Objective To prevent bile duct injury, a new anatomy marker, named “common bile duct window” is created. Methods From November 2005 to March 2006, 60 patients who underwent laparoscopic cholecystectomy were researched in this hospital. All data were collected, including: age, gender, course of disease, body mass index (BMI), blood lipid level (triglyceride and cholesterol), the thickness of gallbladder wall and the degree of cholecystitis. The frequency, location and mean size of “common bile duct window” were recorded and calculated. Patients were divided into two groups according to the presence of “common bile duct window”, and the diference of data between two groups was analyzed by using χ2 test or t test. Results “Common bile duct window” was found at the end of hepatoduoduenal ligament with oval-shaped, the mean longitude of “common bile duct window” was (1.20±0.60) cm, and mean width was (0.45±0.30) cm. “Common bile duct window” were found in 81.6% (49/60) of patients. Age, gender, course of disease, BMI, triglyceride and cholesterol were proved to have no relationship with the presence of “common bile duct window” （Pgt;0.05）, but the thickness of gallbladder wall and the degree of cholecystitis affected the presence （P＜0.05）. Conclusion An oval-shaped “common bile duct window” can be found in almost all patients undergoing laparoscopic cholecystectomy. During the operation, the common bile duct can be located easily by the surgeon through “common bile duct window”, thereby to avoid common bile duct injury when the cyst duct was dissected. It is believed that during laparoscopic cholecystectomy the chances of bile duct injuries can be effectively decreased by the presence of “common bile duct window”.
Anatomical venous distribution around the lower esophagus, gastric cardia and fundus in 100 adult cadavers had been observed. The results showed that the occurrence rate of the left gastric and the right gastric veins were 96% and 92% respectively. Venous distribution in the lesser curvature of the stomach can be classified into five types: the left gastric vein type, the right gastric vein type,the left gastric vein dominant type, the right gastric vein dominant type, and the balance type (of the left and the right gastric veins). The retrogastric veins were found in 73.6% of 100 cadavers showed portacaval anastomoses. From March 1976 to March 1992, we had treated with transthoracic interruption of portoazygous circulation, 52 cases of portal hypertension resulting in bleeding du to rupture of esophageal and venriculi fundus varices ( male 43, female 9). Among the 41 emergency operations, 2 cases died (4.9%), and bleedings were controlled by emergency surgery in 92.6% of cases. 44 of the 50 cases (88%) were followed up. The recurrence of bleeding occured in 5 cases, with a long-term bleeding rate of 11.4%. The authors suggest that anatomical factors might be the reason of inadequacy of portaoazygous interruption, and claim the advantages of transthoracic interruption of portoazygous circulation.
Objective To review the recent anatomy and biomechanical research progress of knee posteromedial corner, to analyze deficient aspect, and to predict future research directions. Methods Domestic and international l iterature about the anatomy and function of knee posteromedial corner in recent years was reviewed extensively, at the same time, the biomechanics of corresponding structure was summarized and analyzed. Results The anatomical structures ofknee posteromedial corner included the static stabil ity structures and the dynamic stabil ity structures. The dynamic stabil ity structures were more important, including posterior root of medial meniscus, posterior obl ique l igament, semimembranosus extensions, meniscotibial l igament and obl ique popl iteal l igament. The posterior obl ique l igament was most important structure to contribute to stabil ization of valgus, anterior internal rotation of knee and posterior movement of tibia. Conclusion Anatomical reconstruction of knee posteromedial corner especially the posterior obl ique l igament is the key to the reconstruction of knee posteromedial function stabil ity.
OBJECTIVE: To explore the importance of the posterior and lateral arterial network of elbow in the application of the super-regional and mutual-pedicled axial flap. METHODS: Twenty-seven upper extremities of adult cadavers were prepared as casts of Acrylomintril Batradiene Styrene(ABS) resin and corroded in a b solution of NaOH according to natural layers of human tissue. The source, site and structure of the posterior and lateral arterial network of elbow were observed, the number and total sectional area of anastomosing branches crossing the line between two humeral epicondyles were measured and compared with the medial and anterior region. RESULTS: There are 8.64 +/- 2.74(36.42%) and 8.30 +/- 1.19(35.0%) anastomosing branches crossing the posterior and lateral regions, and total section areas are (0.48 +/- 0.11) mm2 and (0.37 +/- 0.03) mm2 respectively. So there is very rich arterial network around the elbow. CONCLUSION: The enough number of anastomosing branches and their section areas of the posterior and lateral region of the elbow make it possible to connect super-regional and mutual-pedicled axial flaps crossing the elbow.
Seven cases of strangulated obturator hernia are reported. All cases were confirmed by operation .The incidence in female were 6 timed higher than that in male. The mean age of the patients in this series was 72.7 years. All the patients were thin and had a history of multiple pregnancies. The diagnoses were delayed for 7.4 days in average and the preoperativve diagnoses were correct in only two of seven operation (28.6%). The cure rate was 71.4% with a mortality rates of 28.6%. Based on the anatomy related to obtutor hernia, the clinic manifectation and diagnosis and method of treatment are discussed.
ObjectiveTo investigate the distance between the screw-out point and the middle sacral artery, and evaluate the safety when the S1 pedicle screw placed by the three cortical fixation techniques.MethodsFrom March to June 2018, randomized CT scan data of 98 adult pelvic angiography were selected to measure the distance from the middle sacral artery to the anterior edge of the vertebral body (a) and the distance from the middle sacral artery to the midline of the vertebral body (b). S1 screw entry point was set as the intersection of lines where extension of S1 facet joint inferior margin and lateral margin cross over. Introversion angles of 10, 15, 20, and 25° were used; the distance between the screw insertion point and the middle sacral artery (d) was measured.ResultsThe middle sacral artery was usually located on the left side of the upper endplate plane of S1. The distance a was (5.40±2.95) mm in 49 males and (4.43±2.32) mm in 49 females, and the difference between the males and females was not statistically significant (t=1.818, P=0.72). The distance b was (12.07±5.42) mm in 45 males and (14.12±4.88) mm in 48 females, and the difference between the males and females was not statistically significant (t=–1.914, P=0.59). The distance d was (12.67±6.00), (9.40±5.17), (7.50±3.76), and (8.10±3.64) mm when the nail was placed at a common internal inclination of 10, 15, 20, and 25°. The differences in the distance d at a common internal inclination of 10° vs. 15°, 10° vs. 20°, 10° vs. 25°, and 15° vs. 20° were all statistically significant (t=16.828, 11.609, 6.073, 6.254; P<0.008 3); there was no statistically significant difference in that at 15°vs. 25°, or 20° vs. 25° (t=2.034, –1.723; P>0.05).ConclusionBy analyzing the relationship between the middle sacral artery and the upper endplate plane of the S1 vertebra, the risk of middle artery injury is small while the biomechanical stability of the screw is increased when using the Lenham method.
Objective To investigate the number and location of parathyroid glands in relation to thyroid gland, to increase the knowledge about anatomical variation of parathyroid glands, and to reduce injury of the parathyroid and recurrent laryngeal nerve. Methods A total of 50 cadavers were sectioned. The number and distribution of parathyroid glands and their relations with adjacent structures were observed. Results Mean number of parathyroid glands in one individual was 3.52±0.48, mainly located at the retro-medialis of thyroid, which was called “tri-domain and one area”. Superior parathyroid glands were mainly located in the area of cornu inferior thyroidal cartilage; the inferior parathyroid glands except ectopic parathyroid glands were located in radix nasi of thyroid glands; while the area around inferior thyroid artery contains both the superior and inferior parathyroid glands. These three areas constitute the region of retro-medialis of thyroid that parathyroid glands were inclined to get injured. Most superior parathyroid glands were located beside the lateral of recurrent laryngeal nerve （67.8%） and the inferior parathyroid gland mainly located next to recurrent laryngeal nerve （71.9%）, both showed statistical significance (P＜0.005). About 85.0% of superior parathyroid located in the area around posterior suspensory ligament of thyroid, and most common place for ectopic parathyroid gland was around lingual lobe of thymus (28.6%). Conclusion With extreme caution, familiarity with anatomy and skillful technique, the injury to parathyroid glands and recurrent laryngeal nerve can be prevented, which may not be a restrain of putting standard thyroid operation into practice.
OBJECTIVE: To observe the heart anatomic and histological structure of the Banna mini-pig inbred-lined and to provide the morphological data for heart xenotransplantation and breeding transgens pig. METHODS: Ten Banna mini-pigs (12-18 months old) were affused and fixed by common coratid artery. The heart were observed and measured by gross anatomy and histology. RESULTS: There were many similarities between the Banna pig heart and the human heart in anatomy and histology. However, the following differences were observed in the Banna pig heart: 1. Azygos vein directly drew into right atrium cordis. 2. The intercalated disk of cardiac muscle was less than that of human. 3. The Purkinje’s fibre was bigger than that of human. CONCLUSION: On the morphology and histology, the structure of Banna pig heart is similar to the heart of human being. It is possible that Banna minipig heart becomes organ donors for xenotransplantation.
Abstract: Objective To investigate the clinical anatomy of ventricular septal defect(VSD) in tetralogy of Fallot(TOF)，reassess its classification and technique of surgical closure. Methods The data of one hundred consecutive patients with TOF (between January 2002 and June 2006) were reviewed. Their ages ranged from 2 months to 13 years, weights ranged from 5 to 38kg, percutaneous oxygen saturation(SpO2) ranged from 57％ to 92％, haematocrit(HCT) ranged from 0.34 to 0.74, Nakata index ranged from 90 to 210mm2/m2 and McGoon ratio ranged from 0.8 to 2.0. The clinic anatomy of the VSD was studied intraoperatively. Results Among them, seventy one patients had fibrous continuity between the leaflets of the aortic and tricuspid valve. Ninteen patients had a muscular postero-inferior border. Ten patients had subpulmonary VSD’s. There was no third degree atrioventricular block (3°AVB). Two patients had transient-atrioventricular dissociation but subsequent returned to sinus rhythm. Twenty two patients had incomplete right bundle branch block. Three patients were found to have very small residual VSD (less than 0.2cm) in the posteroinferior borders which closed spontaneously after 6 months. ConclusionVSD in TOF when classified as peri-membranous, muscular and subpulmonary VSD may improve the accuracy of surgical closure.
ObjectiveTo provide the anatomical basis for the selection of osteotomy site in leg lengthening or tibial slip. MethodsBetween August 2010 and July 2014, 10 adult fresh amputated leg specimens were collected. The pressure perfusion of red latex was performed by the popliteal artery. The anterior tibial artery and its main branches were separated and exposed, and the periosteal branch of anterior tibial artery was adequately exposed;the posterior tibial artery and its main branches were exposed;the peroneal artery was separated and exposed. The tibial and peroneal artery and its branches were observed and measured. When measuring the proximal end, the medial tibial plateau bone margin, the most prominent part of the tibial tuberosity, and the fibular head edge were used as a reference;when measuring the distal end, distal medial condyle of tibia malleolus tip, tibial lateral malleolus lateral tip, and distal tibial articular surface were used as a reference;the vertical distance between tibia proximal and distal main arteries and bone end reference was measured to determine the optimal osteotomy position of upper and lower tibia. The osteotomy index was calculated which was used to represent the relative position of osteotomy site in the whole tibia. ResultsThe proximal tibial osteotomy site located at (78.2±19.5) mm from medial tibial plateau margin, (41.8±16.0) mm from the tibial tuberosity pole, and (66.7±16.4) mm from the fibular head edge. The distal tibial osteotomy site located at (70.8±12.1) mm above the inferior margin of tibial medial malleolus, (83.3±13.0) mm above the inferior margin of lateral malleolus tip, and (59.1±11.7) mm from distal tibial articular surface. The proximal tibial osteotomy index was 18.45-23.35 (mean, 20.46);the distal tibial osteotomy index was 14.36-23.05 (mean, 18.81). ConclusionThe metaphyseal-diaphyseal connection shold be selected in the proximal and distal tibia osteotomy, the lower one third of the tibia is not suitable for ostetomy.