经皮腘静脉插管的临床应用解剖学研究

目的 :研究分析静脉的基础解剖及影像学表现 ,提高静脉穿刺插管的准确性和成功率。方法 :对 3例尸体标本、35例 (支 )顺行性下肢静脉造影片、5例膝部CT/MRI片及 8例经皮静脉穿刺插管病例等基础、临床及影像学资料进行分析、总结 ,观察窝局部解剖结构、静脉与动脉及神经毗邻关系、静脉血管管径、走行路径、与膝关节的关系等。结果 :窝呈菱形 ,浅层结构有皮肤及浅筋膜 ,深层有深筋膜 (筋膜 )。静脉与动脉伴行 ,共同包于一个血管鞘中 ,静脉居动脉与胫神经之间。动脉位于静脉前方 (3例 )或前内侧 (2例 ) ,二者部分重叠。静脉直径 9～ 15mm ,于膝关节两髁间垂直上升 5 0～ 70mm后向内上斜行 ,侧位见与股骨后缘贴近上行 ,距皮肤深度 4 0～ 70mm。上述表现均随性别、年龄及疾病等而有所不同。静脉穿刺点位于窝正中线与皮肤皱褶交点外侧 5～ 10mm处。结论 :熟悉局部解剖、掌握正确的穿刺技术有助于提高插管的成功率 ,减少动静脉瘘等并发症的发生。经皮静脉插管在静脉系统疾病的介入性诊断和治疗中具有重要意义。

Clinical and Anatomic Study of Percutaneous Transpopliteal Vein Intubatton

Objective: To improve the accurate site and successful rate of popliteal vein puncture by analyzing anatomic structure and imaging findings. Methods: The popliteal fossa anatomy, the anatomic relationship among the popliteal vein, artery, nerve and knee, and the diameter of popliteal vein were analyzed through 3 cases cadaveric specimens, 35 cases (35 extremities) ascending venography of lower limbs, 5 cases CT/MRI scans of knee and 8 cases transcatheter venography of popliteal. Results: The popliteal fossa was rhombus and made up of the shallow struction and deep struction. The popliteal vessels were enclosed in a common sheath and the vein was located between the artery and nerve. There were 3 cases that the popliteal arteries were anterior to the veins and 2 cases that were anteromedial to the veins, and both superimposed each other partly. The diameter of the popliteal vein was about 9～15 mm. The above findings varied with the gender, age and disease. The skin incision of popliteal vein puncture was located exterior 5～10 mm to the center between the popliteal fossa and skin crease. Conclusion: Being familiar with part anatomise, and mastering the technique for puncture and intubatton of the popliteal vein would be beneficial to increase susscessful rate and decrease arteriovenous fistula. It is an important way to diagnose and treat interventionally veinous diseases by percutaneous transpopliteal vein intubatton.