■在颈胸交界处(CTJ),仅后路入路的工作空间有限。因此,在某些情况下,需要联合前路。然而,大血管和胸骨阻塞前廊,使前路手术困难。我们分析了CTJ前路手术中遇到的相关解剖结构,并评估了先前报道的手术走廊的可行性。
■我们回顾性检查了2015年1月至2020年5月期间接受颈部计算机断层扫描血管造影的49例患者。利用日冕图像,我们测量了颈动脉角度(ICAA),颈动脉距离(ICAD),头臂干(BCT)的形状,和BCT基地的位置。然后,我们测量了需要进行前路手术(ML)的最颅骨水平,通过上级走廊(SC)可到达的最尾水平,根据外科医生使用矢状轴图像的视线,通过下走廊(IC)的最尾水平。
■平均ICAA和ICAD为50.83°±15.23°和33.38±12.11mm,分别。值得注意的是,BCT形态多数为凸型(42.9%),其次是直型(36.7%)。此外,BCT的基础最常见于体内(49%)。此外,男性的ICAA和ICAD显著增高。尽管男性大多在体内有BCT基地(64.3%),女性大多在身体边缘(47.6%)。值得注意的是,ML在T1下体和上体中显示出最高的频率(16.3%)。此外,通过SC和IC,可以接近T4下体和T6中体,分别。SC在T3下体表现出最高的频率(16.3%),和IC在T5中体显示最高频率(20.4%)。
■ICAA和ICAD在男性中较大和较高。在大多数情况下,BCT是凸起的,位于体内。ML的可访问级别,SC,和IC分别为T1、T3和T5。对于CTJ的前路,术前血管和通道可达水平分析对于决定合适的通道和减少并发症至关重要。
UNASSIGNED: In the cervicothoracic junction (CTJ), there is limited working space to perform the posterior-only approach. Therefore, a combined anterior approach is required in some cases. However, the great vessels and sternum obstruct the anterior corridor and make the anterior approach difficult. We analyzed relevant anatomical structures encountered during the anterior approach in the CTJ and evaluated the feasibility of previously reported surgical corridors.
UNASSIGNED: We retrospectively examined 49 patients who underwent neck computed tomography angiography between January 2015 and May 2020. Using the coronal images, we measured the intercarotid artery angle (ICAA), intercarotid artery distance (ICAD), shape of the brachiocephalic trunk (BCT), and position of the BCT base. We then measured the most cranial level requiring manubriotomy for the anterior approach (ML), the most caudal level accessible through the superior corridor (SC), and the most caudal level through the inferior corridor (IC) according to the surgeon\'s line of sight using the sagittal axis image.
UNASSIGNED: The mean ICAA and ICAD were 50.83° ± 15.23° and 33.38 ± 12.11 mm, respectively. Notably, BCT shape was of the convex type in most cases (42.9%), followed by the straight type (36.7%). In addition, the base of BCT was most commonly located inside the body (49%). Moreover, ICAA and ICAD were significantly greater in men. Although men mostly had the BCT base inside the body (64.3%), female mostly had it on the edge of the body (47.6%). Notably, ML showed the highest frequency (16.3%) in the T1 lower and upper bodies. Furthermore, through SC and IC, it was possible to approach the T4 lower body and T6 midbody, respectively. SC showed the highest frequency (16.3%) in the T3 lower body, and IC showed the highest frequency (20.4%) in the T5 midbody.
UNASSIGNED: ICAA and ICAD were larger and higher in men. BCT was convex and located inside the body in most cases. The accessible level of ML, SC, and IC were T1, T3, and T5, respectively. For the anterior approach in the CTJ, preoperative vascular and accessible level analysis of corridors is essential to decide on the appropriate corridor and reduce complications.