腹腔镜下腹腔神经节阻滞术的临床解剖

目的:为腹腔镜引导下腹腔神经节阻滞术提供解剖学基础。方法:解剖人体标本腹腔神经节,观测腹腔神经节的形态、各径及其周围的标志性结构以及神经节与周围毗邻结构的位置关系;探究左、右侧腹腔神经节在以腹腔干中心点建立的三维直角坐标系中的位置(X,Y,Z)。结果:左侧腹腔神经节上下径1.73 cm、左右径1.75 cm、前后径0.38 cm;至贲门右缘4.04 cm、幽门上缘5.79 cm、角切迹上缘3.85 cm、胰上缘1.67 cm、脾静脉上缘1.64 cm;三维直角坐标系坐标为(1.35,-0.03,1.19)cm,易在脾动脉后方附近找到。右侧腹腔神经节上下径1.30 cm、左右径1.52 cm、前后径0.27 cm;至贲门右缘5.48 cm、幽门上缘5.68 cm、角切迹上缘4.90 cm、胰上缘3.04 cm、脾静脉上缘2.41 cm、距肝门静脉内侧缘1.81 cm、距下腔静脉内侧缘1.00 cm;三维直角坐标系坐标为(1.38,0.10,0.99)cm,易在肝总动脉后方附近找到。结论:腹腔镜直视下阻滞左、右侧腹腔神经节,应分别以腹腔干两侧脾动脉和肝总动脉后方为标志寻找。手术时注意保护神经节周围毗邻脏器,防止损伤重要血管和神经。

Clinical anatomy of laparoscopic neurolytic celiac ganglion block

Objective:To provide anatomical basis for the application of laparoscopic neurolytic celiac ganglion block (LCGB). Methods:Morphology and length (superoinferior diameter),width (left-right diameter)and thickness (anteroposterior diameter)of bilateral celiac ganglia and their adjacent anatomic structures were observed and measured during dissection of abdominal ganglions in cadaveric specimens.In addition,we had established a celiac axis-centered three-dimensional cartesian coordinate system,based on which,position of celiac ganglion in the coordinate system was measured and calculated.Results:The superoinferior diameter,left-right diameter and anteroposterior diameter of left celiac ganglion were 1 .73 cm,1 .75 cm and 0.38 cm respectively.The distance between the left celiac ganglion and the cardia,pylorus,angle notch,pancreatic head and splenic vein was 4.04 cm,5.79 cm,3.85 cm,1.67 cm and 1.64 cm respectively.The superoinferior diameter,left-right diameter and anteroposterior diameter of right celiac ganglion were 1.30 cm,1.52 cm and 0.27 cm respectively.The distance between the right celiac ganglion and cardia,pylorus,angle notch,pancreatic head,splenic vein,hepatic portal vein and inferior vena cava was 5.48 cm,5.68 cm,4.90 cm,3.04 cm,2.41 cm,1.81 cm and 1.00 cm respectively.In the celiac axis-centered three-dimensional Cartesian coordinate system,the position of left celiac ganglion and right celiac ganglion was (1.35,-0.03,1.19)cm and (1.38,0.10,0.99)cm respectively.The splenic artery and common hepatic artery on both sides of celiac trunk were used to identify the left and right ganglia respectively.Conclusion:Taking splenic artery and common hepatic artery as landmarks to locate the left and right celiac ganglion respectively will be beneficial for dealing with LCGB.Protecting the adj acent anatomic structures around celiac ganglion and avoiding the damage to considerable vessels and nerves are important during the operation.