不阻断肾动脉左肾静脉移位术治疗胡桃夹综合征的临床疗效观察

目的 探讨不阻断肾动脉左肾静脉移位术治疗胡桃夹综合征的临床疗效。方法 回顾性分析山东省立第三医院泌尿外科1999年1月—2017年1月收治的10例胡桃夹综合征患者的临床资料(手术组),男8例、女2例,年龄22~53(39.9±10.5)岁,均行不阻断肾动脉左肾静脉移位术;观察手术时间、术中出血量、肾静脉阻断时间、术后引流量、拔管时间、血尿消失时间;比较手术组患者手术前后站立位和平卧位时的左肾静脉狭窄段与扩张段血管管径及血流速度。随机选取2016年7月健康管理中心体检已排除肾脏疾病的10名健康成人(对照组),男5例、女5例,年龄21~45(37.0±5.8)岁;比较手术组术后与对照组的左肾静脉血管管径、血流速度。结果 手术组10例患者手术时间(171.0±10.8)min,术中出血量(138.0±42.1)mL,肾静脉阻断时间(9.5±1.3)min,术后引流(130.0±24.5)mL,拔管时间(3.3±0.8)d,肉眼血尿消失时间为(4.2±1.2)d,镜下血尿消失时间为(7.3±1.1)d。术后随访2~6个月,平均3个月。患者术后均无血尿、蛋白尿,左肾静脉狭窄段内径较术前增加、血流速度较术前下降。比较不同体位下左肾静脉狭窄段与扩张段内径及血流速度,手术组患者术前差异均有统计学意义(P值均＜0.01),术后末次随访差异均无统计学意义(P值均＞0.05);手术组患者术后站立位左肾静脉狭窄段内径及血流速度与对照组比较,差异均无统计学意义(P值均＞0.05)。结论 不阻断肾动脉的左肾静脉移位术治疗胡桃夹综合征疗效较好。     

Rare origin of supernumerary renal vessels supplying the lower pole of the left kidney

The current observations have documented rare vascular anomalies in the right and left kidneys from a male and female cadaver, respectively. In the female left kidney in addition to being supplied by the normal renal artery and vein it contained a left lower polar renal artery and vein. The polar artery took origin from the inferior mesenteric artery to supply the lower pole and was drained by the left lower polar vein that opened into the left common iliac vein. The right kidney from a male cadaver showed supernumerary renal arteries and veins. The supernumerary upper renal artery took origin from the aorta and after a short course it gave rise into a cranial branch that took a long course to supply the lower pole and a caudal branch that entered the right kidney at the hilum. The supernumerary lower renal artery also took origin from the aorta and passed to supply the lower pole of the right kidney. Therefore, the lower pole of the right kidney received two arteries, but was not associated with a polar vein. The right kidney in addition to the normal right renal vein contained a supernumerary right renal vein. The vein was seen at the hilum and was the most posterior structure; passing behind the supernumerary lower renal artery to open into the posterior surface of the inferior vena cava. The anomalies described in the current observation present a unique pattern of congenital renal vascular abnormalities that may be of surgical importance.     

Unusual fibrous band on the left aspect of the aortic arch

During dissection of a 63-year-old female cadaver, a firm ribbon-like band was found on the left aspect of the aortic arch. Careful dissection showed that the band (6 cm long, 8 mm wide, 2 mm thick) connected the left superior intercostal vein with the accessory hemiazygos vein. Histological examination showed the fibrous structure of the band and showed the presence of a thread-like vascular lumen. The topography and venous connections of the band indicated its origin from persistence of the embryonic anastomosis between the left superior intercostal and accessory hemiazygos veins. This anastomosis derives from the rostral portion of the supracardinal vein that usually regresses on the left side but forms the terminal arch of the azygos vein on the right side. The severe atherosclerosis present in this patient at the level of the aortic arch may have enhanced the effects of arterial pressure on the adjacent venous anastomotic vessel causing reduction of blood flow and progressive fibrosis. The persistence of this venous anastomosis and its possible age-related fibrosis may have clinical relevance in central venous catheter placement.     

The left retro-aortic brachiocephalic vein: morphologic data and diagnostic ultrasound in 27 cases

A left retro-aortic brachiocephalic vein is a rare anatomic entity. A retrospective study was made of 5218 congenital cardiopathies treated between 1982 and 1998 in a medico-surgical department of paediatric cardiology. A left retro-aortic brachiocephalic vein was demonstrated in 27 patients, i.e. an incidence of 0.5%. The chief cardiopathy in these patients was a tetralogy of Fallot in 25 cases (93%). Among these 25 cases of Fallot’s tetralogy the aortic arch was rightsided in 19 cases (70%). The paraclinical diagnosis of this anomaly was facilitated by ultrasonography, provided it was sought for. In this series 6 cases (22%) were discovered during surgery without previous ultrasound diagnosis. The embryological origin of the left retro-aortic brachiocephalic v. differs from that of the venous trunk in its classical anatomic form. It derives from the inferior (but not superior) transverse plexuses, connecting the two anterior cardinal veins. One of the main consequences of this anomaly is its possible confusion with other vascular structures, particularly the right pulmonary artery. Such confusion may give rise to inappropriate surgical procedures. The differential diagnosis is facilitated by the use of the Doppler the venous flow is biphasic and regulated by respiration, whereas the Doppler recording from a pulmonary artery is that of a characteristic systolic arterial flow.     

Duplication of the inferior vena cava associated with other variations

Multiple vascular variations, including duplication of the inferior vena cava, double renal arteries and anomalies of the testicular blood vessels, were observed during dissection of the retroperitoneal region of a cadaver of an 87-year-old Japanese man. The right inferior vena cava arose from the union of right common iliac veins and a thinner interiliac vein. This interiliac vein ascended obliquely from right to left and joined the left common iliac veins to form the left inferior vena cava. The right and left inferior venae cavae were of approximately equal width. The right testicular vein consisted of medial and lateral venous trunks. The two venous trunks coalesced to form a single vein, which drained into the confluence of the right inferior vena cava and right renal vein. The left testicular vein was composed of the medial and lateral testicular veins, which drained into the left renal vein. Double renal arteries were seen bilaterally, which originated from the lateral aspects of the abdominal aorta. The right testicular artery arose from the right inferior renal artery and accompanied the lateral trunk of the right testicular vein running downwards. The left testicular artery arose from the ipsilateral inferior renal artery and ran downwards accompanied by the left lateral testicular vein. In addition, the bilateral kidneys showed multicystic changes.     

Multiple Vascular Anomalies with Double Gallbladder - A Case Report

While doing the routine dissection in NRS Medical College, Kolkata, we came across a cadaver (a male subject about 70 years old) who had multiple vascular anomalies along with double gallbladder. Among the vascular anomalies there were persistent left superior vena cava (PLSVC), left sided azygos vein ( draining into the PLSVC), left vertebral artery arising from the arch of aorta and the right gonadal vein draining into the right renal vein at a right angle. There were two gall bladders on the undersurface of the liver with two separate cystic ducts opening into the common bile duct. One of these two gallbladders was supplied by a cystic artery arising from the gastroduodenal artery and the other one was supplied by the cystic branch of the right hepatic artery. This study may enhance our knowledge in the field of Embryology and may help the clinicians to adopt an investigative (like coronary angiography) or surgical procedure.     

性腺静脉插管的应用解剖学

为了给临床提供性腺静脉、尤其是睾丸静脉插管的应用解剖学资料,在45具成尸上(男30、女15)对性腺静脉的回流部位、角度和外径等进行了详细观测(性别差异不显著)。     

Variations of the bilateral testicular veins: embryological and clinical considerations

Variations of the bilateral testicular veins were observed during routine dissection of the posterior abdominal wall in a 77-year-old male Japanese cadaver. The right testicular vein consisted of the lateral and medial testicular veins. The right lateral testicular vein drained into the right renal vein. The right medial testicular vein accompanied the right testicular artery to ascend obliquely and drained into the left aspect of the inferior vena cava. The left testicular vein was composed of the lateral, middle and medial testicular veins. Three left testicular veins accompanied the left testicular artery to course cranially and then finally drained into the left renal vein.     

Clinical implications of concomitant variations of the testicular, suprarenal and renal veins: A case report

Multiple venous anomalies have been observed during dissection of the posterior abdominal wall in a 65-year-old, white male cadaver. The left testicular and suprarenal veins united inferior to the superior mesenteric artery, coursed anterior to the abdominal aorta and drained into the inferior vena cava (IVC). Further the left renal vein coursed retroaortically and divided into three branches. The superior branch coursed on the vertebral column and drained into the azygos vein while middle and inferior branches drained into the IVC. The right renal vein was double and both drained into the IVC separately. Due to implications for numerous therapeutical and diagnostic procedures in the retroperitoneal region knowledge of these variations could be useful for clinicians in its recognition and protection.     

Experience in identifying the venous drainage of the adrenal gland during laparoscopic adrenalectomy

Laparoscopic adrenalectomy (LA) is the procedure of choice for most adrenal tumors. An important part of LA is the early identification and ligation of the adrenal veins. The venous drainage from each adrenal gland is usually via a single vein: the right vein draining into the inferior vena cava (IVC) and the left vein into the left renal vein. Although infrequent, variable venous drainage has been documented. The aim of the study was to clarify if LA identified venous drainage and its variants. Between January 1999 and January 2008, 142 consecutive patients underwent LA. Adrenal vein anatomy was documented on a prospective database. In total, 142 patients underwent 162 LA (right = 62, left = 66, bilateral = 17). All adrenal veins were identified at the time of laparoscopy. For 157 LA, the adrenal venous drainage was constant: right vein drained into the IVC and left vein drained into left renal vein. Five patients had adrenal vein variants: two right veins draining separately into IVC (n = 1), two right veins draining into the IVC and right renal vein (n = 1), and two left veins draining separately into the left renal vein (n = 3). Adrenal vein variants were present in patients with phaeochromocytomas (n = 4) or adrenocortical carcinoma (n = 1). The laparoscopic approach allowed an excellent view of the main adrenal venous anatomy. This has helped confirm the constant nature of the venous drainage and successfully identify variant adrenal veins.     

An anomalous case of paraportal circulation. A case of an abnormal, enlarged, communicating vein between the left gastric vein and a gastro-renal shunt

During dissection practice, an enlarged communicating vein between the portal and left renal vv. was found. This paraportal route seemed to be formed by the union of the left gastric v. and the cardioesophageal branch of the left inferior phrenic v. which opened into the left renal v.     

A double aortic arch with a deformed trachea accompanied by a subaortic left innominate vein.

During our dissection of a Japanese elderly female cadaver, a double aortic arch with a deformed trachea was found in the cadaver. The ascending aorta was bifurcated to form the left (anterior) and right (posterior) aortic arches. Encircling and compressing the trachea and esophagus, they confluenced into the descending aorta. We concluded that it was a case of the double aortic arch forming a vascular ring. In the vascular ring the trachea was deformed. In addition, the left innominate vein coursed under the aortic arches (subaortic left innominate vein, SLIV) and crossed the mediastinum posterior to the ascending aorta and anterior to the trachea.     

下肢股段主要静脉及其瓣膜的解剖及临床意义

目的通过对103侧成人尸体下肢股段主要静脉及其瓣膜的观测,为临床血管疾病的外科及介入诊疗提供形态学依据。方法在103侧成人尸体下肢股段中观测主要静脉瓣膜的数量及形状、静脉特别点外径、静脉特别点的体表位置。结果大隐静脉股段瓣膜均为双瓣型,隐股点处外径(真径)为(5.18±1.25)mm,隐股点至腹股沟韧带的距离为(3.92±0.71)cm;股浅静脉第一对瓣膜多为双瓣型,瓣膜附着缘静脉外径(压扁径)为(1.06±0.17)cm,其位置较恒定,距股深静脉入口下缘(1.16±0.66)cm,到隐股点距离为(6.16±1.69)cm;股深静脉注入点下缘至隐股点下缘的距离为(5.00±1.57)cm,至腹股沟韧带的距离为(7.84±1.89)cm。结论以上观测结果为临床血管外科手术及介入治疗提供解剖学基础。     

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.     

Anomalous subaortic left brachiocephalic vein in surgical cases and literature review

Anomalous subaortic left brachiocephalic vein (ASLBV) is a rare systemic venous anomaly. We review our experience with patients associated with ASLBV who underwent cardiac surgery at three institutions. From 1989 to 2009, the medical records of surgically treated patients with ASLBV were analyzed; the incidence of ASLBV, clinical characteristics, and associated anatomical findings were assessed. Fifteen patients had ASLBV. All ASLBVs coursed left lateral to the aortic arch, passed under the ascending aorta anterior to the central pulmonary artery, and joined the right brachiocephalic vein. Fourteen patients had congenital heart disease (CHD), and the remaining patient did not have cardiac anomalies. Its incidence was 0.57% (14 of 2,449) in patients with CHD and only 0.02% (1 of 4,805) in patients without CHD. In patients with CHD, 73.3% (11 of 15) of the patients had conotruncal cardiac anomalies such as tetralogy of Fallot, ventricular septal defect with pulmonary atresia, truncus arteriosus, and interruption of the aortic arch. Eight patients had aortic arch anomalies, including right aortic arch and cervical aortic arch. The deletion of chromosomal 22q11.2 was confirmed in two patients, and one patient was diagnosed with DiGeorge syndrome. ASLBV was clinically silent even without any surgical intervention. ASLBV is a very rare anomaly and is highly associated with conotruncal cardiac anomalies and aortic arch anomalies, including right aortic arch and cervical aortic arch. Preoperative diagnosis is important when any surgical interventions are intended, especially, in patients with conotruncal cardiac anomalies. Clin. Anat. 23:950–955, 2010. © 2010 Wiley‐Liss, Inc.     

Multiple vascular variations at the vicinity of the left kidney

Although isolated variations of the renal artery, renal vein and testicular artery are commonly described in the literature, the concurrent presence of variations in all three of these vessels has seldom been reported. Here, we report concurrent vascular variations in the vicinity of the left kidney. The left renal vein was found to have a retropelvic tributary, and a communicating vein connecting the inferior vena cava and retropelvic tributary was also noted. In addition, the left renal artery separated into anterior and posterior divisions just before reaching the hilum. The anterior division further divided into two segmental branches which had a peculiar ‘ram horn’ shape. The posterior division of the renal artery entered the substance of the kidney without forming any further branches. The left testicular artery arose from the aorta above the level of the renal artery and then passed in front of left renal vessels following a tortuous course. The anatomical knowledge of this unusual vascular pattern may be useful during renal vascular reconstruction, treatment of renal artery stenosis, endoscopic surgeries and clinical evaluation of renovascular hypertension.     

新生儿左肾上腺静脉动脉化异体移植的外科解剖

在47具新生儿左肾上腺及有关静脉系统的解剖观测基础上,着重探讨了新生儿左肾上腺静脉动脉化导体移植的可行性。为解决新生儿左肾上腺静脉细小的问题,本文提出将在肾上腺、肾上腺静脉及肾静脉整块取出,在肾门处结扎切断左肾静脉,利用左肾静脉根部与受者的动脉吻合。     

髂总静脉汇合点的形态特点及其临床意义

目的：观察髂总静脉汇合点（CCIV）及其周围结构与腰椎椎间盘的位置关系，为腹腔镜前路腰椎间盘入路的选择提供血管解剖依据。方法：对36具成人防腐固定标本进行血管解剖观察与测量，并分析各测量值在性别、年龄间的差异。结果：CCIV的平均高度为（2．02±1．42）cm，其夹角为（77．08±20．98）°，其高度越大，夹角越小。左髂静脉较恒定的位于髂间三角左侧内面；左髂总静脉（LCIV）比右髂总静脉更斜行地汇入下腔静脉。各测量数据在性别间差异无统计学意义（P〉0．05）。结论：CCIV变异较大，LCIV较恒定的位于髂间三角左侧内面。腹腔镜腰椎间盘手术时应注意两者的特点，并应用现有技术手段进行术前评估，可以降低手术风险。     

非血栓性髂静脉狭窄支架成形术对深静脉瓣膜功能的影响

目的 探讨髂静脉支架成形术对非血栓性髂静脉压迫病变（NIVCL）患者深静脉瓣膜功能的影响。方法 收集2015年 4月~2018年4月我院血管外科22例行髂静脉支架成形术治疗的NIVCL合并下肢深静脉瓣膜反流患者的临床资料及随访结果,其中21例左侧髂静脉狭窄,1例右侧髂静脉狭窄,比较患者手术前后深静脉瓣膜反流持续时间（VCT）及静脉疾病严重程度评分（VCSS）。结果 22例患者手术均成功,成功率100.00%,术后无支架闭塞、下肢感染和深静脉血栓形成等严重并发症。术后3个月随访时,一期支架通畅率100