Funami Y, Okuyama K, Koide Y, Sakamoto A, Kouzu T, Yamamoto Y, Seki Y, Shimada Y, Isono K
Second Department of Surgery, School of Medicine, Chiba University, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Dec;41(12):2325-32.
In view of the operative field of esophageal cancer, anatomical findings of the right bronchial arteries were studied in specimens of 71 cadavers. Intercostobronchial arteries were absent only in 3 cadavers (4.2%; group A). As 22.6% of the cadavers had only one intercostobronchial artery supplied as the right bronchial artery (group B), it was considered to be important to preserve this artery. Cadavers both with the intercostobronchial artery and with the other right bronchial-arteries were observed in 70.4% (group C). Right bronchial arteries deriving from the aorta to course similarly to intercostobronchial arteries were present in small number (group D). Further, right bronchial arteries were classified into three types according to the deriving arteries as follows: (I) intercostobronchial arteries, (II) bronchial arteries deriving from the aorta, (III) other right bronchial arteries deriving from right subclavian artery, right inferior thyroid artery or right interthoracic artery. Considering difficulty of the approach from the operative field with right thoracotomy and the anatomical relationship with neighboring organs, it was thought that preserving the type (I) arteries is easy, the type (III) has a possibility to be preserved, and (II) is hard to be preserved. We concluded that preserving intercostobronchial arteries is important in esophageal cancer surgery approached through right thoracotomy because of small number of cadavers without these arteries and ease of preservation.
鉴于食管癌的手术视野,对71具尸体标本的右支气管动脉的解剖学发现进行了研究。仅3具尸体(4.2%;A组)无肋间支气管动脉。由于22.6%的尸体仅有1支肋间支气管动脉作为右支气管动脉供血(B组),因此保留该动脉被认为很重要。70.4%的尸体既有肋间支气管动脉又有其他右支气管动脉(C组)。少数右支气管动脉起源于主动脉,走行与肋间支气管动脉相似(D组)。此外,右支气管动脉根据其起源动脉分为以下三种类型:(I)肋间支气管动脉,(II)起源于主动脉的支气管动脉,(III)起源于右锁骨下动脉、右甲状腺下动脉或右胸内动脉的其他右支气管动脉。考虑到右胸切开术从手术视野进入的难度以及与相邻器官的解剖关系,认为保留(I)型动脉容易,(III)型有可能保留,而(II)型难以保留。我们得出结论,由于无这些动脉的尸体数量少且易于保留,在右胸切开术治疗食管癌手术中保留肋间支气管动脉很重要。