Toni Roberto, Della Casa Claudia, Mosca Salvatore, Malaguti Anna, Castorina Sergio, Roti Elio
Dipartimento di Anatomia Umana, Farmacologia e Scienze Medico-Forensi, Università degli Studi di Parma, Oespedale Maggiore, Parma, Italy.
Thyroid. 2003 Feb;13(2):183-92. doi: 10.1089/105072503321319495.
Knowledge of anatomic variability of the superior (STA), inferior (ITA), and lowest accessory (IMA) thyroid arteries may be helpful in certain clinical conditions. However, details of this variability have not been thoroughly described. Specifically, whether the presence and site of origin of STA, ITA, and IMA are influenced by the anthropological group, to what extent their origin is symmetric or asymmetric, and the role played by this variability in visualizing each thyroid artery by nonselective thyroid angiography is not known. To clarify this we conducted a meta-analytical study on Caucasian and Asian subjects, the latter including only Japanese and Koreans. In Caucasians and Asians the presence of superior vessels compared to inferior vessels was more frequent and the probability of symmetric or asymmetric arterial origin for STA were equivalent. However, better recognition of inferior rather than superior vessels was achieved by nonselective angiography in Caucasians. Finally, different frequencies of presence and site of origin for each artery were identified in Caucasians compared to Asians. Our results suggest that the higher frequency of IMA in Asians than in Caucasians should result in a search for an IMA-dependent feeding artery of inferior parathyroid adenomas, primarily the mediastinal ones, especially in Asians both by imaging and transcatheter ablative approaches. In addition, we have found that a small percentage of Caucasian subjects lack an STA on the left side. Therefore, anatomic arterial compatibility should be carefully evaluated in the preoperative stage of laryngeal transplantation maintaining in situ the donor's thyroid by terminal anastomoses between donor and recipient STAs. Finally, the lack of any individual thyroid artery in either Caucasians or Asians might influence the distribution of autonomic supply that runs with thyroid vessels to the thyroid parenchyma. This appears functionally relevant in cases of traumatic or surgical lesions of the cervical sympathetic chain involving thyroid nerves. In fact, a restricted local autonomic control of thyroid activity might be related to individual rami of thyroid nerves.
了解甲状腺上动脉（STA）、甲状腺下动脉（ITA）和最低位甲状腺副动脉（IMA）的解剖变异在某些临床情况下可能会有所帮助。然而，这种变异的细节尚未得到充分描述。具体而言，STA、ITA和IMA的存在及其起源部位是否受人类学群体的影响，其起源在多大程度上是对称或不对称的，以及这种变异在通过非选择性甲状腺血管造影可视化每条甲状腺动脉中所起的作用尚不清楚。为了阐明这一点，我们对高加索人和亚洲人（后者仅包括日本人和韩国人）进行了一项荟萃分析研究。在高加索人和亚洲人中，与甲状腺下动脉相比，甲状腺上动脉的存在更为常见，且STA对称或不对称起源的概率相当。然而，在高加索人中，通过非选择性血管造影对甲状腺下动脉的识别优于甲状腺上动脉。最后，与亚洲人相比，在高加索人中发现了每条动脉存在和起源部位的不同频率。我们的结果表明，亚洲人IMA的频率高于高加索人，这应该促使我们在影像检查和经导管消融治疗时，尤其是在亚洲人中，寻找依赖IMA供血的下甲状旁腺腺瘤的供血动脉，主要是纵隔内的下甲状旁腺腺瘤。此外，我们发现一小部分高加索人左侧没有STA。因此，在喉移植的术前阶段，当通过供体和受体STA之间的端端吻合原位保留供体甲状腺时，应仔细评估解剖学上的动脉相容性。最后，高加索人或亚洲人中任何一条甲状腺动脉的缺失都可能影响与甲状腺血管一起走向甲状腺实质的自主神经供应的分布。这在涉及甲状腺神经的颈交感神经链创伤或手术损伤的情况下似乎具有功能相关性。事实上，甲状腺活动的局部自主神经控制受限可能与甲状腺神经的单个分支有关。
