本文關鍵詞：髂腰靜脈和腰升靜脈的解剖結(jié)構(gòu)特點及其臨床意義　出處：《廣西醫(yī)科大學》2008年碩士論文　論文類型：學位論文

  更多相關文章： 髂腰靜脈 腰升靜脈 閉孔神經(jīng) 腰骶干 解剖

【摘要】： 目的:探討腰骶段靜脈的解剖結(jié)構(gòu)特點,為臨床腰骶段前路手術(shù)提供解剖學依據(jù)。 方法:對20具甲醛固定的成人尸體標本(男17具,女3具)的雙側(cè)髂腰靜脈(iliolumbar vein)和腰升靜脈(ascending lumbar vein)進行解剖。觀察髂腰靜脈,腰升靜脈的引流特點和匯入髂血管的位置,并進行解剖結(jié)構(gòu)分型。測量髂腰靜脈和腰升靜脈開口處的直徑與主干的長度;測量它們到髂總靜脈匯合點和到L5椎體下位終板的距離以及分清它們與腰骶干(lumbosacral trunk)、閉孔神經(jīng)(obturator nerve)、髂腰動脈的關系。向內(nèi)側(cè)牽拉下腔靜脈和髂總動靜脈至暴露L4到S1椎體,以此來明確髂腰靜脈和腰升靜脈是否有撕脫的危險。 結(jié)果:20具尸體標本的雙側(cè)均存在髂腰靜脈,但有5側(cè)沒有發(fā)現(xiàn)腰升靜脈。髂腰靜脈和腰升靜脈的主干及其分支引流著髂肌、腰大肌和第五腰椎椎體的血供。在我們的研究中發(fā)現(xiàn)髂腰靜脈有11種引流方式,腰升靜脈有5種引流方式。髂腰靜脈主干的平均長度是7.89±3.30mm,開口處的平均直徑是4.95±1.08mm。髂腰靜脈到髂總靜脈匯合點的平均距離是49.1±14.93mm,到L5椎體下位終板的平均距離是13.94±6.94mm。腰升靜脈主干的平均長度是12.94±5.89mm,開口處的平均直徑是5.20±2.69mm。腰升靜脈到髂總靜脈匯合點的平均距離是43.98±10.77mm,到L5椎體下位終板的平均距離是15.60±8.28mm。在所有的標本中閉孔神經(jīng)都是走行于髂腰靜脈和腰升靜脈的淺外側(cè)。35側(cè)標本中有26側(cè)的腰骶干位于腰升靜脈的外側(cè),其余9側(cè)位于腰升靜脈的深部。40束腰骶干中有29束是在髂腰靜脈深面下行,有8束是在其淺面下行,余下的3束腰骶干分淺深兩支夾住髂腰靜脈下行,這是以前的研究沒有報道過的。 結(jié)論:髂腰靜脈和腰升靜脈分布在L5椎體的側(cè)方,引流L5椎體的血供,實際上相當于第五腰椎的節(jié)段血管。因為它們與閉孔神經(jīng)和腰骶干關系密切而且解剖學變異非常大,所以在行前路手術(shù)處理腰骶段各類脊柱問題時,應該仔細解剖并結(jié)扎髂腰靜脈和腰升靜脈,以避免損傷大血管和神經(jīng)而引起嚴重的并發(fā)癥。我們不主張電凝髂腰靜脈和腰升靜脈,因為電凝容易損傷它們周圍的腰叢神經(jīng)。
[Abstract]:Objective: to study the anatomical characteristics of lumbosacral vein and provide anatomic basis for clinical lumbosacral anterior approach. Methods: 20 formaldehyde-fixed adult cadavers (17 males) were studied. The iliolumbar vein of bilateral iliolumbar vein and ascending lumbar vein of 3 females were dissected. The iliolumbar vein was observed. The drainage characteristics of the ascending lumbar vein and the location of the iliac vessels were analyzed and the anatomical types were carried out. The diameter and length of the opening of the iliolumbar vein and the ascending lumbar vein were measured. Their distance to the convergent point of common iliac vein and to the L5 vertebra inferior endplate and to distinguish them from lumbosacral trunk were measured. Obturator nerveau, the relationship between iliolumbar artery and inferior vena cava (IVC) and common iliac artery (CAV) to the exposed L4 to S1 vertebrae. This is used to determine whether the iliolumbar vein and the ascending lumbar vein are at risk of avulsion. Results the iliolumbar veins were found in both sides of 20 cadavers, but no ascending veins were found in 5 sides. Iliac muscles were drained from the trunk and branches of iliolumbar veins and ascending lumbar veins. The blood supply of the psoas major muscle and 5th lumbar vertebrae. In our study, 11 drainage methods were found in the iliolumbar vein. The average length of iliolumbar vein trunk was 7.89 鹵3.30mm. The mean diameter of opening was 4.95 鹵1.08mm. the average distance between iliolumbar vein and common iliac vein was 49.1 鹵14.93 mm. The average distance to L5 lower end plate was 13.94 鹵6.94mm. the average length of lumbar ascending vein trunk was 12.94 鹵5.89mm. The mean diameter of the opening was 5.20 鹵2.69 mm. the average distance between the ascending lumbar vein and the common iliac vein was 43.98 鹵10.77 mm. The average distance to the lower end plate of the L5 vertebra is 15.60 鹵8.28 mm. in all the specimens, the obturator nerve is located on the superficial lateral side of the iliolumbar vein and the ascending lumbar vein. There are 26 sides of the waist. The sacral trunk is located on the lateral side of the ascending lumbar vein. The other 9 were located in the deep. 40 lumbosacral trunk of ascending lumbar vein, 29 of them were descending on the deep side of iliolumbar vein, 8 of them were descending on the superficial side. The remaining 3 cases of lumbosacral trunk were divided into shallow and deep branches and two branches were clamping the iliolumbar vein. This has not been reported in previous studies. Conclusion: iliolumbar vein and ascending lumbar vein are distributed in the lateral side of L5 vertebra and drain blood supply of L5 vertebra. They are actually equivalent to 5th lumbar vertebrae. Because they are closely related to obturator nerve and lumbosacral trunk and have great anatomical variation, they are used to deal with all kinds of spinal problems in lumbosacral segment by anterior approach. The iliolumbar vein and the ascending iliolumbar vein should be carefully dissected and ligated to avoid serious complications resulting from the injury of the large vessels and nerves. We do not advocate electrocoagulation of the iliolumbar vein and the ascending iliolumbar vein. Because electrocoagulation can easily damage the lumbar plexus around them.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2008
【分類號】：R687;R322

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