脐孔与腹膜后大血管解剖相对位置关系的探讨

The anatomic relationship of the umbilicus to retroperitoneal major vessels

目的探讨脐孔与腹膜后大血管解剖位置关系。方法随机抽取89例非盆腔疾病进行动脉造影的患者,根据中国肥胖工作组制定的中国人肥胖标准,将患者分为标准体重、超重、肥胖3组。标准体重组32例,超重组35例,肥胖组22例。所有患者均以直径为1 cm的圆形铅块定位脐孔,仰卧位,Seld inger法穿刺右侧股动脉,行数字减影腹主动脉造影(DSA),以腹主动脉分叉处为参照点(0点),测定脐孔与腹膜后大动脉的垂直投影关系。结果(1)标准体重组、超重组、肥胖组3组患者的脐孔距腹主动脉分叉处距离分别为(14.8±19.7)mm、(0.04±2.5)mm、(-12.6±15.4)mm。(2)89例患者中,50例(63.9%)的患者脐孔对应于腹膜后大动脉,其中47例(94%)脐孔垂直投影在腹主动脉或右髂动脉,3例(6%)投影在左髂总动脉;32例(82.1%)患者的脐孔垂直投影在腹主动脉或右髂总动脉右侧,7例(17.9%)在右髂总动脉左侧。结论随患者体重增加,脐孔垂直投影逐渐下移至腹主动脉分叉下方。在气腹针或套管针行第一穿刺时,一旦发生腹膜后大血管损伤,腹主动脉和右髂血管损伤几率大。

Objective To study the anatomic relationship of the umbilicus to the retroperitoneal major vessels and the characteristics of such relationships among the Chinese with different body weights so as to provide a clear reference to the operator of laparoscopy. Methods Eighty-nine patients without pelvic disease, 57 males and 32 females who accepted digital subtraction angiography （DSA） of aorta were randomly selected and divided into 3 groups： non-obese group, overweight group, and obese group according to body mass index （BMI）. All the patients lied supine with a round block of lead 1 cm in diameter located on the umbilicus. Seldinger technique was used to puncture the right femoral artery so as to conduct DSA. Using the bifurcation of the abdominal aorta as reference point the vertical projection relationships of the umbilicus to the retroperitoneal major vessels, abdominal aorta, right common iliac artery, and left common iliac artery were evaluated and the distance from the umbilicus to the aortic bifurcation was measured. The distance was regarded as positive if the umbilicus was cephalic to the aortic bifurcation and as negative if the umbilicus was caudal to the aortic bifurcation Results There were 32 patients in the normal body weight group, 35 in the overweight group, and 22 in the obese group with the mean distances from the umbilicus to the aortic bifurcation of （ 14.8±19.7 ） mm, （0.04 ± 2.5 ） mm, and （ - 12.6 ± 15.4 ） mm respectively. In 50 of the 89 patients （63.9%） the location of umbilicus corresponded to the retroperitoneal major vessels, among which the umbilicus of 47 patients （ 94% ） projected vertically to the abdominal aorta or the right common iliac, and the umbilicus of 3 patients （6%） projected vertically to the left common iliac artery. Compared to the above-mentioned 50 patients, in the other 39 patients （36. 1% ） the location of umbilicus did not corresponded to the retroperitoneal major vessels （ P 〈 0. 05 ）, among which the umbilicus of 32 patients （82.1%）projected vertically to the right side of the aorta or of the right common iliac artery, and the umbilicus of 7 patients （ 17.9% ） projected vertically to the internal side of the right iliac common artery. Along with the increase of body weight the projection of umbilicus gradually moved downward to the inferior side of the bifurcation of the abdominal artery. For example, among the male subjects, the distance were （10.4±4.0） mm, （ -0.51±5.5） mm, and （ -13.1±2.2） nun respectively in the normal body weight group, overweight group, and obese group （ all P 〈 0.05 ）, and in the females, the distance were （ 13.7 ± 2.8） mm, （ - 0. 14 ± 4.4） mm, and （ - 11.5 ± 3.2） nun respectively in the normal body weight group, overweight group, and obese group （ all P 〈 0.05 ）. Condusion The location of umbilicus was more caudal with the increase of BMI. So once the retroperitoneal major vessels are injured, the incidence of aorta or the right common iliac artery is higher than that of other vessels.