应用腹腔镜行下腰椎手术的入路选择

目的观察下腰椎各椎间隙节段前方和侧前方毗邻的血管结构,测量各节段手术空间的大小,为应用腹腔镜行下腰椎手术选择合适的入路提供依据。方法解剖15具成人尸体标本（男9例,女6例）,记录下腰椎各椎间隙节段前方和侧前方毗邻的主要血管解剖学参数,并计算出相应的结果。结果 L3～4、L4～5节段前方为腹主动脉及其分支或下腔静脉及其属支,经过分离及牵拉大血管后仍无法满意显露L3～4、L4～5椎间隙;L3～4、L4～5节段左右侧前方各有一无血管神经分布的矩形区域,可以满足腰椎侧前方的手术操作。L5～S1椎间隙位于左髂总静脉与右髂总动脉所形成的＂∧＂形区域内,该区域可以满足手术需要的空间;L5～S1椎间隙侧前方由于大血管的分布和髂嵴的遮挡,不利于手术空间的显露。结论应用腹腔镜行下腰椎手术是可行的,L3～4、L4～5节段经腹膜后途径通过左右侧前方的无血管神经分布的区域可以进行手术的操作;L5～S1椎间隙经腹腔通过椎体前方途径可以满意显露手术空间。

An anatomy study of operative approach of laparoscopic lower lumbar spine Surgery

Objective To study the anatomic characteristics of blood vessels situated at the lower lumbar spine and to provide anatomic data for laparoseopie lumbar surgery. Methods 15 formal dehyde-preserved cadavers were studied with special attention to the blood vessels of lower lumbar, and the anatomic data were recorded and calculated. Re- sults Abdominal aorta and its branches or inferior vena cava and its tributaries situated in front of L3 -4 disc and L4 -5 disc. It was difficult to expose the L3 -4 disc and L4_5 disc by distracting Large vessels. But there were enough area for operation from anterolateral of L3 -4 disc and L4 -5 disc. Also, it was satisfactory to expose L5 - S1 disc from the area of ＂ A ＂between left common lilac vein and fight common iliae artery. Conclusions It is feasible for lower lumbar spine surgery under laparoscope. It is better to reveal L3-4 disc and L4-5 disc through the retroperitoneal cavity and to reveal the L5 - S1 disc by peritoneal approach.