体外腹主动脉末端施压控制骨盆骨折大出血的应用解剖

目的为体外腹主动脉末端加压控制骨盆骨折大出血提供应用解剖学基础。方法14例尸体标本,以第5腰椎上缘水平为基点,观测:①脐中点与腰椎体及腹主动脉端的位置关系;②腹主动脉末端与第5腰椎椎体的关系。③腹主动脉、下腔静脉与腰椎的位置关系。结果腹主动脉远段位于脊柱椎体前,以平L4椎体和L5椎体上部动脉血管段较为居中。腹主动脉末端分杈平面在基点以上22mm、以下15mm之间。脐中点在基点以上4.0cm、以下2.8cm范围内。结论可以脐为标志点定位腹主动脉末端对腹主动脉远端实施体外压迫,阻断血流或降低远端血压,达到紧急止血目的。     

腰椎椎弓根螺钉双皮质固定的椎前大血管解剖学研究

目的观测腰椎椎体前面与椎前大血管的解剖关系,为腰椎椎弓根螺钉双皮质固定技术提供血管解剖学依据。方法62例成年人行腰椎CT三维重建及腹部血管成像检查（其中男32例,女30例）,观测腰椎椎弓根平面椎体前面与腹主动脉、下腔静脉或髂动静脉之间的距离,腹主动脉、下腔静脉或髂动静脉相对于椎体前面的相对位置关系。结果L1-L4椎体左侧平椎弓根平面腹主动脉距椎体前面距离为0．26-0．37cm、位于椎体前面-7°-34°区域;L1-L3椎体右侧平椎弓根平面下腔静脉距椎体前面距离分别为1．03cm、0．75cm、0．36cm,位于椎体前面17°-63°区域;L。椎体右侧、L5椎体双侧平椎弓根平面髂动静脉距椎体前面距离小于0．15cm,位于椎前73°区域内。结论L1-L4左侧双皮质椎弓根螺钉置钉过深容易损伤腹主动脉,L1-L3椎右侧椎弓根螺钉最容易操作完成,损伤下腔静脉的可能性较小,L4右侧、L5双侧的双皮质椎弓根螺钉最容易损伤椎前大血管。     

下腔静脉及双侧睾丸动脉变异一例

在制作一成年男性腹后壁脏器及血管陈列标本时 ,见其下腔静脉走行异常及双侧睾丸动脉起始变异。经复习有关文献 ,发现此变异报道较少。1 .主动脉腹部位于脊柱的左前方。下腔静脉起于第五腰椎椎体左侧 ,由左右髂总静脉汇合而成 ,继而沿主动脉腹部左侧上升 ;在第二腰椎椎体上缘平     

左下腔静脉一例

本例为重庆地区收集的成年男性尸体。下腔静脉由左髂内静脉与右髂总静脉在平第五腰椎上缘处汇合而成。左髂总动脉跨越其起始端的前方。左髂外静脉在第四腰椎平面汇入下腔静脉左缘。下腔静脉上行于腹主动脉左侧,位于腰椎椎体左侧,上升至第二腰椎下缘平面在接受左肾静脉后,即以130°角折向右上,越过腹主动脉前方至第一腰椎     

2例下腔静脉异常

<正> 作者在行下腔静脉系观察测量时,发现几例下腔静脉异常,现将典型的2例报导如下:例1:左下腔静脉(老年女性、身长1.60米)两侧髂总静脉及髂内、外静脉均位于同名动脉的后方.左髂总静脉(长40mm、外径14mm)与右髂总静脉(长50mm、外径20mm)在第5腰椎左前方汇合形成下腔静脉.下腔静脉沿腹主动脉左侧上行至第3腰椎上缘成为下腔静脉的远端(长68mm、外径21mm),在第2腰椎下缘下腔静脉向右上斜跨腹主动脉并与其形成约30度的夹角.(重合27mm)经肠系膜上动脉的右下方、右肾动脉的左上方至第1腰椎右侧而成为下腔静脉斜段(长82mm、外径28mm),断之沿脊柱右侧上行,穿膈的腔静脉孔入右心房.构成下腔静脉近端(长85mm、外径31mm).左下腔静脉行程中,在第2腰椎平面接受左肾静脉,第一腰椎体下缘接受右肾静脉.(附左肾长120mm、宽65mm,右肾长60mm、宽38mm)例2:左下腔静脉合并右侧支形成.(1)左下腔静脉:在左骶髂关节前外侧由左髂外静脉接受左髂内静脉(均位于同名动脉的后     

腹主动脉分叉解剖位置的影响因素

目的 探讨腹主动脉分叉解剖位置影响因素。 方法 在CT影像下分别观测腹主动脉分叉与L4下缘和正中线垂直距离、在正中矢状面用3种不同方法测量腰椎前凸角度,记录年龄、性别、体重指数(BMI)等。 结果　随着年龄增长，腹主动脉分叉呈现逐渐下降，右侧移动趋势。男性主动脉末端持续下移，而女性65岁后才出现明显下移。腰椎前凸角度、性别、BMI与腹主动脉末端位置无相关性(P>0.05)。腰椎前凸与年龄密切相关(P<0.01)。 结论 腹主动脉末端下降，右移与年龄有关，这些发现对低位阻滞有指导作用。     

左下腔静脉一例

<正> 本例为5岁的女性童尸。左下腔静脉起始于第四腰椎下缘,由左、右髂总静脉汇合而成,沿腹主动脉下段的左侧上行,至第一腰椎处斜向右上方,跨经腹主动脉前方,至其右侧,继续上行,经肝脏的腔静脉窝,最后穿膈肌腔静脉孔入右心房。它全长可区分为三段:即腹主动脉的左侧段(下段),腹主动脉前段(斜行段),和腹主动脉右侧段(上段)。下段长5.5厘米,口径(压扁测外径)1.2厘米;斜行段长3     

左下腔静脉一例

<正> 本例为3岁的女性童尸。左下腔静脉系由左右骼总静脉于第五腰椎左侧前方汇合而成,位于腹主动脉左侧,紧密地相依而向上行,可区分为左段、斜行段和右段。下腔静脉左段系指腹主动脉左侧,向上至第二腰椎平面移行为下腔静脉斜行段。此段长6.1厘米,口径1.2厘米。由下而上沿途接受第四对腰静脉,左侧第三腰静脉,左肾静脉上下支,左卵巢静脉,第二对腰静脉。腰静脉分别在相应腰椎平面注入下腔静脉左段后壁;左肾静脉上下支,在第二腰椎平面分别注入左段外侧;左卵巢静脉斜行的注入左肾静脉下支与下腔静脉左段汇合处。     

不同体位腹膜后大血管及腰大肌的MRI影像解剖学差异

目的 比较仰卧位、俯卧位及侧卧位时，腹主动脉和下腔静脉在腰椎各椎间隙水平的位移变化和腰大肌厚度及位移变化，确定经侧路进行腰椎融合术的安全工作区。方法 15名志愿者在3种体位接受腰椎磁共振检查，记录L_1/2～L_4/5椎间隙水平腹主动脉和下腔静脉的位置、腰大肌的厚度及位移情况并进行比较。结果 相同节段不同体位下腔静脉分布相似。而在L_1/2～L_3/4水平，相较于仰卧位，腹主动脉在侧卧位和俯卧位部分向前方移动至椎体前缘。相同节段不同体位腰大肌厚度存在差异(L_2/3A区，L_3/4A区、Ⅳ区和P区，L_4/5Ⅱ区和Ⅳ区)(P<0.05)。不同节段腰大肌前移距离存在差异，在L_1/2水平，俯卧位(-7.53±3.30)mm及侧卧位(-7.25±3.96)mm的前移距离大于仰卧位(-10.90±3.31)mm,P=0.012；在L_2/3水平，侧卧位的前移距离(-0.12±5.59)mm明显大于仰卧位(-5...     

腰椎椎弓根螺钉预出钉部位的影像解剖学研究

目的：探讨腰椎前方大血管与腰椎椎弓根螺钉预出钉部位的位置关系,为腰椎椎弓根螺钉内固定时椎前大血管损伤的预警提供形态依据。方法：对33套成人腰椎标本进行放射解剖学测量,得出腰椎椎弓根螺钉进钉角度与预出钉点位置关系;通过成人120例CT片的相关测量,得出椎前大血管与椎体周缘的位置关系。结果：（1）X线解剖学观测,当进钉角度在0—5°时,出钉点多在椎体侧方0—60°;当进钉角度为5～10°时,出钉点在椎体前外侧方60～70°;当进钉角度为10～20°时,出钉点在椎体前方70～90°。（2）CT观测,在L1～L4椎体水平,腹主动脉大多位于椎体左侧前方70-90°,下腔静脉位于椎体右侧前外侧方50—80°。L5椎体水平,髂部血管位于左、右侧方45～70°。结论：以人字嵴顶点为进钉点行腰椎椎弓根螺钉手术时,在L1～L4进钉角度为0～5°时,预出钉点在椎体前外侧方60～70°可避开椎前大血管,相对安全。左侧较右侧相对安全。在L5进钉角度为10～20°可避开椎前大血管,相对安全。     

腰椎椎弓根螺钉双皮质固定的椎前大血管三维重建的解剖学研究

目的　基于造影及CT扫描对腰椎椎前大血管行三维重建及测量,探讨实施腰椎弓根螺钉双皮质固定手术的可行性及安全性。 方法　采用明胶-氧化铅混悬液灌注的新鲜成人标本10例,CT扫描后三维重建,测量椎弓根轴线与椎体前缘交点与大血管的解剖结构关系。L/RAD（L/RVD）: 左右侧腰椎椎弓根轴线与椎体前缘的交点和腹主动脉（下腔静脉或髂动静脉）之间的距离。 结果 L3（RAD）与L5（LAD）分别为(0.51±0.12) cm和(0.16±0.11) cm, L1（LVD）与L4（RVD）分别为(1.03±0.08) cm和(0.10±0.16) 　cm。L1~3 L/RAD及L3,L5 L/RVD对比均有显著性统计学意义（P<0.05）。L1~L3腹主动脉逐渐靠近椎体前缘(0.38~0.46 cm),L3~5则反之(0.46~0.16 cm)。L1~4下腔静脉逐渐远离椎体前缘(1.00~0.11 cm)。腹主动脉位于L1~4椎体左侧-6°~30°区域; 下腔静脉位于 L1~3椎体前面右侧-15°~57°,L4椎体前面-10°~60°。髂血管在L5椎体前面左内外、右内外分别为4°~10°,-20°~60°,-18°~35°,-50°~70°。 结论　L1~5左侧双皮质椎弓根螺钉置钉过深容易损伤腹主动脉及髂血管,L1~3椎右侧椎弓根螺钉易操作,L4~5双侧损伤下腔静脉及髂血管的可能性较大。     

Morphological study of a horseshoe kidney with special reference to the vascular system

This is a morphological study on an autopsy case of horseshoe kidney found in a 79-year-old-female cadaver. This kidney consisted of two distinct renal masses that were connected at their lower poles by a parenchymal isthmus that was located in the front of the abdominal aorta at the level of the fourth lumbar vertebra. The kidney was supplied by four arteries arising from the abdominal aorta. The distribution of intrarenal arteries showed that the nature of segmental arteries in the present case was basically the same as in the normal kidney, except that the isthmus had its own blood supply from the artery directly arising from the aorta approximately 28 mm below the origin of the inferior mesenteric artery. Venous drainage from the kidney, including the isthmus, was taken by three veins that opened independently into the inferior vena cava. No congenital malformations were found in other organs. We discuss the anatomical and embryological significance of this anomaly and its associated vascular system.     

Left inferior vena cava with regressed right inferior vena cava

A left inferior vena cava was found in the cadaver of an 88-year-old Japanese man during a student dissection course at Kumamoto University School of Medicine. The right common iliac vein ascended obliquely toward the left behind the right common iliac artery and united with the left common iliac vein to form the inferior vena cava in front of the fifth lumbar vertebral body behind the left common iliac artery. The inferior vena cava ascended on the left side to the aorta, and after the left renal vein joined to it at the level of the third lumbar vertebral body, it turned obliquely to the right and crossed superficially to the aorta. At the right side of the aorta, the common stem of the third lumbar vein and the posterior renal vein was joined to the oblique part. The inferior vena cava then ascended, receiving the right renal vein as it would normally. The inferior vena cava is thought to develop symmetrically but this left inferior vena cava shows a persistence of the left channel of the infrarenal part, which normally disappears. Although the common stem of the veins that joined to the oblique part on the right side did not continue to the right common iliac vein, gross anatomical findings suggested it to be the remnant of the right inferior vena cava.     

A rare case of a complete left inferior vena cava associated with the symptoms of Dunbar syndrome

We report a case of an 82-year-old female with an anomalous left inferior vena cava. The left inferior vena cava ascends parallel and to the left of the descending abdominal aorta. At the level of the celiac trunk, the inferior vena cava courses anteriorly and to the right to reach the posterior surface of the liver. The patient also suffers from chronic mild postprandial abdominal pain. It is possible that position of inferior vena cava anterior to the aorta, at the level of the celiac trunk, may lead to intermittent celiac artery compression syndrome (Dunbar syndrome).     

经腹膜后间隙抢救骨盆骨折大出血的解剖研究及临床应用

目的　探讨髂腹股沟入路腹膜后间隙的解剖要点及在抢救骨盆骨折大出血中的应用。  方法    37具国人尸体标本左右两侧髂腹股沟入路显露腹膜后间隙,观测血管、输尿管走行关系及肠系膜下动脉和输尿管、睾丸（卵巢）动静脉的前移距离。并临床应用该入路抢救12例骨盆骨折大出血患者,男10例,女2例。  结果    腹膜后间隙内腹主动脉、下腔静脉、髂总动静脉等紧贴盆壁与壁腹膜间有腹膜外脂肪相隔;肠系膜下动脉、睾丸（卵巢）动静脉与壁腹膜之间有致密结缔组织连接,易随壁腹膜掀起,输尿管上部与壁腹膜有连接,下部连接松弛;在L4椎体平面肠系膜下动脉可前移19.3 mm,睾丸（卵巢）动静脉可前移26.4 mm(右)和28.0 mm(左);输尿管可前移37.0 mm(左)和41.0 mm(右)。临床应用该入路抢救12例骨盆骨折大出血患者,术中对腹主动脉临时压迫阻断控制出血,抢救休克,修复或结扎损伤血管,复位固定骨折。11例成功,1例死亡;无血管、神经再损伤发生。  结论    经髂腹股沟腹膜后间隙入路手术可充分显露盆腔大血管,对腹主动脉临时压迫阻断可快速控制出血,纠正休克,提高了骨盆骨折大出血抢救成功率,是救治骨盆骨折大出血的理想入路。     

Radiographic analysis of the arteries of human lumbar lymph nodes.

Twenty-seven cadavers (12 male, 15 female aged 28 to 94 years, average 75 years) were dissected to analyze the arterial supply of the lumbar lymph nodes with angiography and an image processor-analyzer. The lymph nodes on the left side of the abdominal aorta fused to form several elongated nodes. The lymph nodes on the right side remained separated. A few lymph nodes aggregated below the bifurcation of the abdominal aorta. They received a few branches directly from the abdominal aorta or from the renal, gonadal and/or iliac arteries, which anastomosed with each other to form an arterial arc. This anastomosis gave small paired twigs to the parenchyma continuously. In the case of well developed lymph nodes dorsal to the inferior vena cava, a vessel from the lower abdominal aorta passed upward to supply them. The diameter of these vessels in the angiogram was 0.09-0.27 mm, measured with the image processor-analyzer. These results show that the lumbar lymph nodes do not receive a single artery through the hilus, but through several branches, whose anastomoses form a collateral system associated with the abdominal aorta.     

Radiographic analysis of the arteries of human lumbar lymph nodes

Twenty-seven cadavers (12 male, 15 female aged 28 to 94 years, average 75 years) were dissected to analyze the arterial supply of the lumbar lymph nodes with angiography and an image processor-analyzer. The lymph nodes on the left side of the abdominal aorta fused to form several elongated nodes. The lymph nodes on the right side remained separated. A few lymph nodes aggregated below the bifurcation of the abdominal aorta. They received a few branches directly from the abdominal aorta or from the renal, gonadal and/or iliac arteries, which anastomosed with each other to form an arterial arc. This anastomosis gave small paired twigs to the parenchyma continuously. In the case of well developed lymph nodes dorsal to the inferior vena cava, a vessel from the lower abdominal aorta passed upward to supply them. The diameter of these vessels in the angiogram was 0.09–0.27 mm, measured with the image processor-analyzer. These results show that the lumbar lymph nodes do not receive a single artery through the hilus, but through several branches, whose anastomoses form a collateral system associated with the abdominal aorta. © 1992 Wiley-Liss, Inc.     

Duplicate testicular veins accompanied by anomalies of the testicular arteries.

Duplicate testicular veins associated with other anomalies of the testicular arteries were observed during dissection of the posterior abdominal wall in a 90-year-old Japanese male cadaver. The right testicular vein was composed of the medial and lateral testicular veins. The medial testicular vein drained into the inferior vena cava, whereas the lateral testicular vein drained into the confluence of the inferior vena cava and right renal vein. Several anastomosing branches were seen between the medial and lateral testicular veins. The left testicular vein was formed after the medial and lateral venous trunks joined and drained into the ipsilateral renal vein. The right testicular artery originated from the anterior surface of the abdominal aorta at the level of the left renal artery, passed posterior to the inferior vena cava, and accompanied the right lateral testicular vein running downwards. The left testicular artery arose from the abdominal aorta at a level of 5 cm below the origin of the right testicular artery, and then ran downwards accompanied by the medial trunk of the left testicular vein.     

Right-sided duplication of the inferior vena cava

An infrarenal duplication of the inferior vena cava with both channels lying on the right side of the aorta was fortuitously found during an abdominal Computed Tomography performed on a 52 year-old woman. Only two same cases seem to be reported in the literature. This very uncommon abnormality probably results from persistence of the infra-renal part of the right subcardinal vein. Radiologists have to be aware of this right-sided ipsilateral duplication for it may be a trap in abdominal imaging as well as "classical" inferior vena cava duplication located on both sides of the abdominal aorta.