后入路顯露右腎外動(dòng)脈主干的一級(jí)分支和腹側(cè)二級(jí)分支處的相關(guān)解剖研究
發(fā)布時(shí)間：2019-05-21 14:56
【摘要】： 目的: 通過(guò)觀察測(cè)量右腎外動(dòng)脈一級(jí)分支處與腎門(mén)和下腔靜脈之間距離的解剖、右腎腹側(cè)支二級(jí)分支處與腎門(mén)的關(guān)系,探討后入路顯露右腎外動(dòng)脈主干的可行性及注意事項(xiàng)。 材料與方法: 1.解剖標(biāo)本來(lái)源與觀測(cè)指標(biāo) 選取經(jīng)常規(guī)防腐處理的成年尸體解剖教學(xué)標(biāo)本30具(男性27具,女性3具)全部標(biāo)本由昆明醫(yī)學(xué)院解剖教研室提供,腹部各個(gè)臟器按常規(guī)解剖都已暴露(全部標(biāo)本為解剖教研室制成的解剖教學(xué)標(biāo)本和為外院制作的解剖教學(xué)標(biāo)本)標(biāo)本右腎外血管無(wú)破壞、下腔靜脈無(wú)破壞、后腹膜右側(cè)腎臟位置未變動(dòng)納入本研究對(duì)象。觀測(cè)指標(biāo):1)觀察每具標(biāo)本的右腎動(dòng)脈的支數(shù)、副腎動(dòng)脈的存在與否。2)一級(jí)分支處分別距下腔靜脈、腎門(mén)的距離、腎門(mén)到下腔靜脈距離之間的腎動(dòng)脈的長(zhǎng)度。3)一級(jí)分支處在下腔靜脈右側(cè)緣內(nèi)和外—0.5cm、＞0.5 cm區(qū)段例數(shù)和比例。4)腹側(cè)支二級(jí)分支處與腎門(mén)的關(guān)系。 2.DSA動(dòng)脈造影資料來(lái)源與觀測(cè)指標(biāo) 收集2003年—2007年昆明醫(yī)學(xué)院附屬二院介入DSA造影室提供的臨床右腎動(dòng)脈血管造影的影像資料(男性21例、女性9例),所有研究對(duì)象均為或懷疑腎臟、腎動(dòng)脈或腎上腺疾病而行腎動(dòng)脈造影。術(shù)后DSA動(dòng)脈造影診斷:右腎癌5例(病變未侵及右腎外動(dòng)脈)、右腎炎性病變1例、右腎上腺病變3例、右腎動(dòng)脈狹窄2例;左腎病癌3例、左腎動(dòng)脈狹窄2例、左腎萎縮2例、左腎上腺病變2例,左腎病變的病例同時(shí)行右腎外動(dòng)脈主干顯像;術(shù)前診斷動(dòng)脈狹窄術(shù)后未見(jiàn)雙腎動(dòng)脈異常10例。觀測(cè)指標(biāo):1)觀測(cè)右腎動(dòng)脈的支數(shù)、副腎動(dòng)脈的存在與否;2)右腎動(dòng)脈一級(jí)分支與腎門(mén)和下腔靜脈的關(guān)系即:一級(jí)分支處在下腔靜脈右側(cè)緣的內(nèi)或外;一級(jí)分支處在腎門(mén)的內(nèi)或外。3)腹側(cè)支二級(jí)分支處在腎門(mén)內(nèi)或外。 結(jié)果: 1.解剖標(biāo)本觀測(cè)結(jié)果 1)右腎動(dòng)脈支數(shù)1支型28具尸體(93.3%)、2支型2具尸體(6.7%)。副腎動(dòng)脈出現(xiàn)的尸體有4具(13.3%),副腎動(dòng)脈均進(jìn)入腎上極。2) 20例右腎動(dòng)脈一級(jí)分支處位于下腔靜脈右側(cè)緣外距腎門(mén)的距離為2.4±0.11 cm、距下腔靜脈距離為0.7+0.59;20例右腎動(dòng)脈一級(jí)分支處位于下腔靜脈右側(cè)緣外的腎門(mén)到下腔靜脈距離之間腎動(dòng)脈長(zhǎng)度為2.7±0.74。10例右腎動(dòng)脈一級(jí)分支處位于下腔靜脈后段距下腔靜脈右側(cè)緣的距離為-0.7±0.41cm;10例右腎動(dòng)脈一級(jí)分支處位于下腔靜脈后段,下腔靜脈到腎門(mén)之間腎動(dòng)脈的長(zhǎng)度為2.2±0.24。3)右腎動(dòng)脈一級(jí)分支處位于下腔靜脈右側(cè)緣外的有20例(66.7%):右側(cè)緣外到0.5cm段13例(43.3%)、＞0.5cm段7例(23.3%):右腎動(dòng)脈一級(jí)分支處位于下腔靜脈右側(cè)緣內(nèi)的有10例(33.3%)(包括兩只型動(dòng)脈的解剖標(biāo)本)。4)腹側(cè)支二級(jí)分支處在腎門(mén)內(nèi)10例(33.3%);腹側(cè)支二級(jí)分支處在腎門(mén)外20例(66.7%)。 2.DSA動(dòng)脈造影觀測(cè)結(jié)果 1) DSA動(dòng)脈造影資料1支動(dòng)脈型30例:存在副腎動(dòng)脈有5例(16.7%),副腎動(dòng)脈均進(jìn)入腎上極。2)腎動(dòng)脈一級(jí)分支處在各段間例數(shù)和比例為:一級(jí)分支部位在腎門(mén)內(nèi)側(cè)9例(30.0%);腎門(mén)到腔靜脈段15例(50.0%);下腔靜脈右側(cè)緣內(nèi)6例(20.0%)。3)腹側(cè)支二級(jí)分支處在腎門(mén)內(nèi)12例(40.0%);腹側(cè)支二級(jí)分支處在腎門(mén)外18例(60.0%)。 結(jié)論: 1.右側(cè)下腔靜脈外可顯露2/3研究對(duì)象腎動(dòng)脈主干,越靠近腎門(mén)則越易顯露腎動(dòng)脈段支而不易顯露腎動(dòng)脈主干。 2.13.3%--16.6%腎上極存在副腎動(dòng)脈當(dāng)分離腎上極時(shí),應(yīng)高度警惕,避免損傷。 3.當(dāng)一級(jí)分支處位于下腔靜脈后或太接近下腔靜脈,前后入路結(jié)合分離前、后支是更合理的選擇。
[Abstract]:Purpose: The feasibility and attention of the posterior approach to the main trunk of the right kidney were discussed by observing the anatomy of the distance between the primary branch of the right kidney and the inferior vena cava, the relationship between the secondary branch of the right and the ventral branch and the renal hilum. (b) Matters. Materials and Methods:1. Anatomy 30 (27 male and 3 female) specimens of adult cadaveric anatomy were selected from the source of specimen and the observation index. The anatomic teaching and research room of the Ming Medical College is provided. Each organ of the abdomen has been exposed according to the routine anatomy (all the specimens are the anatomical teaching specimen made of the anatomical study chamber and the anatomic teaching specimen made for the external hospital). The right kidney external blood vessel is not damaged, the inferior vena cava is not damaged, and the right kidney position on the right side of the retroperitoneum No change was included in the study object. Observation index:1) The number of right renal artery and the presence or absence of the secondary renal artery were observed for each specimen. The distance from the inferior vena cava, the renal gate, the length of the renal artery between the renal gate and the inferior vena cava.3) The primary branch is located in the right margin of the inferior vena cava and the outer diameter of 0.5 cm, the number and the proportion of the 0.5 cm section, and 4) the ventral branch The relationship between the secondary branch and the kidney. The image data of the clinical right renal artery angiography (n = 21, female) provided by the interventional DSA in the second hospital of Kunming Medical College in 2003 and 2007 were collected from the data source and the observation index of the SA arteriography. 9), all study subjects were or suspected of the kidney There were 5 cases of right renal cell carcinoma (non-invasion of right and right renal artery),1 case of right nephritis,3 cases of right adrenal lesion,2 cases of right renal artery stenosis,3 cases of left renal disease and 2 cases of left renal artery stenosis. 2 cases of left renal atrophy,2 cases of left adrenal gland,2 cases of left renal disease, and right renal artery trunk imaging at the same time; pre-operative diagnosis No 10 cases of double renal artery were found in the operation of the artery stenosis. The observation index:1) The number of the right renal artery and the presence or absence of the secondary renal artery were observed;2) The relationship between the branch of the right renal artery and the renal and inferior vena cava was as follows: The internal or external of the right margin of the inferior vena cava; the primary branch is in or out of the kidney. .3) The secondary branch of the ventral branch is in the kidney Inside or outside of the door. Results:1.1) Right renal artery count 1 supported by the anatomical specimen (1) 28 cadavers (93.3%) and 2 cadavers (6.7%). The body of the secondary renal artery was 4 (13.3%) and the secondary renal arteries were all in the suprarenal pole.2) The distance between the right margin of the right renal artery and the right edge of the inferior vena cava was 2. .4-11cm, the distance from the inferior vena cava was 0.7 + 0.59; the length of the renal artery located outside the right edge of the inferior vena cava to the inferior vena cava at the first-stage branch of the right renal artery was 2.7-0.74.10, and the branch of the right renal artery was located in the lower cavity. The distance of the posterior segment from the right margin of the inferior vena cava was-0.7 to 0.41 cm;10 cases of the right renal artery were located at the posterior segment of the inferior vena cava, the length of the renal artery between the inferior vena cava and the renal gate was 2.2 (0.24.3), and there were 20 cases (66 .7%):13 (43.3%),> 0.5 cm,7 (23.3%) in the right margin to 0.5 cm,10 (33.3%) in the right margin of the inferior vena cava at the right renal artery (33.3%) (including the anatomy of the two arteries) ).4) The secondary branch of the ventral branch was located in 10 (33) cases of the inside of the kidney. 3%); the secondary branch of the ventral branch 20 cases (66.7%) of the outside of the kidney (66.7%).2. DSA arteriography (1) DSA arteriography (1) DSA arteriography (30 cases): there were 5 cases (16.7%) of the secondary renal artery, and the subrenal artery both entered the suprarenal pole. (2) The branch of the renal artery The number and proportion in each segment were:9 (30.0%) of the first-grade branch in the inside of the kidney-door;15 (50.0%) of the kidney-door to the vena cava;6 (20.0%) in the right margin of the inferior vena cava; and 3) the secondary branch of the ventral branch was in the renal door 1. 2 ( Conclusion:1. The right inferior vena cava can be exposed. 2/3 The main artery of the renal artery of the study object, the closer to the renal gate, the more easily the renal artery segment is exposed, and the renal artery trunk is not easy to be exposed. 2.13.3%--16.6% of the upper and lower renal arteries of the kidney, when separating the upper pole of the kidney, should be highly alert to avoid injury.
【學(xué)位授予單位】：昆明醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類(lèi)號(hào)】：R699;R322
本文編號(hào)：2482177
[Abstract]:Purpose: The feasibility and attention of the posterior approach to the main trunk of the right kidney were discussed by observing the anatomy of the distance between the primary branch of the right kidney and the inferior vena cava, the relationship between the secondary branch of the right and the ventral branch and the renal hilum. (b) Matters. Materials and Methods:1. Anatomy 30 (27 male and 3 female) specimens of adult cadaveric anatomy were selected from the source of specimen and the observation index. The anatomic teaching and research room of the Ming Medical College is provided. Each organ of the abdomen has been exposed according to the routine anatomy (all the specimens are the anatomical teaching specimen made of the anatomical study chamber and the anatomic teaching specimen made for the external hospital). The right kidney external blood vessel is not damaged, the inferior vena cava is not damaged, and the right kidney position on the right side of the retroperitoneum No change was included in the study object. Observation index:1) The number of right renal artery and the presence or absence of the secondary renal artery were observed for each specimen. The distance from the inferior vena cava, the renal gate, the length of the renal artery between the renal gate and the inferior vena cava.3) The primary branch is located in the right margin of the inferior vena cava and the outer diameter of 0.5 cm, the number and the proportion of the 0.5 cm section, and 4) the ventral branch The relationship between the secondary branch and the kidney. The image data of the clinical right renal artery angiography (n = 21, female) provided by the interventional DSA in the second hospital of Kunming Medical College in 2003 and 2007 were collected from the data source and the observation index of the SA arteriography. 9), all study subjects were or suspected of the kidney There were 5 cases of right renal cell carcinoma (non-invasion of right and right renal artery),1 case of right nephritis,3 cases of right adrenal lesion,2 cases of right renal artery stenosis,3 cases of left renal disease and 2 cases of left renal artery stenosis. 2 cases of left renal atrophy,2 cases of left adrenal gland,2 cases of left renal disease, and right renal artery trunk imaging at the same time; pre-operative diagnosis No 10 cases of double renal artery were found in the operation of the artery stenosis. The observation index:1) The number of the right renal artery and the presence or absence of the secondary renal artery were observed;2) The relationship between the branch of the right renal artery and the renal and inferior vena cava was as follows: The internal or external of the right margin of the inferior vena cava; the primary branch is in or out of the kidney. .3) The secondary branch of the ventral branch is in the kidney Inside or outside of the door. Results:1.1) Right renal artery count 1 supported by the anatomical specimen (1) 28 cadavers (93.3%) and 2 cadavers (6.7%). The body of the secondary renal artery was 4 (13.3%) and the secondary renal arteries were all in the suprarenal pole.2) The distance between the right margin of the right renal artery and the right edge of the inferior vena cava was 2. .4-11cm, the distance from the inferior vena cava was 0.7 + 0.59; the length of the renal artery located outside the right edge of the inferior vena cava to the inferior vena cava at the first-stage branch of the right renal artery was 2.7-0.74.10, and the branch of the right renal artery was located in the lower cavity. The distance of the posterior segment from the right margin of the inferior vena cava was-0.7 to 0.41 cm;10 cases of the right renal artery were located at the posterior segment of the inferior vena cava, the length of the renal artery between the inferior vena cava and the renal gate was 2.2 (0.24.3), and there were 20 cases (66 .7%):13 (43.3%),> 0.5 cm,7 (23.3%) in the right margin to 0.5 cm,10 (33.3%) in the right margin of the inferior vena cava at the right renal artery (33.3%) (including the anatomy of the two arteries) ).4) The secondary branch of the ventral branch was located in 10 (33) cases of the inside of the kidney. 3%); the secondary branch of the ventral branch 20 cases (66.7%) of the outside of the kidney (66.7%).2. DSA arteriography (1) DSA arteriography (1) DSA arteriography (30 cases): there were 5 cases (16.7%) of the secondary renal artery, and the subrenal artery both entered the suprarenal pole. (2) The branch of the renal artery The number and proportion in each segment were:9 (30.0%) of the first-grade branch in the inside of the kidney-door;15 (50.0%) of the kidney-door to the vena cava;6 (20.0%) in the right margin of the inferior vena cava; and 3) the secondary branch of the ventral branch was in the renal door 1. 2 ( Conclusion:1. The right inferior vena cava can be exposed. 2/3 The main artery of the renal artery of the study object, the closer to the renal gate, the more easily the renal artery segment is exposed, and the renal artery trunk is not easy to be exposed. 2.13.3%--16.6% of the upper and lower renal arteries of the kidney, when separating the upper pole of the kidney, should be highly alert to avoid injury.
【學(xué)位授予單位】：昆明醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類(lèi)號(hào)】：R699;R322
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 錢(qián)明珠;林偉;姜麗;黃敏華;王建梅;魏倩倩;;三維增強(qiáng)磁共振血管成像在腎動(dòng)脈造影中的應(yīng)用[J];南方醫(yī)科大學(xué)學(xué)報(bào);2006年05期
2 曾鉅宣;李鴻杰;黃偉昭;楊文光;陳培禮;李啟強(qiáng);李振強(qiáng);;腎血管外段的觀察[J];廣西醫(yī)學(xué)院學(xué)報(bào);1984年02期
3 陳黔南;;腎血管的應(yīng)用解剖[J];貴陽(yáng)醫(yī)學(xué)院學(xué)報(bào);1992年02期
4 劉毅生,張文,沈家亮;腎迷走血管引起腎盂輸尿管連接部梗阻[J];廣州醫(yī)學(xué)院學(xué)報(bào);1997年02期
5 陳湘秋,易德保;腎后段動(dòng)脈的應(yīng)用解剖[J];解剖與臨床;1999年01期
6 張為龍;戴桂林;;國(guó)人器官外腎臟動(dòng)脈的觀察[J];解剖學(xué)報(bào);1963年04期
7 張為龍;吳德昌;戴桂林;;中國(guó)人器官內(nèi)腎動(dòng)脈的觀察[J];解剖學(xué)報(bào);1966年03期
8 譚允西;周秉文;丁士海;韓振藩;蓋維繽;;腎靜脈的觀察[J];解剖學(xué)通報(bào);1965年04期
9 龔斌;費(fèi)軍;石堯;汪定濤;施恩娟;張成立;黃瀛;;下腔靜脈的應(yīng)用解剖觀察[J];解剖學(xué)通報(bào);1990年01期
10 王佑懷;吳先國(guó);艾壽坤;嚴(yán)桂民;;腰動(dòng)脈的X線解剖及特征[J];解剖學(xué)雜志;1992年06期
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