Anatomske posebnosti in klinični pomen zadnjih medrebrnih arterij (aa. intercostales posteriores)

doktorska disertacija

Lidija Kocbek (Avtor), Božena Pejković (Mentor), Ivan Krajnc (Član komisije za zagovor)

Povzetek

Anatomske posebnosti izvora, poteka, vej in medsebojnih anastomoz enajstih parov zadnjih medrebrnih arterij (AIP) imajo velik praktični pomen na različnih področjih medicine, od diagnostičnih metod do kirurgije, zaradi obsežne direktne ali indirektne preskrbe medrebrnih prostorov (SIC), mišic, hrbtenjače, kože in mlečne žleze. Z anatomsko disekcijo smo pri 43 človeških kadavrih fiksiranih s Thielovo metodo, ki so imeli z rdečo barvo injicirane arterije, določili nove anatomske posebnosti izvora, poteka in vej AIP. Ugotoviti smo želeli povezavo med pojavom novih anatomskih posebnosti, njihovimi frekvencami in razlikami med levimi in desnimi AIP v populaciji in pri posamezniku ter kliničnim pomenom le-teh. Rezultati raziskave so pokazali, da obstajajo nove posebnosti izvora, poteka in vej AIP. V raziskavi so bile glede na izvor iz podključnične arterije (AS) in prsne aorte (AT) najbolj variabilne AIP I. - III., njihovi izvori pri posamezniku pa so bili največkrat bilateralno simetrični. Dorzalno za rebri potekajočo AIP, ki jo imenujemo prsna vertebralna arterija (AVT), smo našli pri AIP IV. in AIP V., posamezen osebek pa je imel lahko več AVT. Posebnosti poteka AIP so pomembne pri določitvi in prepoznavi arterij v diagnostične namene, ker se lahko njihovo najdbo zaradi nenormalnega poteka narobe interpretira, obenem pa so posebnosti poteka pomembne pri patoloških stanjih, ki zahtevajo kirurško oskrbo, kot so ateroskleroza, elongacija aorte, fraktura hrbtenice in reber. Od vseh najdenih variacij smo v raziskavi največkrat našli skupna debla, ki so jih sosednje AIP oblikovale na izvoru iz AT, med katerimi je bil pogost pojav multiplih skupnih debel. Na račun multiplih skupnih debel se zmanjša število segmentalnih aortnih AIP, ki oddajo veje za preskrbo hrbtenjače, s čimer se potencialno poveča tveganje za pojav pooperativne paraplegije ali parapareze, ker se arterije pri operacijah anevrizem na torakalni ali torakoabdominalni aorti podveže. V raziskavi smo določili število kolateralnih medrebrnih vej AIP in njihovih anastomoz in ugotovili, da med medrebrnimi prostori (SIC) IV. - XI. ni takega, ki bi bil za izvedbo torakocenteze varnejši od drugih. V raziskavi smo določili posebnosti izvora desne bronhialne arterije (AB), ki je največkrat izvirala iz prve desne aortne AIP, izvor pa je variiral od skupnega debla AIP I. - III. iz AS ter AIP II. do AIP V. iz AT. Vloga posebnosti izvora desne AB je pomembna v terapiji karcinomov pljuč, saj se preko arterije aplicira kemoterapevtska sredstva. S stališča anatomskih posebnosti AIP in njihove pomembnosti v klinični praksi, še posebej, če je hkrati prisotno več raznolikih posebnosti ali se le-te pojavljajo v večjem številu, je njihov opis v klasičnih anatomskih knjigah omejen. Zaradi razvoja moderne torakalne kirurgije, posebno srčno-žilne, predstavljajo podatki dobljeni z raziskavo osnovo za natančno opredelitev anatomskih posebnostih AIP in njihovega pomena v klinični praksi.

Ključne besede

arterije;anatomija;

Podatki

Jezik:	Slovenski jezik
Leto izida:	2013
Izvor:	[S. l.
Tipologija:	2.08 - Doktorska disertacija
Organizacija:	UM MF - Medicinska fakulteta
Založnik:	L. Kocbek]
UDK:	611.13.08(043.3)
COBISS:	512251704
Št. ogledov:	2856
Št. prenosov:	174
Ocena:	0 (0 glasov)
Metapodatki:

Ostali podatki

Sekundarni jezik:	Angleški jezik
Sekundarni naslov:	Anatomical peculiarities and clinical significance of the posterior intercostal arteries (aa. intercostales posteriores)
Sekundarni povzetek:	Anatomical peculiarities of the origin, course, branches and anastomoses of the eleven paired posterior intercostal arteries (AIP) have practical significance in different fields of medicine, from diagnostic methods to surgery, because of extensive direct and indirect vascularization of the intercostal spaces (SIC), muscles, spinal cord, skin and mammary gland. During anatomical dissection of 43 human cadavers fixed using the embalming method of Thiel, with injected arteries with red color mass, we found new anatomical variations of the origin, course and branches of the AIP. Aim of the study was to evaluate linkage between occurrences of new anatomical variations, their frequencies and differences among left and right AIP in population and individuals and discus their clinical significance. The study revealed new variations of the origin, course and branches of the AIP. The most variable origins from the subclavian artery (AS) or thoracic aorta (AT) were origins of AIP I. - III., the patterns of origins being mostly bilateral symmetrical in individuals. Dorsal course of the AIP known as thoracic vertebral artery (AVT) was found at AIP IV. and AIP V., in some individuals more of AVT were present. Peculiarities of the course of AIP are important in determination and identification of the arteries for diagnostic purposes, because finding of unusual course can be misinterpreted, and also in pathological conditions which need surgical treatment such as atherosclerosis, elongation of the aorta and fracture of the spine and ribs. Common trunks of the AIP at the origin from AT formed by neighboring arteries were the most frequent among all anatomical variations and numerous of multiple common trunks were simultaneously present. Multiple common trunks reduce the overall number of segmental aortic AIP which give off branches for the vascularisation of the spinal cord and potentially increase the risk of postoperative paraplegia or paraparesis in patients undergoing thoracic or thoracoabdominal aortic aneurysm repair when vessels are being ligated. Study determined that regarding the number of the collateral branches of the AIP and their anastomoses there is not any intercostal space (SIC) between IV. - XI. that is as safe as others in performing thoracocentesis. Study of anatomical peculiarities of the origin of right bronchial artery (AB) recorded that most of the arteries originated from the first aortic AIP, the origins varied from common trunk of the AIP I. - III. from AS to AIP II. - V. from AT. The role of variations of AB origin is important in lung cancer therapy because the arteries serve as therapeutic pathways for infusion of chemotherapeutic agents. Regarding the anatomical peculiarities of AIP and their significance in clinical practice, especially if different peculiarities are present at once or if they often occur in one individual, description in classic anatomical books is limited. In the era of modern thoracic surgery, particularly cardiovascular, the data of the anatomical peculiarities of the AIP and their significance in clinical practice from the study represent basis for their detailed recognition and clinical evaluation.
Sekundarne ključne besede:	Posteriorne interkostalne arterije;Disertacije;Anatomske variacije;
URN:	URN:SI:UM:
Vrsta dela (COBISS):	Doktorska disertacija
Komentar na gradivo:	Univ. v Mariboru, Medicinska fak.
Strani:	IX, 84 f.
Ključne besede (UDK):	applied sciences;medicine;technology;uporabne znanosti;medicina;tehnika;medical sciences;medicina;anatomy;human and comparative anatomy;anatomija;anatomija človeka in primerjalna anatomija;
ID:	13995