摘要
目的研究腰交感神经的局部解剖关系,为临床开展腹腔镜腰交感神经节切除术(VALLS)提供解剖学资料。方法观察总结成人尸体128侧的腰部交感神经及其毗邻结构的解剖关系;回顾性分析21例VALLS。结果①腰交感神经节数目每侧1～6个不等,以3～4个最多见,位置、形态变异较大。②128侧中发现腰交感干节间支的分裂有12侧,占9.38%。③腰动脉均位于神经干的深面,腰静脉多位于腰交感干浅面,占68.42%。④生殖股神经穿出腰大肌平面多数与L2～L4椎体或椎间盘对齐,穿出点距腰大肌内侧缘(0.81±0.48)cm。⑤输尿管髂血管交界处距腰大肌外缘距离:左侧为(3.36±0.59)cm,右侧为(3.41±0.59)cm。⑥本组21例VALLS手术时间2～3.5h,术中出血50～80ml,术中术后未出现严重并发症,手术效果良好。结论腹腔镜腰交感神经节切除术成功的关键是掌握良好的腹腔镜操作技巧,熟悉腰交感神经的局部解剖关系,术中认真仔细的操作。
Objective To research regional anatomy of lumbar sympathetic trunk and provide anatomic information for video-assisted laparoscopic lumbar sympathectomy （VALLS）. Methods Lumbar sympathetic trunk and its neighboring anatomic relation in 128 sides of adult cadavers and 21 clinic VALLS were retrospectively reviewed. Results （1） The location, shape and number of the sympathetic ganglia were quite variable. There was 1 to 6 in number unilaterally. （2） Lumbar sympathetic trunks of 12 sides in 128 sides were found dividing into 2 -3 branches at the distal part. （3） Lumbar arteries were all located under the lumbar sympathetic trunk and the lumbar veins consisting 68.42% situated superficially to the trunk. （4） Genitofemoral nerve pierced the psoas muscle at the level of 2nd to 4th vertebrate or its intervertebral disc. It was only （0.81 ± 0.48） cm away from the medial rim of the psoas muscle. （5） Distance between ureter-iliac vessel junction and the lateral rim of the psoas muscle was （3.36 ±0.59） cm at left side and （3.41 ±0.59） cm at right side. The operation time was 2 - 3.5 hours and the intraoperative blood loss was 50 - 80 ml. There were no severe complications and the effects were satisfying. Conclusion Because of great variants and complex neighboring anatomic relation of lumbar sympathic nerve, the critical factor of successful microinvasive VALLS is to grasp the laparoscopic operation skill and anatomy of retroperitoneal space （especially the regional anatomy of lumbar sympathetic trunk） and carefully operating.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2007年第11期1116-1119,共4页
Journal of Third Military Medical University
基金
重庆市卫生局资助项目(04-2-124)~~
