腹腔镜腰交感神经节切除术的解剖学基础

目的 研究腰交感神经的局部解剖关系,为临床开展腹腔镜腰交感神经节切除术(VALLS)提供解剖学资料.方法 观察总结128侧成尸的腰部交感神经及其毗邻结构的解剖关系;回顾性分析13例VALLS.结果 (1)腰交感神经节数目每侧1～6个不等,以3～4个最多见,位置、形态变异较大;(2) 128侧中有12例发现腰交感干节间支分裂,占9.38%;(3)腰动脉均位于神经干的深面,腰静脉多位于腰交感干浅面,占68.42%±4.35%;(4)生殖股神经穿出腰大肌平面,多数与L2～L4椎体或椎间盘对齐,穿出点距腰大肌内侧缘0.81±0.48cm;(5)输尿管髂血管交界处距腰大肌外缘距离:左侧为3.36±0.59cm,右侧为3.41±0.59cm.(6)13例VALLS手术时间2～3.5h,术中出血50～80ml,术中术后未出现严重并发症,手术效果良好.结论 腰交感神经变异较大,毗邻结构关系复杂;腹腔镜腰交感神经节切除术成功的关键是掌握良好的腹腔镜操作技巧,熟悉腰交感神经的局部解剖关系,术中认真仔细的操作.

Anatomic study of lumbar sympathetic nerve for endoscopic lumbar sympathectomy

Objective To study systematically regional anatomy of lumbar sympathetic trunk to provide anatomic information for endoscopic lumbar sympathectomy (VALLS). Method The anatomy of the lumbar sympathetic trunk and its relationship with neighboring structures were studied in 128 sides of adult cadavers, and it was substantiate in 13 cases of endoscopic lumbar sympathectomy. Results (1) The location, shape and number of the sympathetic ganglia were quite variable. The number varied from 1 to 6 on one side. (2) It was found that the lumbar sympathetic trunk split into 2-3 branches at the distal portion. (3) Lumbar arteries were all located under the lumbar sympathetic trunk and the lumbar veins situated superior to the trunk in 68.42%±4.35% of instance. (4) Genitofemoral nerve was found to pierce the psoas muscle at the level of 2nd to 4th vertebra or its intervertebral discs. It was only 0.81±0.48 cm away from the medial rim of the psoas muscle. (5) Distance between ureter- iliac vessel junction and the lateral edge of the psoas muscle was 3.36±0.59 cm on the left side, and 3.41±0.59 cm on the right side. (6) A report of the experience of our 13 VALLS was presented. Conclusions Because of great variation and complicated anatomic relation between lumbar sympathetic trunk with its neighboring structures, familiarity to the anatomy of the retroperitoneal space is cracial for a successful minimal invasive laparoscopic lumbar sympathectomy.