【摘要】 目的 探讨心脏血管铸型技术对临床冠心病的诊断与分型、心肌梗死的定位、心脏搭桥手术和心血管造影术等的指导意义。方法 选用新鲜成人心脏30个,采用左右冠状动脉起始部插管、分色灌注的方法,运用过氯乙烯结合牙托材料的复合填充剂制作冠状血管的铸型标本。结果 ①铸出冠状血管铸型标本血管饱满、色泽艳丽、清晰直观,可以清楚地显示出冠状血管和开口于心腔内的血管走行、分支、分布及血管的立体构筑,并能保留原有的形状,较真实地反映血管的内径,为我们选用配型血管提供了客观的解剖学数据。②左冠状动脉和右冠状动脉起始处的外径分别为(4.16±1.31)mm和(4.07±1.46)mm,二者末端分叉处的外径分别为(4.74±1.52)mm和(4.52±1.33)mm;旋支与前室间支起始处的外径分别是(3.26±1.04)mm和(3.10±1.05)mm。左冠状动脉与前室间支,左冠状动脉与左旋支,两两形成的夹角分别为(171.0±5.0)°和(114.0±4.4)°。结论 ①左、右冠状动脉分叉处常形成一膨大,这不利于左、右冠状动脉内安放支架的稳定。②冠心病左旋支内扩管与安放支架时,相对前室间支的扩管与安放的支架外径大。在冠状动脉介入治疗中,分叉处的病变增加了手术的难度。③左冠状动脉与左旋支的夹角小于左冠状动脉与前室间支的夹角,提示对左旋支的介入治疗或是管内支架的安放要比前室间支的难度大。④心大静脉横跨前室间支、左旋支两动脉之间,与动脉的位置关系复杂,没有一定的明显规律,特别是心大静脉突向左冠状动脉分叉处,形成角静脉。因此,当此角邻接左冠状动脉分叉处时,在施行主动脉和二尖瓣替换手术时宜加注意,避免损伤。更多还原

【Abstract】 Objective To study the guiding significance of Blood Vessel Casting in diagnosis and categorizing of coronary of heart disease,positions of myocardial infarction,PCI,as well as coronary artery bypass surgery Methods Thirty fresh adult hearts were selected.Left and right Coronary artery was inserted into the starting part,where as Intubation Separation was employed.A vinyl chloride Combined with Upper plate material composite filler was used to mode the Coronary vascular.Results First,the model of Coronary vascular showed that blood vessels were full,colorful,clear and directly-viewed.It clearly showed the opening of coronary blood vessels and blood vessels in the heart cavity,branches,distributions,and three-dimensional and vascular construction which reserved the original shapes.The vascular diameter of blood vessels used here provided with the type of anatomical data which was a more real response.Second,the left coronary artery and right coronary artery diameter at the beginning were(4.16 ±1.31)mm and(4.07 ±1.46)mm,the diameter of both ends of the bifurcation were(4.74±1.52)mm and(4.52±1.33)mm,rotation with a branch room between the branch starting at the outer diameter were(3.26±1.04)mm and(3.10±1.05)mm.The angle between the left coronary artery with the anterior interventricular branch,and the angle between the left coronary artery with L-branch were(171.0±5.0)° and(114±4.4)°,respectively.Conclusion 1.The left and right coronary artery bifurcation usually form a swelling,which was not conducive to the secure stent of left and right coronary and its stability.2.L-branch of coronary heart disease within the expansion of its management and stent,the relative expansion of the anterior interventricular branch of the tube and placed large diameter stent.In coronary intervention,bifurcation lesions increased the difficulty of surgery.3.The angle between the L-branch of the left coronary artery and the left coronary artery is less than the angle between the branch and the front chamber angle which suggests the involvement of treatment for L-branch tube or stent placement was more difficult than in the anterior interventricular branch is more difficult.4.Cardiac vein across the anterior interventricular branch,L-branch between two arteries,and the complex relationship between the location of arteries,the law is not necessarily obvious,especially sudden cardiac vein to the left coronary artery bifurcation,forming angular vein.Therefore,when the angle is closer to the bifurcation of the left coronary artery,aorta and mitral valve replacement in the implementation of surgery should be noticed to avoid injury.更多还原