下腰椎侧前方静脉的解剖及其在腹腔镜腰椎手术中的临床意义

Clinical anatomy of the anterolateral vein of lower lumbar spine and its significance with retroperitoneal endoscopic surgery

目的:探索在腹膜后腹腔镜行下腰椎手术时,下腰椎侧前方血管的解剖及手术暴露时的注意事项。方法:对15具腰椎标本两侧观察腰升静脉和髂腰静脉走行、变异及其与周围组织的关系。结果:腰升静脉和髂腰静脉在每具标本中均存在,有静脉分干和共干汇流到髂总静脉等4种形式。在牵拉髂总静脉时,可能导致它们的破裂,并且在暴露血管时需注意避免损伤闭孔神经和腰骶干。结论:髂腰静脉和腰升静脉是下腰椎很重要的解剖结构,腹腔镜手术显露下腰椎时应注意在牵拉髂总静脉时暴露和结扎这两个静脉,是手术避免血管破裂导致大出血的关键。

objective： to explore the anatomic characteristics of veins situated at the lower lumbar spine and provide anatomic data for laparoscopic lumbar surgery. Methods： 15 formaldehyde-preserved cadavers were studied with special attention to the variety and surrounding structure of ascending lumbar vein （ALV） and iliolumbar veins（ILV）, and their relationship with lumbar plexus. Results： ALV and ILV can be found in every sample, which included four variant forms concerning with separate entry and common entry. For 18 cases, the ascending vein and iliolumbar vein separately drained into common iliac vein, and for 12 cases a common trunk entered into the common iliac vein. When dragging common iliac vein medially for the exposure of the disc space, both the ascending lumbar and the iliolumbar veins were always at the risk of avulsion. At the process of exposing vessels, the injury of obturator nerve and lumbosacral trunk of the lumbar plexus may be occurred. Conclusions： Awareness of those anatomic variation should assist a surgeon to perform a careful ligation of these veins before medially retracting of the common iliac vein and prevent the possibility of hemorrhage. Our findings emphasize the necessity for proper dissection of the ALV and ILV before ligating them during the exposure of the lower lumbar spine.