关键词: 食管重建, 膈肌瓣, 膈下动脉, 临床解剖

Abstract:

Objective　To explore the feasibility of the pedicled diaphragmatic flap on esophageal reconstruction through anatomic study.　Methods　To dissect and observe the origin, course, outer diameters, distribution, length and anastomosis of diaphragmatic neuro-vascularity in 12 adult antiseptic specimens perfused with red latex.　Results　The blood vessels of diaphragm were mainly from inferior phrenic artery, muscle phrenic artery, pericardiacophrenic artery, superior phrenic artery and the branches of the lower posterior intercostal artery. Inferior phrenic artery was the primary one among them, which mainly originated from the trunk of the celiac artery or the abdominal aorta, with the left and right outer diameters at their original site of (1.52±0.06)mm and (1.61±0.04)mm respectively. They passed through the both phrenic angle and reached the diaphragm, and given the anterior and posterior branches to diaphragm. The anterior one coursed anterolaterally, and supplied the center of the central tendon, the anterior part of the both lobes of the central tendon and the anterior costal part of diaphragm. The posterior one coursed posterolaterally, and supplied the posterior part of the both lobes of the central tendon, the posterior costal part and waist of diaphragm. Conclusions　It is absolutely anatomically feasible to reconstruct esophagus with pedicled diaphragmatic flap which takes the inferior phrenic artery as the vascular pedicle.

Key words: Esophageal reconstruction, Pedicled diaphragm flap, Inferior phrenic artery, Clinical anatomy