选择性腰升静脉插管造影的应用解剖研究

<正> 经股腰升静脉插管(TALC)造影是近年来显示椎内静脉丛,是否移位及中断来诊断椎间盘突出部位的一项新技术。Gargano报告自1968年以来采用TALC检查那些怀疑椎间盘突出但经脊髓造影是正常或可疑的病人,其术前诊断正确率达91％。随后许多作者亦报告了类似的结果,国内刘德华等自1978年以来应用选择性插管法硬膜外静脉造影检查腰腿痛患者,其术前诊断正确率

ANATOMICAL STUDIES ON VENOGRAPHY BY SELECTIVE CATHETERIZATION OF THE ASCENDING LUNBAR VEIN

The ascending lumbar vein(ALV)was observed and measured on 140 sides of adult cadavers. The results were as follows: 1.In 62.86％ of the left side, the opening orifice of the left ALV was located on the lateral wall of the common iliac vein(CIV) and the external iliac vein(EIV), only one case opened into the internal iliac vein(IIV), In 67.14％ of the right side, the opening orifice of the. right ALV was located on the posterior wall of the CIV and EIV, in 28.57％ they opened into the IIV. 2.In 92.14％ sides, the opening orifice of the ALV was located at the level from the inferior margin of the intervertebral disc between L_5 and S_1 to the middle part of L_5 body. 3.The average calibre of the initial part of the ALV was 4.40 ± 0.82mm at the left side, and 4.05 ± 0.94mm at the right side, that is the calibre of the initial part of the left ALV was larger than that of right one(P<0.05). 4.The average angle size between the ALV and CIV or EIV was 149.20° ±18.04° at the left side, and 125.59° ± 34.43. at the rigt side, that is, the angle size between the left ALV and CIV or EIV was clearly larger than that of right one(P<0.01). 5.At the fifth lumbar intrvertcbral foramen the patterns of the ALV may be classified into four types: Type Ⅰ which had a main trunk running upward presented in 72.14％, while type Ⅱ , Ⅲ , Ⅳ which had a main trunk perforating into the deep structure or had not a clear main trunk presented in 27.86％. 6.The distance from the opening orifice of the ALV to the saphenafemoralis point was 14.57 ± 1.27cm. 7.The distance from the openig orifice of the ALV to the inguinal ligament was 10.88 ± 1.35cm. 8.The distance from the opening orifice of the ALV to the fifth lumbar intervertebral foramen was 1.54 ± 0.76cm. These results suggested that: (1) The catheterization of the left ALV was easier than that of the right ALV, so that it is better to select the left ALV for unilateral catheterization. ( 2 ) The entering length of the catheter through the femoral vein should be 14.53～16.12cm, that is, the catheter cannot be advanced over the distance from the saphena-femoralis point to the fifth lumbar intervertebral formen. ( 3 ) The diameter of the catheter for use should be 2.5～1.2mm. (4) The position of the opening orifice of the ALV and the angle between the ALV and CIV or EIV should be noted when the selective catheterization of the ALV was performed,