腹部手术致乳糜漏解剖学基础的研究

目的　为预防上腹部与腹膜后区手术引起的乳糜漏提供解剖学依据。方法　对 32例成人尸体标本的胸导管起始端、乳糜池、肠干和左、右腰干进行观察。结果　①乳糜池出现率为 2 2 %( 7/32 ) ,其中椭圆形 4例、三角形 3例。乳糜池长 ( 2 4± 6 )mm ,中间宽为 ( 4 1± 0 9)mm ,位于T12 ～L2椎体的右前方。②胸导管起始部外径为 ( 2 8± 0 7)mm ;左腰干和肠干先汇合成共干再与右腰干合并者为 9例 ( 36 % ) ;右腰干和肠干先汇合成共干再与左腰干合并者为 8例 ( 32 % )。③肠干长 ( 36± 15 )mm ,位于降主动脉左侧、左肾动脉的上、下方 ,经L2 椎体前方 ,在椎体右侧与左、右腰干汇合成共干 ,至乳糜池或胸导管。④左、右腰干的长度分别为 ( 10 7± 2 4 )mm和 ( 111± 18)mm ,起始端外径为( 1 7± 0 4 )mm和 ( 1 9± 0 4 )mm ,汇入处外径为 ( 2 2± 0 6 )mm和 ( 2 2± 0 5 )mm。结论　在腹部手术分离腹腔干、肠系膜上动脉根部及肠系膜下静脉末端时 ,应注意保护此手术区域内较大的淋巴管

The anatomic study of chyle leakage due to operation on abdominal region

OBJECTIVE: To provide morphological basis for chyle leakage due to operation on upper abdomen or retroperitoneum region. METHODS: The original part of thoracic duct, cisterna chyle, intestinal trunk, left and right lumbar trunks were examined in 32 adult cadavers. RESULTS: (1) The occurrence rate of cisterna chili was 22% (7 cases), among which 4 cases were oval, 3 cases were triangle. The cisterna chyle was (24 +/- 6) mm in length; the width of middle part was (4.1 +/- 0.9) mm. It was located to the right of midline at the level between the twelfth thoracic vertebral body and the second lumbar vertebral body anteriorly. (2) The original part of thoracic duct was (2.8 +/- 0.7) mm in diameter. The confluence form of thoracic duct included: left lumbar trunk and intestinal trunk united to form the common trunk first, right lumbar trunk then joined the common trunk (9 cases, 36%); right lumbar trunk and intestinal trunk united to form the common trunk first, left lumbar trunk then joined the common trunk (8 cases, 32%); left and right lumbar trunk united to form the common trunk first, intestinal trunk then joined the common trunk (4 cases, 16%); left, right lumbar trunk and intestinal trunk joined together (3 cases, 12%). (3) The intestinal trunk was (36 +/- 15) mm in length. It ascended on the left of descending aorta, superior to the left renal artery, crossed the second lumbar vertebra anteriorly, and joined left or right lumbar trunk to form common trunk, which extended to the cisterna chili or thoracic duct to the right of lumbar vertebra. (4) The lengths of left and right lumbar trunks were (107 +/- 24) mm and (111 +/- 18) mm, the external diameters of origins were (1.7 +/- 0.4) mm and (1.9 +/- 0.4) mm, and the external diameters of terminations were (2.2 +/- 0.6) mm and (2.2 +/- 0.5) mm, respectively. CONCLUSION: The larger lymph tubes should be protected emphatically in the relevant region when dissecting the root of celiac and superior mesenteric artery and the termination of inferior mesenteric vein during abdominal operation.