【作者】 岳修勤；

【导师】 钟世镇；

【作者基本信息】 南方医科大学 ， 人体解剖学， 2007， 博士

【摘要】 目的：1了解颈交感神经干的形态、走行，确定其主要的毗邻关系，认识颈交感干的局部解剖特点；2观察颈上交感神经节、颈下交感神经节（颈胸神经节、星状神经节）营养动脉的来源及在神经节上的分布情况；了解颈交感神经上节、中节及下节形态、位置，确定其主要的毗邻关系，并对它们进行体表定位；3探讨椎动脉起始段、横突段的形态学特点，为防止颈中、下神经节阻滞术中损伤椎动脉严重并发症提供解剖学基础；4了解颈交感神经干及颈交感神经中节及下节与膈神经、喉上神经、喉返神经的位置关系；5探讨第7颈椎横突前结节法（C₇-SGB）、第6颈椎横突前结节法（C₆-SGB）、斜角肌前沟接近法径路、肌间沟侧入法径路颈交感神经节阻滞术产生并发症的解剖学因素。方法：选用新鲜成人尸体标本4具、经防腐处理的成人尸体标本20具，显露两侧颈长肌，暴露两侧颈交感干。切去胸锁乳突肌及其表面其它组织，去除锁骨，并将肺尖向下掀起，解剖显露整个颈交感神经干及颈上、中、下（星状）神经节、椎动脉、膈神经、喉上神经、喉返神经及其周围结构；显露斜角肌间隙。在头戴式放大镜或肉眼下作如下观察和测量：1颈交感干及神经节位置、形状、大小、距正中线距离；颈交感干及颈上、中、下（星状）神经节与周围结构关系及解剖特点；颈交感干的直径；颈交感干距前正中线及颈长肌内缘的最近距离。2颈上神经节的位置、形态及大小；与主要毗邻结构的位置关系及距离。颈上交感神经节营养动脉的来源及在神经节上的分布情况。3星状神经节的位置形态及大小；至临近血管、神经的距离；至颈前正中线的距离；至皮肤的垂直深度。颈下交感神经节（星状神经节）营养动脉的来源及在神经节上的分布情况。4椎动脉的起源、发出方位、走行及变异情况。5肌间沟侧入法星状神经节阻滞入路的解剖及体表定位。6膈神经与大血管、胸膜顶、肺尖、胸导管、迷走神经等结构毗邻的关系；膈神经的长度及穿刺部位的宽度；膈神经距离颈交感干的最近距离。7喉上神经及喉返神经分支的形态、分布及变异；喉上神经及喉返神经分支及与颈交感干、颈交感神经节的毗邻的关系。结果1颈交感神经干相关的解剖观察及测量：颈交感神经干在C₅横突附近位于前斜角肌键性交叉起点和头长肌、颈长肌的腱性束带之间，颈交感神经干在该处与二者距离最近。1．2颈交感神经干与前正中线的距离：C₃～C₇颈交感干与前中线的距离逐渐减小，左右侧平均值：C₃水平：25.89±2.98mm，C₄水平：25.35±2.45mm，C₅水平：23.56±2.01mm，C₆水平：21.67±2.29mm，C₇水平：19.78±2.67mm。1．3颈交感干与颈长肌内缘的距离：C₃～C₇颈交感干与颈长肌内缘的距离逐渐减小，达C₇上缘距离最小；以椎体的上缘对作为测量平面，自上至下，上述距离逐渐减小，C₃最大为20.56±2.62mm；C₇最小为12.35±2.97mm。左右侧平均值：C₃水平：20.56±2.62mm，C₄水平：19.68±2.91mm，C₅水平：18.55±2.21mm，C₆水平：15.49±2.58mm，C₇水平：12.35±2.97mm。1．4颈交感神经干的直径：左右侧平均值：C₃平面：2.24±0.51mm；C₄平面：2.12±0.41mm；C₅平面：2.04±0.23mm；C₆平面：2.22±0.25mm；C₇平面：1.82±0.59mm。2颈上神经节的解剖学观察及测量2．1颈上神经节的形态左右多不对称，但两侧最常见的形态为梭型，占60％，椭圆型次之。位于第1～3颈椎横突前方，颈内动脉后方。2．2颈上神经节的大小：左侧长：24.42±7.44mm；宽8.05±1.32mm；厚度2.69±0.51mm。右侧长：26.41±0.65mm；宽：7.45±0.73mm；厚度2.52±0.84mm。2．3颈上神经节前缘距舌骨大角的距离：左侧：8.3±4.4mm；右侧：5.4±3.2mm。2．4颈上神经节下端至舌骨大角的距离：左侧：7.14±4.26mm；右侧：2.38±1.41mm。2．5颈上神经节下端距颈总动脉分叉处的距离：左侧：9.54±4.07mm；右侧：12.81±3.67mm。2．6颈上神经节下端至下颌角与乳突连线的距离：左侧：7.64±2.42mm；右侧：8.64±1.76mm。2．7颈3平面颈交感干至颈前正中线的距离：左侧：25.51±4.78mm；右侧：24.83±4.30mm。2．8颈上交感神经节的血液供应颈上交感神经节营养动脉主要来源于甲状腺上动脉以及与颈总动脉外膜之间的血管网。营养血管及血管网主要分布于神经节的前内侧，神经节的上极；3星状神经节解剖学观察及测量3．1星状神经节的位置形态及大小星状神经节位于颈根部，位于C₇横突至第一肋颈高度40侧，占83.33％；位于T₁高度的星状神经节8侧，占16.67％。上缘至T₁上缘0.17±0.13cm，有43侧，占89.58％；上缘至C₇上缘0.84±0.15cm，有5侧，占10.42％；在椎动脉起始部后方38侧，占79.17％，后外侧6侧，占12.5％，后内侧4侧，占8.33％。星状神经节的形态：星状神经节最常见的形态为：星形：左侧8例，占66.67％，右侧7侧，占58.33％；其次为椭圆形：左侧3侧，占25.00％，右侧4例，占33.33％；哑铃形：左侧1例，占8.33％，右侧1例，占8.33％。大小：左侧长16.85±4.57mm，宽4.94±0.33mm，厚4.17±0.68mm；右侧长17.13±5.19mm，宽4.73±0.56mm，厚4.78±0.27mm。3．2星状神经节至临近血管、神经的距离：星状神经节距颈总动脉的最近距离为6.24±1.96mm；距膈神经的水平距离为16.25±4.89mm；距甲状颈干的最近距离为15.72±3.75mm；距甲状腺下动脉的最近距离为7.86±2.13mm；至喉返神经的水平距离为11.92±3.42mm；距臂丛神经上干中点的水平距离为23.97±5.36mm。颈下神经节的上缘至环状软骨下缘的距离：左侧平均值为31.15±7.79mm；右侧平均值为31.4±6.81mm。颈下神经节至颈前正中线的距离：左侧平均值30.92±6.67mm；右侧平均值30.53±6.65mm；颈下神经节至皮肤的垂直深度：左侧平均值为32.87±7.59mm；右侧平均值为33.54±6.62mm。颈下神经节的中部至胸骨颈静脉切迹中点的垂直距离：左侧平均值31.95±6.82mm；右侧平均值31.74±7.79mm。3．3星状神经节的血液供应星状神经节营养动脉主要来源于甲状腺下动脉、椎动脉以及与锁骨下动脉、椎动脉外膜之间的血管网，营养血管主要分布于神经节的上极、神经节的下极。4椎动脉起始段及横突段解剖学观察及测量4．1椎动脉起始段形态观察结果：椎动脉起始段管腔呈圆柱状，无明显塌陷，全程向上后内侧上升逐渐靠近前斜角肌直至进入横突孔。椎动脉的起源、发出方位：左侧有18例（75％）起自锁骨下动脉上壁，3例（12.5％）起自上后壁，1例（4.17％）起自前上壁，另一例（4.17％）直接起自主动脉弓上壁；右侧有17例（70.8％）起自锁骨下动脉上壁，4例（16.7％）起自上后壁，3例起自后壁（12.5％）。起始段于锁骨下动脉上起始部方向呈向后上方集中的趋势。椎动脉横突段的起止点：横突段自第6颈椎横突孔下缘至第2颈椎横突孔上口，1例（右侧）自第5颈椎横突孔进入。绝大多数穿C₆～C₃横突孔向上。在上行过程中大多是垂直走行的，只有2例分别在C₃～C₂和C₄～C₃之间稍有弯曲。4．2椎动脉起点距中线距离：左侧椎动脉起点距中线距离平均2.69±0.18cm；右侧平均2.52±0.36cm。4．3椎动脉走行情况：椎动脉起始段大部分（左25例，占83.3％，右24例，80.0％）均直行上升。起始段走行中主要呈矢、冠状位弯曲，椎动脉起始段弯曲改变以‘S’型弯曲为多见，其中内外方向弯曲为32.4％（34侧），前后方向弯曲占16.2％（17侧）。4．4椎动脉脉始段与颈交感干的位置关系左侧：颈下神经（星状）节位于椎动脉内侧、内后方1～2cm以内，颈交感干及颈中神经节均位于椎动脉后方者9例（占37.5％）；颈下神经节位于椎动脉内侧、内后方，但颈交感神经干及颈中神经节位于椎动脉前方者14例58.33％，仅1例位于椎动脉外侧、另1例缠绕在椎动脉周围上行。右侧：颈交感神经干及神经节位于椎动脉内侧或后方者11例（45.83％），有13例（54.17％）颈交感神经干位于椎动脉前方，另有1例位于椎动脉外侧。5前斜角肌与颈交感神经干相关的解剖观察及测量：前斜角肌起于第3～6颈椎横突前后结节，肌纤维行向外下方，止于第一肋骨上面的斜角肌结节，前斜角肌的前缘邻近颈交感神经干，距交感干的距离为25.84±2.38mm，在第5颈椎横突处恰是其腱性成分最集中的区域。6膈神经与颈交感干相关的解剖学观察及测量：膈神经的前内侧与颈交感干相邻，在C₆平面膈神经距离颈交感干的距离为：左侧1.58±0.53cm；右侧1.62±0.28cm。颈中、下神经节位于其前内侧，颈下神经节距膈神经的水平距离为：左侧1.59±0.46cm；右侧1.61±0.89cm；颈交感神经干与膈神经的联系的出现率为43.6％，主要与膈神经相联系，与副膈神经则较少。它们与颈下神经节联系最多为60.4％，其次与颈中神经节为17.5％。此外也有与椎动脉神经节、锁骨下袢、颈中、下神经节之间相联系，膈神经在颈部与交感干有广泛的联系。7喉返神经的分支、形态、分布及变异：48侧喉返神经中，43侧其分支呈树枝状，称树型分支；有5侧其分支之间或分支与颈交感干之间互相吻合，形成袢状，我们称之为喉返神经袢，其前支和后支直接从袢上发出喉返神经从迷走神经分出后，沿颈部气管食管沟上行，沿途发出数条分支分布于喉、气管、食管及邻近肌。结论1颈交感神经干直接位于颈长肌前方，椎前筋膜后方，并有分支与颈长肌相连，在行颈中下交感神经节阻滞时注入药液的扩散受肌肉和肌筋膜的限制，进针的部位、方向、深浅及速度都会影响药液的扩散而产生不同的阻滞效果。颈中下交感神经节阻滞产生的效果并非因神经节被直接阻滞所致，是因在颈长肌膜内出入的颈中神经节及星状神经节的节前、节后纤维被阻断的效果。2颈上神经节阻滞穿刺入路的体表定位：先触及舌骨大角，胸锁乳突肌前缘与舌骨大角连线的中点即为穿刺点，乳突尖下1.5cm处定点为第2颈椎横突所在；第4颈椎横突在胸锁乳突肌后缘与颈外静脉交叉点上1.5cm处，相当于甲状软骨上缘；第3颈椎横突在第4颈椎横突上方1.5cm处，相当于舌骨水平。患者取仰卧、头偏向对侧位，在第2～4颈椎横突处作标记，用22G或24G、长3.5cm穿刺针连接注射器作向内、下、后方向刺入约2～3cm，当触及骨质感时可确定为第2或第3颈椎横突，回拔针2mm。颈上神经节的手术入路：先触及舌骨大角，胸锁乳突肌前缘与舌骨大角连线的中点上、下各延长1.5厘米切口即可。逐层切开，将颈动脉鞘拉向内侧，再向深面可明显触第二颈椎的横突，用钝器剥离椎前筋膜，可见一浅凹，颈上神经节即在其浅凹内。3星状神经节的体表定位点：此点位于锁骨胸骨端上方22.38±3.97mm与中线旁开24.18±2.35mm的交点处或颈动脉结节下方37.14±5.86mm与中线旁开24.21±3.79mm交点部位；经此点垂直进针32.48±2.54mm即达星状神经节。4椎动脉起始段的变异是颈交感神经节阻滞术中损伤椎动脉而产生严重并发症的主要原因。5肌间沟侧入法星状神经节阻滞入路的体表定位：取仰卧位，头偏向对侧，充分暴露阻滞侧颈部，穿刺点选在前中斜角肌之间的肌间沟与环状软骨平行线相交处，此平行线相当于C₆横突。于环状软骨平面处触摸第6颈椎横突顶端，用左手食、中两指稍用力下压肌间沟，并将前后肌群分离，用指甲侧顶于胸锁乳突肌及颈动脉鞘，指腹侧位于斜角肌群、膈神经及C₆横突。此时两指指腹之间恰好压住C₆横突的前方或前结节，两指间留有3～5mm指缝，作为进针间隙。穿刺点皮肤距离C₆横突面的距离为：左侧：1.53±0.32cm；右侧：1.49±0.36cm。穿刺点皮肤距离肌间筋膜的距离为：左侧：1.26±0.13cm；右侧：1.19±0.14cm。肌间沟侧入法的特点在于：C₆横突结节在肌间沟处较表浅，容易触及，是阻滞穿刺时明显的解剖标记；且此处远离大血管，穿刺不易伤及；当穿刺针触及C₆横突后退针向内后下方再刺入2.5cm左右即可较容易触及C₇横突，在此注射即可阻滞位于其稍下方的星状神经节。6颈交感神经节阻滞术中定位不准确、进针过深、注射局麻药量过大是产生膈神经损伤、阻滞并发症的主要原因。7颈交感神经节阻滞术中对喉返神经的走行、分支数目及神经主干的形态、分支变异及其与颈交感干的关系认识不足是造成喉返神经被阻滞的主要原因。8行颈上交感神经节及星状神经节阻滞术时，应避免穿刺针直接刺入神经节，否则将造成神经节及神经节营养血管的损伤，药液经局部血管吸收而影响阻滞效果。更多还原

【Abstract】 Objectives:1. To comprehend the appearance and courser of cervical sympathetic trunk, todetermine the main adjacent relationship and recognise the topography feature ofcervical sympathetic trunk.2. To observe the nutrient artery’s origin of the superior thyroid ganglion, the inferiorcervical ganglion（cervicothoracic ganglion、ganglion stellare） and the dispositioncondition in the neural ganglion. To comprehend the appearance and location ofthe upper, midplate and inferior segment of cervical sympathetic ganglia, todetermine the main adjacent relationship and then to carry out the body surfaceallocation.3. To approach the morphology feature of arteria vertebralis initial segment andprocessus transversuss segment, to apply the anatomy basis for preventing fromthe servere complication of damaging arteria vertebralis in the middle and inferiorcervical ganglion blocking method. 4. To comprehend the locational relationship of cervical sympathetic trunk,midplate, inferior segment of cervical sympathetic ganglia and diaphragmaticnerve, laryngeal nerve, recurrent nerve.5. To approach the anatomy factor which can cause complication in the blockingmethod of cervical sympathetic ganglia with the method of the seventh transverseprocess anterior tubercle of cervical vertebra（C₇-SGB）, the sixth transverse processanterior tubercle of cervical vertebra（C₆-SGB）, the approaching method of thescalene muscle sulcus anterior and the lateral approaching method of myointergroove.MethodsChoose 4 fresh adult body types; 20 adult body types which had beenantisepticized, expose bilateralis collilongus and reveal bilateralis cervicalsympathetic trunk. Cut off cleidomastoidal and the other tissue of the surface. Removethe clavicle and open the apex of lung down. Dissect to expose the whole of cervicalsympathetic trunk and the upper segment midplate inferior segment（stellate）ofcervical sympathetic ganglia, arteria vertebralis diaphragmatic nerve laryngealnerve, recurrent nerve and the periph structure, expose scalene muscle blank. To dothe following observation and measure with microscopic spectacles on the head or bynaked eye:1. The location, appearance, size and distance to the median line of cervicalsympathetic trunk, and neuroganglion; the relationship and anatomy featurebetween the cervical sympathetic trunk and the upper segment midplate inferior segment（stellate ）of cervical sympathetic ganglia and the periph structure; Thediameter of the cervical sympathetic trunk. The nearest distance between thecervical sympathetic trunk and the anterior median line and the collilongus innermargin.2. The position, appearance, and size of ganglion cervicale superius, with mainadjacent structure position relations and distance. The nutrient artery’s origin of thesuperior thyroid ganglion and the disposition condition in the neural ganglion.3. The position, appearance and the size of ganglion stellare, the distance offorthcoming the blood vessel and nerve, the distance of cervical anterior medianline, the vertical depth to the skin., The nutrient artery’s origin of the inferiorcervical ganglion（ganglion stellare） and the disposition condition in the neuralganglion.4. The origin, erupting aspect, Courser and the variation situation of arteria vertebralis.5. The lateral approaching method of myo-intergroove ganglion stellare blocks theroad of the anatomy and the body surface localization.6. The adjoining relations of the diaphragmatic nerve and the big blood vessel,cervical pleura, the apex of lung, alimentary duct, vagus nerve and so on; thelength of diaphragmatic nerve and the width of the puncturing spot; the minimumdistance is from the diaphragmatic nerve to the cervical sympathetic trunk.7. The appearance, distribution and the variation of the superior laryngeal nerve andthe laryngeal nerve branch, the adjoining relations of the superior laryngeal nerveand the laryngeal nerve branch and with the cervical sympathetic trunk and the cervical sympathetic ganglia.Results1. The dissection observation and the survey with the cervical sympathetic trunk: the5th cervical vetebrae processus transversus is the cervical sympathetic trunk whichis located between the scalene muscle tendinous crossing beginning and thetendinous balteum of the musculus longus capitis and the collilongus, thesympathetic nerve in this place is away from recent with the two.1.2. The distance from the truncus sympathicus cervicalis to the anterior median line:the 3rd～7th cervical vertebra truncus sympathicus cervicalis is involved the medianline distance gradually to reduce, left right flank mean value: the 3rd cervicalvertebra level: 25.89±2.98mm, the 4th cervical vertebra level: 25.35±2.45mm, the5th cervical vertebra level:23.56±2.01mm, the 6th cervical vertebra level:21.67±2.29 mm, the 7th cervical vertebra level: 19.78±2.67mm.1.3 The distance between the truncus sympathicus cervicalis and the posterior marginof collilongus: the distance between the truncus sympathicus cervicalis and theposterior margin of collilongus becomes smaller from the 3rd to the 7th cervicalvertebra, until the 7th cervical vertebra superior border to be smallest. When it takethe centrum superior border as the plane of survey, At the 3rd cervical vertebralevel the distance is about 20.56±2.62mm and the 7th cervical vertebra is12.35±2.97mm. The mean value of the left and right sides: the 3th cervicalvertebra level: 20.56±2.62mm, the 4th cervical vertebra level: 19.68±2.91mm, the5th cervical vertebra level: 18.55±2.21mm, the 6th cervical vertebra level: 15.49±2.58mm, the 7th cervical vertebra level: 12.35±2.97mm.1.4 The diameter of the cervical sympathetic trunk: The mean value of the left andright sides: the 3th cervical vertebra plane: 2.24±0.51mm; the 4th cervical vertebraplane: 2.12±0.41mm; the 5th cervical vertebra plane: 2.04±0.23mm; the 6thcervical vertebra plane: 2.22±0.25mm; the 7th cervical vertebra plane:1.82±0.59mm.2 Anatomy observes and surveys on the ganglion cervicale superius2.1 The appearance of the ganglion cervicale superius is always asymmetrical, buttwo sides most common appearance for the shuttle, account for 60%, the ellipsenext. the ganglion cervicale superius is located front the 1st～3th cervical vertebraprocessus transversus, behind carotis interna.2.2 The size of ganglion cervicale superius: Left side long: 24.42±7.44mm; Width:8.05±1.32mm; Thickness: 2.69±0.51mm. Right flank long: 26.41±0.65mm; Width:7.45±0.73mm; Thickness2.52±0.84mm.2.3 The distance from ganglion cervicale superius anterior border to the tongue bonebig angle: Left side: 8.3±4.4mm; Right flank: 5.4±3.2mm.2.4 The distance from ganglion cervicale superius inferior extremity to the tonguebone big angle: Left side: 7.14±4.26mm; Right flank: 2.38±1.41mm.2.5 The distance from ganglion cervicale superius inferior extremity to the arteriacarotis communis furcation place: Left side: 9.54±4.07mm; Right flank:12.81±3.67mm.2.6 The distance from ganglion cervicale superius inferior extremity to the line between the angle of jaw and the mastoid process: Left side: 7.64±2.42mm;Right flank: 8.64±1.76mm.2.7 The distance from the truncus sympathicus cervicalis in the third cervical vertebraplanes to the neck anterior median line: Left side: 25.51±4.78mm; Right flank:24.83±4.30mm.2.8 The superior thyroid ganglion’s nutrient artery is mainly from the vasoganglionbetween the superior thyroid artery and the tunica adventitia of common carotidartery. The nutrient vessels and the vasoganglion mainly distribute theganglionic anteriomedialis, ganglionic upper pole.3. Anatomy observes and surveys on the ganglion stellare3.1. The position, appearance and the size of the ganglion stellareGanglion stellare is located in the collar of the neck, the 7th cervical vertebraprocessus transversus to the first collum costae level 40 examples, accounts for83.33%; the T1 level ganglion stellare 8 examples, accounts for 16.67%. Thesuperior border to T1 superior border 0.17±0.13cm, 43 examples, accounts for89.58%; the superior border to the 7th cervical vertebra superior border0.84±0.15cm, 5 examples, accounts for 10.42%; behind the arteria vertebralisoutset department 38 examples, accounts for 79.17%, the post-outside 6 examples,account for 12.5%, the post-inside 4 examples, account for 8.33%. The shape ofganglion stellare: The ganglion stellare most common shape is: Star type: Left side8 examples, account for 66.67%, right flank 7 examples, account for 58.33%; Nextis the ellipse: Left side 3 examples, account for 25.00%, right flank 4 examples, account for 33.33%; dumb bell shape: Left side 1 example, accounts for 8.33%,right flank 1 example, accounts for 8.33%. Size: Left side is long 16.85±4.57mm,width 4.94±0.33mm, thick4.17±0.68mm; Right flank long 17.13±5.19mm,width4.73±0.56mm, thick 4.78±0.27mm.3.2. The distance of the ganglion stellare to the near vessel and nerve: The minimumdistance from the ganglion stellare to the arteria carotis communis is 6.24±1.96mm;horizontal range to the diaphragmatic nerve is 16.25±4.89mm; Is apart from thethyrocervical trunk minimum distance for 15.72±3.75mm; Is apart from arteriathyreoidea inferior minimum distance for 7.86±2.13mm; Is apart from thelaryngeal nerve horizontal range for 11.92±3.42mm; Is apart from the center of thebrachiplex superior trunk horizontal range for 23.97±5.36mm. The distance frominferior cervical ganglion superior border to the cricoid cartilage inferior border:left side the mean value is 31.15±7.79mm; right flank the mean value is31.4±6.81mm. The distance from inferior cervical ganglion to the neck anteriormedian line: Left side mean value 30.92±6.67mm; Right flank mean value30.53±6.65mm; inferior cervical ganglion to skin vertical depth: Left side the meanvalue is 32.87±7.59mm; Right flank the mean value is 33.54±6.62mm. The centerpoint of the inferior cervical ganglion middle to the middle of breastbone neck veinincisure the vertical range: Left side mean value 31.95±6.82mm; Right flank meanvalue 31.74±7.79mm.3.3 The ganglion stellare’s nutrient artery is mainly from the vasoganglion betweenthe inferior thyroid artery, the arteria vertebralis, the arteriae subclavia and the tunica adventitia of the arteria vertebralis, the nutrient vessels mainly distribute theganglionic upper pole, the ganglionic anus pcrineum.4 Anatomy observes and surveys on arteria vcrtebralises initial sectors and processustransversus section anatomy observes and surveys4.1 Artcria vertebralises initial sectors shape observed result: The arteria vertebralisinitial sector lumens shows the circle columnarly, not obviously collapse, after theentire upward post-inside journey gradually rises to approach scalene muscle untilentering cervical foramen. The origin of the arteria vertebralis and the evolutionposition: The left size has 18 examples （75%） from the arteria subclavia superiorwall, 3 examples （12.5%） from post- superior wall, 1 example（4.17%） from theante-superior wall, another example （4.17%） is direct on the arch of the arteriaeaorta superior wall; Right flank has 17 examples （70.8%） from the arteria subclaviasuperior wall, 4 examples （16.7%） from post- superior wall, 3 examples from thepost wall （12.5%）. The initial sector the outset department direction shows thetendency on the arteria subclavia which place above concentrates to after.Artcria vertebralis processus transversus section insertion: The processustransversus section （right flank） enters from the 6th cervical vertebra cervicalforamen inferior border to the 2nd cervical vertebra cervical foramen upperopening, 1 examples from the 5th cervical vertebra cervical foramcn inters. Themajority puts on the 6th～3rd cervical vertebra cervical foramen to upward. Mostlyvertical walks when bounding to the line, only 2 examples separately slightly havethe curve in 3rd～2nd cervical vertebra and between the 4th～3rd cervical vertebra. 4.2 Arteria vertebralises beginnings are apart from the median line distance: Left sidethe arteria vertebralis beginning is apart from the median line to be away fromaverage 2.69±0.18cm; Right flank average 2.52±0.36cm.4.3 Arteria vertebralises Courser situation: The majority of Arteria vertebralis initialsector （left 25 examples, accounts for 83.3%, right 24 examples, 80.0%）craspedodrome rise. The initial sector walks in the line mainly to show the arrow,the coronal position curving, the arteria vertebralis initial sector curving changewhich is taking’S’, inside and outside directions curving are 32.4% （34 examples）,around the direction curving accounts for 16.2% （17 examples）.4.4 The position relations of the arteria vertebralises arteries beginning segment andthe sympathicus cervicalis. Left flank: The inferior（stellare） cervical ganglion issituated in the arteria vertebralis inside, in rear area 1～2cm, the truncussympathicus cervicalis and the middle cervical ganglion are situated behind thearteria vertebralis 9 examples （37.5%）; the inferior cervical ganglion is situated inarteria vertebralis inside and in rear area, but the truncus sympathicus cervicalisand middle cervical ganglion are situated in the front of arteria vertebralis 14examples （58.33%）, the only 1 example is situated in the arteria vertebralis outside,another 1 example twines around the arteria vertebralis on the line. Right flank:The truncus sympathicus cervicalis and the ganglion are situated in the arteriavertebralis inside or rear area 11 examples （45.83%）, 13 examples （54.17%） thetruncus sympathicus cervicalis is located in front of the arteria vertebralis, and 1example is located in arteria vertebralis outside. 5. The anatomy observation and the survey on the correlation with the anteriorscalenus muscle and the truncus sympathicus cervicalis: Anterior scalenus musclegets up to the 3rd～6th cervical vertebra processus transversus around tubercle,outside the muscle fiber course underneath, stops above the first rib anteriorscalenus muscle the tubercle, the anterior scalenus muscle anterior border neighbortruncus sympathicus cervicalis does, is apart from ganglionated cord the distancefor 25.84±2.38mm, in the 5th cervical vertebra processus transversus placeexactly is its tendinous ingredient most centralized region.6. Anatomy observation and survey on diaphragmatic nerve and truncus sympathicuscervicalis correlation: Diaphragmatic nerve the front inside pate ganglionated cordis neighboring, diaphragmatic nerve is away from the truncus sympathicuscervicalis distance in the 6th cervical vertebra plane is: Left side 1.58±0.53cm;Right flank 1.62±0.28cm. The middle and inferior cervical ganglion is located inits front inside, the horizontal range from the first thoracic ganglion to thediaphragmatic nerve is: Left side 1.59±0.46cm; Right flank 1.61±0.89cm; therelation frequency of the truncus sympathicus cervicalis which is involved indiaphragmatic nerve is 43.6%, mainly with diaphragmatic nerve, with accessoryphrenic nerve then are less. The maximum relation with them and the inferiorcervical ganglion is 60.4%, next with the middle cervical ganglion is 17.5%. Inaddition also has with the arteria vertebralis ganglion, ansa subclavia, middle andinferior cervical ganglion relates, obviously diaphragmatic nerve with ganglionatedcord has the widespread relation to it in the neck. 7. The branch, the shape, the distribution and the variation of laryngeal nerve: In 48laryngeal nerve examples, 43 examples which branch assumes arborization, callsthe tree branch; 5 examples between their branchs or between the branch and thetruncus sympathicus cervicalis mutually anastomose, forms ansiform, and we callsit laryngeal nerve loop, its front and latter directly from the loop on sends outlaryngeal nerve to branch out after the vagus nerve, along the trache-esophaguscanal on line, along the way sends out several branches to distribute in the throat,the trachea, the esophagus and the neighbor muscles.Conclusion1. The truncus sympathicus cervicalis directly is located in front of collilongus, ponethe antero-vertebra anadesma, the branch and the collilongus is connected, theinfused physic liquor diffusion of the middle and inferior cervical ganglionblocking is limited by the muscle nd the fascia musculares, the spot, the direction,the depth and the speed of needling can affect the infused physic liquor to producedifferent blocking effects. The effect of the middle and inferior cervical ganglion isnot caused by the direct blocking the nerve ganglion, for the effect of the blockingby the preganglionic fibre and postganglionic fibre of the middle cervical ganglionand the ganglion stellare out of the collilongus anadesma.2. The body surface of the ganglion cervicale superius localization whenpuncturing: First to touch the tongue bone big angle, then the puncture spotcleidomastoidal process anterior border and the tongue bone big angle segmentcenter point is the puncture spot, the mastoid process point next 1.5 cm place fixed point processus transversus is at the 2nd cervical vertebra; The 4th cervicalvertebra processus transversus cleidomastoidal posterior border and the externaljugular vein intersection 1.5cm place, is equal to the thyroid cartilage superiorborder; the 3rd cervical vertebra processus transversus in the 4th cervical vertebraprocessus transversus place above 1.5 cm place, is equal to tongue bone level. Thepatient takes dorsal decubitus and make the head deviate to the opposite side,processus transversus place makes the mark in the 2nd～4 cervical vertebra, with22G or 24G, long 3.5 cm transfixion pin connects the injector to do to in, under andrear area to prick approximately 2～3cm, when touches the bone sense and maydetermine the 2nd or the 3rd cervical vertebra processus transversus, withdrawal ofneedles 2 mm.The ganglion cervicale superius surgery approuching: First to touch thetongue bone big angle, then cleidomastoidal process anterior border and in thetongue bone big angle segment center point, under respectively lengthens 1.5centimeters margins. By the level incision, pull the carotid artery sheath to theinside, again may obviously touch the second cervical vertebra to the deep surfaceprocessus transversus, strips with the blunt instrument the antero-vertebraanadesma, obviously one shallow concave in, the ganglion cervicale superiusnamely in its shallow is concave.3. Body surface locating point of the ganglion stellare: This spot is located above theextremitas stemalis claviculae 22.38±3.97mm and the median line sid24.18±2.35mm underneath the mm point of intersection or the tuberculum caroticum chassaignaci 37.14±5.86mm opens 24.21±3.79mm points of intersectionspots with the median line nearby; perpendicular needling after this spot32.48±2.54mm namely to reach the star shape ganglion.4. The arteria vertebralis initial sector variation is the truncus sympathicus cervicalisblocking technique in the technique to damage the arteria vertebralis to have theserious illness complication main reason.5. The lateral approaching method of myo-intergroove ganglion stellare blocks theroad of the body surface localization: Take dorsal decubitus and make the headdeviate to the opposite side, expose the blocked side cervical part completely, electthe puncture spot at the intersection place which is located in the myo- intergroovethat is between anterior and medial scalenus muscle and the cricoid cartilageparallel line, which is equal to the 6th cervical vertebra processustransversus. Search the peak of the 6th cervical vertebra processus transversus to thecricoid cartilage plane, with the left hand index and middle figures slightly pressmyo- intergroove, and separate the circa muscle group, go against cleidomastoidalwith the nail side and the carotid artery sheath,and the finger pulp side is among thescalene muscle group, diaphragmatic nerve and the 6th cervical vertebra processustransversus. Then the 6th cervical vertebra processus transversus anterior aspect oranterior tubercle is pressed between the two finger pulps, and during the twofigures there is 3～5 mm seam, that is the needling gap. The distance of the skin ofpuncture spot to the 6th cervical vertebra facio- processus transversus is: Left side:1.53±0.32cm; Right flank: 1.49±0.36cm. The distance of the skin of puncture spot to inter- muscle anadesma is: Left side: 1.26±0.13cm; Right flank: 1.19±0.14cm.The lateral approaching method of myo- intergroove characteristic lies in: The 6thcervical vertebra processus transversus tubercle in myo- intergroove placecomparatively shows shallowly, is easy to touch, the obvious dissection mark ofthe puncture; also it is far away the big vessel comparatively, puncture not easyto harm; after transfixion pin reaches the 6th cervical vertebra processustransversus then retrocede the needle then prick in about 2.5cm to decoct later andthen it can reach the 7th cervical vertebra processus transversus easily, inject intothis place it can block the ganglion stellare located underneath.6. In the truncus sympathicus cervicalis blocking technique, inaccur ganglion stellareate location, deeper needling and the overdose of local anesthesia are the mainreasons to damage the diaphragmatic nerve and the complication of blockage.7. In the cervical sympathetic ganglia blocking technique, the insufficiencyunderstanding to laryngeal nerve Courser, the branch number and the nerve trunkshape, the branch variation and its relation with truncus sympathicus cervicalis isthe main reason that blocks laryngeal nerve.8. When committing the superior thyroid ganglion and the ganglion stellare blockingtechnique, we should prevent the transfixion pin from pricking into the nerveganglion, otherwise it will make the nerve ganglion and the nerve ganglion’snutrient vessel insult, the physic liquor may be absorbed through the part bloodvessel to influence the blocking effect.更多还原