Meдицина/8

Meдицина/8. Mорфология

assistant Skoruk A.G.

Department of pathology, forensic medicine and law

Vinnitsa national Pirogov memorial medical university Vinnitsa, Ukraine

The topographicanatomical features neurovascular bundles of the upper mediastinum in five months human fetuses

The study of formation and topography of organs and structures of the fetus has particular importance for the interpretation of the true flow processes of organogenesis. Especially it is useful today, during the rapidly development of modern endoscopic surgery that requires extensive research morphologists regularities of the structure and formation topographicanatomical relationships of organs and structures of various systems in the fetal period of human ontogenesis. The adequate sonographic conducting research, operations on the organs of the fetus in the womb, the interpretation of the results of modern diagnostic techniques (CT, MRI) and autopsy of the fetus are based on objective anatomical data [1, 4, 6, 7]. Recently, much attention is paid to individual variability structures of the human body. One of the most variable systems is vascular. In the scientific literature highlights the disparate evidences about peculiarities of formation and morphogenesis topography components neurovascular bundles [2, 3, 5, 8]. However, information about typical and variant anatomy of the great vessels of the upper mediastinum and the establishment of the correlation of relationships during the fetal period of prenatal human ontogenesis remain poorly understood and require further investigation.

The aim of the work was to determine syntopy main neurovascular bundles of the upper mediastinum in five-month human fetuses.

Materials and methods. The researches of 6-man fetuses preparations 136,0-185,0 mm parietal-coccygeal length are carried out by methods of preparing thin thymus and mediastinal organs controlled binocular loupe, morphometry, macro- and microscopy-based in Vinnitsa pathoanatomical bureau. The study was conducted in compliance with the guidelines of bioethics and in accordance with the order of the Ministry of Health of Ukraine № 690 from 23.09.2009

Discussion of results. The investigations of variant anatomy of the aortic arch branches and changes in syntopy components left and right neurovascular bundles neck are topical urgent and priority. The group of fetuses of the 5th month of fetal development include fetuses 136,0-185,0 mm parietal-coccygeal length. At the end of the 5th month of fetal development (fetus 185.0 mm parietal-coccygeal length) of a convex semicircle aortic arch with length 12.2 mm, four arteries originate: shoulder-main trunk, left common carotid artery, left vertebral artery and the left subclavian artery. In front to the convexity of the aortic arch and the initial parts of the above vessels that depart from her left shoulder, adjoins the main vein. Shoulder-head stem, length 7.3 mm, directed upwards and slightly to the right, and its rear surface adjacent to anterolateral surface of the trachea. At 5.5 mm above the right sterno-clavicular joint shoulder-main trunk divides into the right common carotid artery and right subclavian artery. The side of the right common carotid artery runs right internal jugular vein, and behind in the groove between them - right vagus nerve. At 4.2 mm above the upper edge of the thyroid cartilage of the right common carotid artery divides into the external and internal carotid arteries. The left common carotid artery passes in front of the transverse processes of the cervical vertebrae. Medialy to the left common carotid artery are placed the esophagus and trachea. At the level of the upper edge of the thyroid cartilage left common carotid artery divides into the external and internal carotid arteries. The feature branches from the aortic arch of the fetus is a discharge between the left common carotid artery and left subclavian artery, left vertebral artery. The neck portion of the right vertebral artery tight to the lateral surface of the left common carotid artery. The left vertebral artery enters the transverse hole III-th cervical vertebra, climbs up on the same hole two upper cervical vertebrae and enters the cranial cavity through the large hole occipital bone. The left vagus nerve within the upper mediastinum tight adjacent to anterolateral surface of the left vertebral artery. Intrathoracic portion of the left subclavian artery located at 4.0 mm below from the left brachiocephalic vein.

Conclusions. 1. Most of the five-month topical fetuses position adjacent to the mediastinal structures thymus (ascending aorta, aortic arch and its branches, superior vena cava, the vagus nerve and diaphragm) depends on the formation of the topography of the mediastinum. 2. In a minority of cases (1 of 6) present individual anatomical features of vessels, which may be the cause of some difficulties for the sonographic diagnosis and during endoscopic surgery in the fetus and newborn.

Literature:

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