后入路显露右肾外动脉主干的一级分支和腹侧二级分支处的相关解剖研究

发布时间：2019-05-21 14:56

【摘要】： 目的: 通过观察测量右肾外动脉一级分支处与肾门和下腔静脉之间距离的解剖、右肾腹侧支二级分支处与肾门的关系,探讨后入路显露右肾外动脉主干的可行性及注意事项。材料与方法: 1.解剖标本来源与观测指标选取经常规防腐处理的成年尸体解剖教学标本30具(男性27具,女性3具)全部标本由昆明医学院解剖教研室提供,腹部各个脏器按常规解剖都已暴露(全部标本为解剖教研室制成的解剖教学标本和为外院制作的解剖教学标本)标本右肾外血管无破坏、下腔静脉无破坏、后腹膜右侧肾脏位置未变动纳入本研究对象。观测指标:1)观察每具标本的右肾动脉的支数、副肾动脉的存在与否。2)一级分支处分别距下腔静脉、肾门的距离、肾门到下腔静脉距离之间的肾动脉的长度。3)一级分支处在下腔静脉右侧缘内和外—0.5cm、＞0.5 cm区段例数和比例。4)腹侧支二级分支处与肾门的关系。 2.DSA动脉造影资料来源与观测指标收集2003年—2007年昆明医学院附属二院介入DSA造影室提供的临床右肾动脉血管造影的影像资料(男性21例、女性9例),所有研究对象均为或怀疑肾脏、肾动脉或肾上腺疾病而行肾动脉造影。术后DSA动脉造影诊断:右肾癌5例(病变未侵及右肾外动脉)、右肾炎性病变1例、右肾上腺病变3例、右肾动脉狭窄2例;左肾病癌3例、左肾动脉狭窄2例、左肾萎缩2例、左肾上腺病变2例,左肾病变的病例同时行右肾外动脉主干显像;术前诊断动脉狭窄术后未见双肾动脉异常10例。观测指标:1)观测右肾动脉的支数、副肾动脉的存在与否;2)右肾动脉一级分支与肾门和下腔静脉的关系即:一级分支处在下腔静脉右侧缘的内或外;一级分支处在肾门的内或外。3)腹侧支二级分支处在肾门内或外。结果: 1.解剖标本观测结果 1)右肾动脉支数1支型28具尸体(93.3%)、2支型2具尸体(6.7%)。副肾动脉出现的尸体有4具(13.3%),副肾动脉均进入肾上极。2) 20例右肾动脉一级分支处位于下腔静脉右侧缘外距肾门的距离为2.4±0.11 cm、距下腔静脉距离为0.7+0.59;20例右肾动脉一级分支处位于下腔静脉右侧缘外的肾门到下腔静脉距离之间肾动脉长度为2.7±0.74。10例右肾动脉一级分支处位于下腔静脉后段距下腔静脉右侧缘的距离为-0.7±0.41cm;10例右肾动脉一级分支处位于下腔静脉后段,下腔静脉到肾门之间肾动脉的长度为2.2±0.24。3)右肾动脉一级分支处位于下腔静脉右侧缘外的有20例(66.7%):右侧缘外到0.5cm段13例(43.3%)、＞0.5cm段7例(23.3%):右肾动脉一级分支处位于下腔静脉右侧缘内的有10例(33.3%)(包括两只型动脉的解剖标本)。4)腹侧支二级分支处在肾门内10例(33.3%);腹侧支二级分支处在肾门外20例(66.7%)。 2.DSA动脉造影观测结果 1) DSA动脉造影资料1支动脉型30例:存在副肾动脉有5例(16.7%),副肾动脉均进入肾上极。2)肾动脉一级分支处在各段间例数和比例为:一级分支部位在肾门内侧9例(30.0%);肾门到腔静脉段15例(50.0%);下腔静脉右侧缘内6例(20.0%)。3)腹侧支二级分支处在肾门内12例(40.0%);腹侧支二级分支处在肾门外18例(60.0%)。结论: 1.右侧下腔静脉外可显露2/3研究对象肾动脉主干,越靠近肾门则越易显露肾动脉段支而不易显露肾动脉主干。 2.13.3%--16.6%肾上极存在副肾动脉当分离肾上极时,应高度警惕,避免损伤。 3.当一级分支处位于下腔静脉后或太接近下腔静脉,前后入路结合分离前、后支是更合理的选择。
[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.
【学位授予单位】：昆明医学院
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R699;R322

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