The autonomic nervous system of the human heart with special reference to its origin, course, and peripheral distribution
The autonomic nervous system of the human heart with special reference to its origin, course, and peripheral distribution
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DOI：
10.1007/s00429-005-0462-1
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发表时间：
2005-07-01
期刊：
影响因子：
--
通讯作者：
Kawashima, T
中科院分区：
文献类型：
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作者：
Kawashima, T
在体视显微镜下，对18具成人身体的36侧心脏自主神经系统从起源到外周分布进行了亚宏观解剖研究。结果表明：(1)颈下神经节和第1胸神经节组成的颈上神经节、颈中神经节、椎神经节和颈胸(星)神经节在标本间基本一致。(2)心上、中、下神经仅跟随大动脉下降而支配心脏。相反，后纵隔的胸心神经由于距离中纵隔较远，走行较为复杂。(3)右胸心神经的实际走行不同于以往的描述，其走行是斜行或横行至椎体，与肋间血管无关。右胸心神经有两个下降过程：右胸心神经经奇静脉和右静脉门下降，右胸返心神经经主动脉下降。(4)颅心神经及其分支偏向心脏内侧分布，心尾神经及分支偏向心脏外侧分布。(5)交感神经和迷走神经的混合部位(心丛)以及臂动脉与喉返神经的明确形态在两侧趋于不同。这些新的和详细的人体自主心脏神经系统的解剖学描述除了有助于心脏外科的改进外，还可能为自主心脏神经的形态发生提供重要线索。
A submacroscopic anatomical investigation of the entire autonomic cardiac nervous system, from origin to peripheral distribution, was performed by examining 36 sides of 18 adult human cadavers under a stereomicroscope. The following new results and points of discussion were obtained: (1) The superior cervical, the middle cervical, the vertebral, and the cervicothoracic (stellate) ganglia, composed of the inferior cervical and 1st thoracic ganglia, were mostly consistent among the specimens. (2) The superior, middle, and inferior cardiac nerves innervated the heart by simply following the descent of the great arteries. In contrast, the thoracic cardiac nerve in the posterior mediastinum followed a complex course because of the long distance to the middle mediastinum. (3) The actual course of the right thoracic cardiac nerve differed from that of the previous descriptions in that it ascended obliquely or ran transversely to the vertebrae, regardless of the intercostal vessels. Regarding the right thoracic cardiac nerve, two descending courses were observed: the descent of the right thoracic cardiac nerve via the azygos vein and right venous porta, and the descent of the recurrent right thoracic cardiac nerve via the aorta. (4) The cranial cardiac nerve and branch tended to distribute into the heart medially, and the caudal cardiac nerve and branch tended to distribute into the heart laterally. (5) The mixing positions (cardiac plexus) of the sympathetic cardiac nerve and the vagal cardiac branch, as well as the definitive morphology of brachial arteries with the recurrent laryngeal nerves, tended to differ on both sides. These new and detailed anatomical descriptions of the human autonomic cardiac nervous system may provide important clues regarding the morphogenesis of autonomic cardiac nerves in addition to contributing to the improvement of cardiac surgery.