应用腹腔镜行下腰椎手术的解剖学研究

An anatomy study of laparoscopic lower lumbar spine surgery

目的观察研究下腰椎前方、侧方毗邻的血管结构的位置及走行,并测量各节段手术空间的大小,为腹腔镜下行腰椎手术提供安全区的解剖学依据。方法解剖15例成人尸体标本(男9例,女6例),记录腰椎前方和侧方毗邻的主要血管解剖学参数,并测量出相应的结果。结果腹主动脉分叉点变异较多,髂总静脉汇合点相对恒定,腹主动脉分叉点、髂总静脉汇合点主要集中在L4-5之间;骶正中动脉均起源于腹主动脉分叉处后壁,在骶前沿中线左或右侧下行,骶正中静脉与之伴行;L5-S1节段前路手术安全区间位于左髂总静脉与右髂总动脉所形成的"∧"三角形区域内;L3动静脉走行变异小,始终走行于腰椎体侧方中部的凹沟内,L4动静脉走行变异较大,约33%走行于L4-5椎间隙表面;腰升静脉纵行于腰椎两侧的椎弓根外侧的凹沟内,髂腰静脉由髂总静脉和腰静脉汇合而成;L3-S1节段左右侧方均有无血管神经分布的区域,可以满足手术需要的空间,且该区域面积左侧较右侧大。结论应用腹腔镜行下腰椎手术是可行的,各节段通过不同的入路能获得镜下操作所需求的手术空间。

Objective To observe the anatomic characteristics of blood vessels 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 blood vessels of lower lumbar,and the anatomic data were recorded and calculated.Results The bifurcation level of the ventral aorta was quite variable,the confluence level of the common iliac vein was consistent,and they were mainly situated at L4-5;the origin of the middle sacral artery was at the back of the bifurcation level,companied with the middle sacral vein often;the operation window of L5S1 disc was in the area of＂∧＂,it was composed of right common iliac artery and left common iliac vein;the 3rd lumbar artery and vein were more costant,which followed the center of the corresponding lumbar vertebral,the 4th lumbar artery and vein varied greatly,vessels of L4 of all samples coursed on the surface of L4-5 interspace（33%）;ascending lumbar veins ascend from the root of lumbar vertebral,and iliolumbar vein was composed of common iliac vein and lumbar vein;there were two nonangioneuro-areas in the both lateral region of lumbar vertebral from L3S1,and the left area was larger than the right area.Conclusion The technique of laparoscopic lower lumbar spine surgery is reliable,there are enough area for laparoscopic lower lumbar spine surgery through different routes.