腰静脉及腰升静脉变异一例

笔者进行标本制作时,发现腰静脉异常的成年男性一例,右侧仅2支腰静脉经下腔静脉后壁汇入下腔静脉,左侧见3支腰静脉全部汇入左肾静脉,未见左侧腰升静脉存在.经作者查询国内相关文献,此种变异属较罕见.     

左肾静脉主要属支的影像学应用解剖

目的:为与左睾丸静脉和左肾上腺静脉相关的临床影像学诊断和治疗提供解剖学资料。方法:成年男尸70具,分别测量左睾丸静脉和左肾上腺静脉的开口至下腔静脉(左缘)和左肾门的距离,以及左肾上腺静脉与左睾丸静脉两开口之间的水平距离,并进行统计学相关性分析。结果:①左睾丸静脉开口距下腔静脉35.6±9.1mm,距左肾门26.1±10.1mm。②左肾上腺静脉开口距下腔静脉29.6±11.8mm,距左肾门31.5±13.6mm。③62.7％的左肾上腺静脉开口于左睾丸静脉内侧,两者相距13.3±7.2mm;23.7％开口于左睾丸静脉外侧,相距8.8±6.6mm;两者相对的占13.6％。结论:两静脉开口距下腔静脉的距离与肾静脉长度呈直线正相关关系;肾静脉越长,两开口距下腔静脉距离越远、距肾门距离相对越近,但两开口之间的距离与肾静脉长度无关。本文还就调查中出现的变异情况提醒临床工作者注意。     

奇静脉逆行灌注在主动脉手术中对脊髓保护的解剖学研究

目的 :为主动脉手术中脊髓保护提供形态基础和术式设计。方法 :解剖观察了 3 1例成人标本的奇静脉系、椎静脉丛 ,以及脊髓静脉回流途径。结果 :观测奇静脉系及相关静脉 ,其直径为 ( x±s) :奇静脉为 (9.2± 1.9)mm ,半奇静脉为 (5 .5± 1.2 )mm ,副半奇静脉为 (3 .8± 0 .9)mm ,左最上肋间静脉为 (2 .0±0 .4)mm ,右最上肋间静脉为 (1.9± 0 .4)mm ,左腰升静脉为 (2 .3± 0 .5 )mm ,右腰升静脉为 (2 .2± 0 .6)mm。根据奇静脉属支的配布和肋间静脉汇入形式 ,将奇静脉系分为 4种类型。奇静脉及其属支中存在静脉瓣 ,有个体差异。脊髓静脉密集 ,与椎内静脉丛有丰富的网络连接 ,并通过神经根静脉与椎外静脉丛、奇静脉系相交通。结论 :在主动脉手术中应用奇静脉逆行灌注脊髓保护 ,是一种行之有效的新术式。     

下腔静脉肝后段的观测及其临床意义

目的 :研究下腔静脉肝后段口径变化规律以及与肝静脉开口的关系。方法 :选用福尔马林固定的离体无病变肝脏 3 4例 ,直角规测量内径 ,剖开管腔观察管壁形态及肝静脉开口情况。结果 :下腔静脉肝后段近心端内径为 ( 2 3 .8± 1.1)mm ,狭部内径为 ( 18.0± 1.4)mm ,远心端内径为 ( 2 0 .2± 1.5 )mm ;狭部管腔内多形成纵行皱襞 ;肝左、中、右静脉开口于下腔静脉肝后段上 1/4段 ,口径较大的肝小静脉开口于肝后段下 2 /4段。并使该段中上部形成一向左开放的夹角 ,其平均角度为 ( 15 9.7± 2 .8)°。结论 :下腔静脉肝后段狭部和腔内纵襞的存在 ,为该段狭窄性疾病和血栓形成的解剖学基础     

肝左静脉的解剖学类型及其临床意义

目的 :为肝移植和肝部分切除术提供解剖学资料。方法 :在 40例成人尸体肝膈面沿肝左肝静脉切除肝实质 ,显露肝左静脉 ;对肝左静脉及其属支进行了观测。结果 :肝左静脉长度 ( 3 0 .3± 1 .1 )mm ;主干直径 ( 1 1 .3±0 .2 6)mm ;主要属支直径为 ( 6.0± 0 .5 2 )mm ;肝左静脉主干在膈面距离下腔静脉汇入口 1 0、2 0、3 0mm处的深度分别是 ( 1 1 .5± 0 .49)、( 1 6± 0 .5 9)和 ( 1 9.1± 0 .64)mm ;肝左静脉在膈面与肝镰状韧带呈 ( 3 0 .2 9± 1 2 .3 3 )°角 ;肝左、中静脉共干的出现率仅为 3 0 % ;肝左静脉按其属支多少分为 6型。结论 :肝左静脉在肝实质内的位置和属支数目不恒定 ,以 3～ 4支最多。所观测的资料 ,对肝外科手术具有重要意义。     

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。     

经静脉韧带门腔分流的应用解剖

目的探讨门腔分流新途径。方法选择成人正常肝 44 例,解剖观测肝圆韧带、静脉韧带等。结果静脉韧带走行于肝下面的静脉韧带裂内,连于门静脉左支和下腔静脉之间,长约 4．09＝0．61 cm;肝圆韧带连于脐和门静脉左支之间,其肝外段和肝内段分别长约 14．51±3．44 cm,5．75±0．99 cm。静脉韧带和肝圆韧带内均有间断残腔存在,且以近心段最为明显,分别长达 1．99±0．39 cm 和 2．91±0．62 cm。肝圆韧带和静脉韧带均可用直径 2 mm 的铁丝使其再通。结论于脐处切口,扩张再通肝圆韧带、静脉韧带至下腔静脉,实现门腔分流通道具有可行性。     

左肾静脉解剖学观察及临床意义

目的:研究左肾静脉的局部解剖关系为临床提供解剖学基础。方法:在72具成人尸体标本,解剖、测量和研究左肾静脉与腹主动脉、肠系膜上动脉和下腔静脉关系。结果:左肾静脉起始处外径(15.6±2.1)mm(12.0～19.0 mm),长度(6.8±1.1)cm(4.3～9.9 cm),注入下腔静脉高度为(11.6±1.9)cm(7.9～15.5 cm),左肾静脉经过腹主动脉和肠系膜上动脉夹角处,距肠系膜上动脉根部为(0.4±0.3)cm(0～1.2 cm),腹主动脉和肠系膜上动脉夹角为(41.6°±9.1°)(20°～60°)。结论:走行于腹主动脉和肠系膜上动脉根之间的左肾静脉易受压,严重时可出现血尿、直立性蛋白尿和男性精索静脉曲张等症状。     

右睾丸静脉分叉变异一例

据谭允西等 1 0 0具尸体右睾丸静脉的观察统计 ,1条者 99例 ,2条者 1例 ,在 99例 1条者中 ,注入下腔静脉者 83例 ,注入右肾静脉者 1 5例 ,注入右肾静脉与下腔静脉汇合角处 1例 ;1例 2条者皆注入下腔静脉。作者在解剖 1具中年男性尸体时发现其右睾丸静脉分叉变异 ,现报道如下 :该例标本右睾丸静脉形成后经回肠末段、十二指肠水平部后方 ,沿腰大肌的前方伴右睾丸动脉上行 ,在第 3腰椎平面以锐角分叉为 2支 ,1支斜向左上注入下腔静脉 ,其起始处压扁外径 5 3mm ,长 0 85cm ,1支继续上行在右肾静脉下方注入右肾静脉 ,其起始处压扁外径 3 0mm ,…     

胃贲门附近静脉的外科解剖

在100具尸体上,对贲门附近的静脉进行了观测.胃左静脉以3属支合成者多见(88.0％),其位于脊柱左前方者占89·0％,汇入脾静脉者占55.0％,外科干长2.6±0.9cm,终末部外经3.8±1.1mm。贲门食管支以1支型者最多(89.0％),汇入弓形部者占81.6％,末端距胰上缘2.1±0.9cm。胃右静脉出现率96.0％。胃后静脉出现率87·0％,1支型者92·0％,有76.6％汇入脾静脉中1/3段。     

下腰椎侧前方静脉的解剖及其在腹腔镜腰椎手术中的临床意义

目的：探索在腹膜后腹腔镜行下腰椎手术时，下腰椎侧前方血管的解剖及手术暴露时的注意事项。方法：对15具腰椎标本两侧观察腰升静脉和髂腰静脉走行、变异及其与周围组织的关系。结果：腰升静脉和髂腰静脉在每具标本中均存在，有静脉分干和共干汇流到髂总静脉等4种形式。在牵拉髂总静脉时，可能导致它们的破裂，并且在暴露血管时需注意避免损伤闭孔神经和腰骶干。结论：髂腰静脉和腰升静脉是下腰椎很重要的解剖结构，腹腔镜手术显露下腰椎时应注意在牵拉髂总静脉时暴露和结扎这两个静脉，是手术避免血管破裂导致大出血的关键。     

Anatomical variations of the iliolumbar vein with application to the anterior retroperitoneal approach to the lumbar spine: a cadaver study

Objectives of this study include identification of lumbosacral venous variations, designation of a critical area of dissection for surgical exposure, and comparison between both male/female and right/left-sided anatomy. Attempts were made to provide anatomic nomenclature that accurately describes these structures. Thirty-eight iliolumbar venous systems in 20 cadavers (11 females/9 males) were dissected. Each system was identified as one of three patterns of variation: common venous trunk (combining ascending lumbar and iliolumbar venous systems) with distal veins, common venous trunk without distal veins, and venous systems without a common venous trunk. Dimensions including distances to the inferior vena cava (IVC) confluence, the obturator nerve, and the lumbosacral trunk, and venous stem length were obtained to aid surgical dissection. Differences between males and females and those between right and left sides were compared. Anterior lumbosacral venous variations could be organized into three groups. A Type 1 venous system (common venous trunk with distal veins) was most common (53% of systems). The anatomical name "lateral lumbosacral veins" adequately describes the anatomical location of these veins and does not assume a direction of venous flow or the lack of individual distal veins. A critical area bordered by the obturator nerve anteriorly, the psoas muscle laterally, the spinal column medially, and sacrum posteriorly within 8.2 cm of the IVC confluence should be defined to adequately dissect the lateral lumbosacral veins. Differences in male and female lateral lumbosacral venous anatomy do not alter surgeon's approach to the anterior lumbar spine.     

Anatomical and radiological evidence for the iliolumbar vein as an inferior lumbar venous system

The purpose of this work was to study an inferior lumbar venous system, which turned out to be the vertical component of the iliolumbar vein as defined in early works by Bourgery and Jacob, though there is a terminological ambiguity between the iliolumbar vein and the ascending lumbar vein in the literature. However, the iliolumbar vein is most commonly defined as a vein draining the fourth and fifth lumbar vertebral segments. Cadaver studies, including one injection-corrosion, and in vivo venograms were analyzed by visual inspection and measurements. Whether the injection was made via the axillary or the saphenous veins, the inferior lumbar vein was always filled, demonstrating that it is part of the vertebral venous system. An interruption or a plexiform shape of the venous system at the level of the third lumbar vertebra, and an increase in caliber as this vein runs downwards, allowed differentiating the inferior lumbar vein from the ascending lumbar vein. The inferior lumbar vein and the superior iliac vein drained into the iliac veins, either external or internal iliac vein, but typically into the common iliac vein, separately or with a single common trunk. This common trunk was observed in 92% of the dissected cases on the right side and in 46% on the left, whereas it was seen in 50% of the radiological studies on the right side and 52% on the left. Consequently, the inferior lumbar vein was the main component of the iliolumbar vein, and as such should be differentiated from the ascending lumbar vein.     

Avulsion of ascending lumbar and iliolumbar veins in anterior spinal surgery: an anatomical study

To expose the disc between the 4th and 5th lumbar vertebrae in anterior spinal surgery, left to right retraction of inferior vena cava and aorta is required. This manoeuvre can be complicated by venous haemorrhage that, in most cases, is due to avulsion of the left ascending lumbar vein (ALV) or the left iliolumbar vein (ILV). We dissected 23 embalmed cadavers to assess the factors that contribute to the risk of tearing these two veins during retraction. We describe a triangular region that should help surgeons in identifying the ALV and ILV. This triangle is defined by the lateral border of the common iliac vein, the medial border of the psoas major muscle, and the superior end-plate of the L5 vertebral body. We observed that 3 cm between the termination of the left ALV, or a common stem with the ILV, and the termination of the common iliac vein is the critical distance, less than which the risk of venous avulsion is highest. Although the sample considered is small, our study seems to suggest that male patients tend to have a higher risk of venous avulsion than female patients.     

Problem in diagnostic imaging: Behind the left renal vein

This study presents, as diagnostic problems, computed tomographic scans from a selection of patients with suspected or known tumors, primary or secondary, in the retroperitoneal area, at the level of the renal hila. The study emphasizes the value of serial CT scans, and of three-dimensional reconstructions made from them, in distinguishing between tumor and incidental venous anomalies in this region, principally those involving communications between the left renal vein and the ascending lumbar vein. Clin. Anat. 10:349–352, 1997. © 1997 Wiley-Liss, Inc.     

髂总静脉汇合点解剖学特点及其临床意义

目的:为经腹膜腰椎前路微创手术提供腰椎前方血管的解剖学依据;方法:选择30例防腐固定尸体标本及120例腰椎MRI断层数据,观察下腰椎区域髂总静脉的解剖学特点;根据腰椎前方血管的断层图片判断髂总静脉汇合点(CCIV)对应椎体的位置;L5～S1前方左髂总静脉对应椎间盘的位置。结果:CCIV的位置范围从L4椎体到S1椎体,相对恒定,主要分布在L5及L5～S1椎间隙(二者占87.5%);左髂总静脉的位置直接决定了进入L5～S1椎间盘的难易程度,88.3%左髂总静脉位于L5～S1椎间盘30°～90°的位置。结论:CCIV存在较大的变异,微创前路经腹膜手术在下腰椎损伤大血管的危险性主要来自髂总静脉汇合点及左侧髂总静脉对应椎体的位置,因此强调术前的MRI检查来判断髂总静脉的位置,评价手术的可行性及安全性。     

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.     

椎前髂静脉通道大小和下腰椎前凸角与性别、年龄的关系及其临床意义

目的 探讨椎前髂静脉通道矢状径(IVTD)和下腰椎前凸角(LLLA)与性别、年龄的关系及其临床意义。方法 收集2009年7月—2014年12月解放军第一七五医院(厦门大学附属东南医院)CT数据库中行腹盆部CT检查患者的资料进行回顾性分析。按年龄和性别分层简单随机抽样方法抽取320例为正常组,每年龄段(1～15,16～25,26～35,36～45,46～55,56～65,66～75及≥76岁)各40例,男女均等。收集同期55例(男18例,女37例)髂静脉压迫综合征(IVCS)患者的CT资料为IVCS组。分别在CT横断面和重建矢状面上测量椎前IVTD和LLLA。统计分析评估正常组LLLA和IVTD在男女性别间和各个年龄组间的差异采用方差分析和Bonferroni检验,Pearson相关分析LLLA和IVTD与年龄的相关性。在正常组中选择与IVCS组同年龄段者为对照组,采用独立样本t检验分别比较对照组与IVCS组中男性组、女性组间LLLA、IVTD的差异,分别建立预测男性和女性罹患IVCS风险的IVTD狭窄阈值。结果 正常组总体LLLA为128.1°±6.7°,椎前IVTD(4.9±1.2)mm,与年龄均呈负相关(r=-0.673、-0.662,P值均＜0.01);LLLA与IVTD呈正相关(r=0.812, P＜0.01)。其中,男性LLLA 为130.6°±6.1°、IVTD为(5.4±1.2)mm;女性LLLA为125.5°±6.0°、IVTD为(4.3±1.0)mm,男性LLLA和IVTD值均高于女性(t=7.426、9.103,P值均＜0.05)。IVCS组中,男性LLLA为123.3°±2.3°,IVTD为(2.5±0.3)mm ,与对照组男性的128.1°±2.7°、(5.0±0.8)mm比较,差异均有统计学意义(t=6.993、12.604, P值均<0.01);女性LLLA为122.1°±5.8°,IVTD为(2.3±0.4)mm,与对照组女性的125.1°±4.9°、(4.1±0.8)mm比较,差异均有统计学意义(t=2.898、12.906, P值均<0.01)。ROC预测IVCS的IVTD最适风险阈值,男性为2.98 mm,女性为2.96 mm,曲线下面积分别为0.99、0.98,其诊断敏感性分别为99%、93%,特异性均为100%。结论 LLLA和椎前IVTD在不同性别与年龄间存在差异, CT成像可以准确评估通道狭窄情况,预测罹患IVCS的风险。