髂腰静脉和腰升静脉的解剖结构特点及其临床意义

发布时间：2018-01-16 16:35

本文关键词：髂腰静脉和腰升静脉的解剖结构特点及其临床意义　出处：《广西医科大学》2008年硕士论文　论文类型：学位论文

【摘要】： 目的:探讨腰骶段静脉的解剖结构特点,为临床腰骶段前路手术提供解剖学依据。方法:对20具甲醛固定的成人尸体标本(男17具,女3具)的双侧髂腰静脉(iliolumbar vein)和腰升静脉(ascending lumbar vein)进行解剖。观察髂腰静脉,腰升静脉的引流特点和汇入髂血管的位置,并进行解剖结构分型。测量髂腰静脉和腰升静脉开口处的直径与主干的长度;测量它们到髂总静脉汇合点和到L5椎体下位终板的距离以及分清它们与腰骶干(lumbosacral trunk)、闭孔神经(obturator nerve)、髂腰动脉的关系。向内侧牵拉下腔静脉和髂总动静脉至暴露L4到S1椎体,以此来明确髂腰静脉和腰升静脉是否有撕脱的危险。结果:20具尸体标本的双侧均存在髂腰静脉,但有5侧没有发现腰升静脉。髂腰静脉和腰升静脉的主干及其分支引流着髂肌、腰大肌和第五腰椎椎体的血供。在我们的研究中发现髂腰静脉有11种引流方式,腰升静脉有5种引流方式。髂腰静脉主干的平均长度是7.89±3.30mm,开口处的平均直径是4.95±1.08mm。髂腰静脉到髂总静脉汇合点的平均距离是49.1±14.93mm,到L5椎体下位终板的平均距离是13.94±6.94mm。腰升静脉主干的平均长度是12.94±5.89mm,开口处的平均直径是5.20±2.69mm。腰升静脉到髂总静脉汇合点的平均距离是43.98±10.77mm,到L5椎体下位终板的平均距离是15.60±8.28mm。在所有的标本中闭孔神经都是走行于髂腰静脉和腰升静脉的浅外侧。35侧标本中有26侧的腰骶干位于腰升静脉的外侧,其余9侧位于腰升静脉的深部。40束腰骶干中有29束是在髂腰静脉深面下行,有8束是在其浅面下行,余下的3束腰骶干分浅深两支夹住髂腰静脉下行,这是以前的研究没有报道过的。结论:髂腰静脉和腰升静脉分布在L5椎体的侧方,引流L5椎体的血供,实际上相当于第五腰椎的节段血管。因为它们与闭孔神经和腰骶干关系密切而且解剖学变异非常大,所以在行前路手术处理腰骶段各类脊柱问题时,应该仔细解剖并结扎髂腰静脉和腰升静脉,以避免损伤大血管和神经而引起严重的并发症。我们不主张电凝髂腰静脉和腰升静脉,因为电凝容易损伤它们周围的腰丛神经。
[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 卤3.30mm. The mean diameter of opening was 4.95 卤1.08mm. the average distance between iliolumbar vein and common iliac vein was 49.1 卤14.93 mm. The average distance to L5 lower end plate was 13.94 卤6.94mm. the average length of lumbar ascending vein trunk was 12.94 卤5.89mm. The mean diameter of the opening was 5.20 卤2.69 mm. the average distance between the ascending lumbar vein and the common iliac vein was 43.98 卤10.77 mm. The average distance to the lower end plate of the L5 vertebra is 15.60 卤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.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R687;R322

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