复发的原因。经胸腔行上肢交感神经切除术治疗多汗症、复合性局部疼痛综合征、雷诺现象等难治性疾病时，应注意这些解剖变异，以改善手术效果。
Objective： To Clearly delineate the upper thoracic sympathetic chains and the neural connections between the upper thoracic sympathetic chains and intercostal nerves or ventral rami of thoracic nerves, and to provide the anatomical basis for a successful upper limb sympathectomy in thoracic route. Methods： The upper thoracic sympathetic chains with sympathetic ganglia and interganglionic segments, upper five thoracic spinal nerves or intercostal nerves, and neural connections between them in 50 sides of 25 adult cadavers routinely embalmed and fixed with formaldehyde solution have been microdissected under a dissecting microscope, measured and mapped. Results： The stellate ganglion was noted in 80% （40/50）. The second to fourth thoracic sympathetic ganglia were located most often at the corresponding intercostal spaces with the presence of 92%（46/50）,68% （34/50） and 50% （25/50） respectively. The presence of first and second intercostal rami or nerve of Kunts was 40%（20/50） and 6% （3/50）, respectively. The incidence of the descending rami from the stellate ganglion was 46% （23/50）. The incidence of ascending or descending rami arising from the second, third and fourth thoracic sympathetic ganglia was 54%（27/50）,24% （12/50） and 14% （7/50）, respectively. The additional rami communicantes joined the ventral ramus of the first thoracic nerve proximal to the point where the latter gave a large branch to the brachial plexus. The farthest horizontal distance from the thoracic sympathetic chain to junction between the additional rami communicantes and the second to fourth intercostal nerves was 29.1 mm. When we compared anatomical structures of the second to fourth tho racic sympathetic ganglia on both sides among the 25 cadavers dissected, only 16% （4/25） had similar anatomy of the rami communicantes bilaterally. And the anatomical variations of rami communicantes connecting the intercostal nerves and the second thoracic sympathetic ganglion was much larger than that of the lower levels. Conclusion ： The anatomical variations of the upper thoracic sympathetic trunk in relation to the intercostal nerves or ventral rami of the thoracic nerves are striking, particularly the way in which the second sympathetic thoracic ganglion gives off its rami communicantes. And the anatomical variations may be one of the main causes resulting in surgical failures and recurrences. To get better surgical effect, more attention should be paid to the anatomical variations during the upper limb sympathectomy in the thoracic route for a group of disparate medical conditions： essential palmar hyperhidrosis, complex regional pain syndrome and Raynaud＇s phenomenon.
出处
《解剖学杂志》
CSCD
北大核心
2009年第4期515-517,共3页
Chinese Journal of Anatomy
关键词
交感神经切除术
交感干
交通支
解剖学
sympathectomy
sympathetic trunk
rami communicantes
anatomy
作者简介
E—mail：ben—si—zhang．@163．com
