Glassberg R M, Sussman S K, Glickstein M F
Department of Radiology, Hartford Hospital, CT 06106.
AJR Am J Roentgenol. 1990 Aug;155(2):397-400. doi: 10.2214/ajr.155.2.2115273.
Knowledge of the anatomy of the internal mammary vessels is important to avoid hemorrhagic complications when an anterior parasternal approach is used for percutaneous transthoracic procedures such as biopsy and empyema drainage. We examined 100 consecutive CT scans of the thorax to assess both the number of internal mammary vessels and their relation to the sternum. The mean distance from the sternum to the most medial vessel, the internal mammary vein, was 1.03 +/- 0.25 cm on the right side and 0.98 +/- 0.23 cm on the left side. The mean distance from the sternum to the most lateral vessel, the internal mammary artery, was 1.57 +/- 0.30 cm on the right and 1.47 +/- 0.30 cm on the left. Three internal mammary vessels were present in 20% of cases on the right side and in 18% on the left side. In nine patients, the internal mammary artery was greater than 2.0 cm from the lateral border of the sternum. We recommend an approach that is greater than 2.5 cm from the sternal border when performing parasternal percutaneous transthoracic procedures in order to avoid hemorrhagic complications from injury to the internal mammary vessels. A "safe" window does exist medially between the sternal border and the internal mammary vein but should be used only in procedures performed under CT guidance.
当采用胸骨旁前路进行经皮经胸操作（如活检和脓胸引流）时，了解胸廓内血管的解剖结构对于避免出血并发症很重要。我们检查了连续100例胸部CT扫描，以评估胸廓内血管的数量及其与胸骨的关系。从胸骨到最内侧血管（胸廓内静脉）的平均距离，右侧为1.03±0.25厘米，左侧为0.98±0.23厘米。从胸骨到最外侧血管（胸廓内动脉）的平均距离，右侧为1.57±0.30厘米，左侧为1.47±0.30厘米。右侧20%的病例和左侧18%的病例有三条胸廓内血管。在9例患者中，胸廓内动脉距胸骨外侧缘大于2.0厘米。我们建议在进行胸骨旁经皮经胸操作时，采用距胸骨边缘大于2.5厘米的进路，以避免因胸廓内血管损伤而导致的出血并发症。在胸骨边缘与胸廓内静脉之间内侧确实存在一个“安全”窗口，但仅应在CT引导下进行的操作中使用。
