摘要
目的对下腰椎椎前自主神经丛进行解剖观察,了解该区域自主神经丛的形态、位置特点,为下腰椎前入路手术中自主神经的保护提供解剖学依据。方法对19具成人尸体标本进行解剖观测,男15例、女4例;年龄44-78岁,平均64岁。确定腹中线（胸骨上窝中点和耻骨联合中点的连线）后,观察腹主动脉丛（abdominal aortic plexus,AAP）、肠系膜下丛（inferior mesenteric plexus,IMP）、上腹下丛（superior hypogastric plexus,SHP）的走行、其神经纤维的分布特点及其与腹中线的位置关系。结果 AAP、IMP主要呈网状分布于腹主动脉前方,两神经丛的神经纤维在腹主动脉左侧较右侧更加密集。SHP主干形态变异较大,分为4种类型。SHP主干长度为（59.38±12.86）mm、宽度（11.25±2.92）mm。SHP主干主要位于腹中线左侧（10具,52.6%）、下腰椎前（13具,68.4%）,主干向下延续为左、右腹下神经。结论行下腰椎前入路手术时,可以考虑从椎体右侧进行显露,将自主神经和血管作为一整体移动,不必单独分离解剖神经丛,从而最大限度避免神经损伤。
Objective To understand the location characteristics of the lumbosacral autonomic nerve plexus and the morphological changes so as to provide the anatomic theoretical basis for the protection of autonomic nerve during the lower lumbar anterior approach operation. Methods A random anatomic investigation was carried out on 19 formalin-treated adult cadavers（15 males and 4 females; aged 44-78 years, mean 64 years）. The anterior median line（connection of suprasternal fossa point and the midpoint of the symphysis pubis） was determined, and the characteristics of abdominal aortic plexus（AAP）, inferior mesenteric plexus（IMP）, and superior hypogastric plexus（SHP） were observed. The relationship between the autonomic nerve and the anterior median line was measured and recorded. Results APP and IMP were found to be located chiefly in front of the abdominal aorta in a reticular pattern, and the nerve fibers of the two nerve plexuses were more densely at the left side of abdominal aorta than at the right side. Superior hypogastric plexus showed more distinct main vessel variations, including 4 types. The main vessel length of the SHP was（59.38 ± 12.86） mm, and the width was（11.25 ± 2.92） mm. The main vessels of SHP were mainly located at the left side of the ventral median line（10, 52.6%） and anterior lumbar vertebra（13, 68.4%）. The main vessels extended down to form the left and right hypogastric nerves. Conclusion It is applicable to expose the nerve from the right side of centrum and move the autonomic nerve and blood vessel as a whole during anterior lower lumbar operation. In this way, the dissection to separate nerve plexus is not needed, thus nerve injury can be avoided to the largest extent.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第10期1248-1252,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
下腰椎前入路
腹主动脉丛
肠系膜下丛
上腹下丛
应用解剖
Lower lumbar anterior approach
Abdominal aortic plexus
Inferior mesenteric plexus
Superior hypogastric plexus
Applied anatomy
