Perotti Pietro, Ferrari Marco, Montalto Nausica, Lancini Davide, Paderno Alberto, Incandela Fabiola, Buffoli Barbara, Rodella Luigi Fabrizio, Piazza Cesare
Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy.
Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy.
Front Oncol. 2018 Apr 30;8:138. doi: 10.3389/fonc.2018.00138. eCollection 2018.
Carbon dioxide laser coagulation during transoral laser microsurgery (TLM) for laryngeal cancer allows control of bleeding from vessels smaller than 0.5 mm. Therefore, larger arteries and veins must be carefully managed by clipping and/or monopolar cautery. The aim of this paper is to detail endolaryngeal vascular anatomy and identify areas of possible bleeding during TLM.
We performed an anatomical study on a series of 11 fresh-frozen human cadavers. After injection of a bicomponent red silicone into the innominate, left common carotid, and left subclavian arteries, 22 hemilarynges were dissected, the course of the supraglottic, glottic, and subglottic vessels were traced after microdissection of the intervening structures, and their size measured at specific landmark points where such vessels are more frequently encountered during TLM.
Three vessels arising from the superior laryngeal artery were identified after its entry point at the level of the thyro-hyoid membrane: (1) the epiglottic artery (EA), documented in 100% of cases, a common trunk dividing into two main vessels (2) the postero-inferior artery (PIA), present in 100% of the specimens, running downward and dividing in a posterior (pPIA), and anterior (aPIA) branches (3) the antero-inferior artery (AIA), present in 95% of our specimens, running downward to the anterior commissure (AC). Two transverse anastomotic networks (TANs) connected the AIA and PIA, both parallel to the vocal muscle, one lateral (present in 100% of cases), and another medial (91% of specimens). Finally, a fourth vessel supplying the glottic plane was found to be the endolaryngeal paracommissural branch of the crico-thyroid artery (PCA), arising from the inferior laryngeal artery and emerging just below the AC, through the crico-thyroid membrane (reported in 100% of the specimens). This vessel anastomosed in 91% of cases with the AIA, through one or both of the TANs.
The course of the endolaryngeal arteries, their relationships with adjacent structures, and size at specific landmark points have been herein described in order to provide surgeons with a map to guide them during the steep learning curve of transoral surgery of the larynx, with special emphasis given to TLM.
在喉癌经口激光显微手术（TLM）中，二氧化碳激光凝固可控制直径小于0.5毫米血管的出血。因此，较大的动脉和静脉必须通过夹闭和/或单极电灼仔细处理。本文旨在详细阐述喉内血管解剖结构，并确定TLM过程中可能出血的部位。
我们对11具新鲜冷冻的人体尸体进行了解剖研究。将双组分红色硅树脂注入无名动脉、左颈总动脉和左锁骨下动脉后，解剖22个半喉，在显微解剖中间结构后追踪声门上、声门和声门下血管的走行，并在TLM过程中更常遇到此类血管的特定地标点测量其大小。
在喉上动脉进入甲状舌骨膜水平后，发现有三条血管发自该动脉：（1）会厌动脉（EA），在100%的病例中可见，一条共同干分成两条主要血管；（2）后下动脉（PIA），在100%的标本中存在，向下走行并分成后支（pPIA）和前支（aPIA）；（3）前下动脉（AIA），在95%的标本中存在，向下走行至前联合（AC）。两个横向吻合网络（TANs）连接AIA和PIA，均平行于声带肌，一个位于外侧（在100%的病例中存在），另一个位于内侧（91%的标本中存在）。最后，发现供应声门平面的第四条血管是环甲动脉的喉内旁联合支（PCA），它发自喉下动脉，恰好在AC下方穿过环甲膜出现（在100%的标本中报告）。在91%的病例中，该血管通过一个或两个TANs与AIA吻合。
本文描述了喉内动脉的走行、它们与相邻结构的关系以及特定地标点的大小，以便为外科医生在喉经口手术的陡峭学习曲线期间提供指导图谱，特别强调了TLM。
