阑尾McBurney切口处的局部形态学的研究

Local Morphological Study on the Incision of McBurney's Point for Appendicitis

目的研究髂腹下神经及髂腹股沟神经与阑尾切除术切口位置的解剖关系,为临床提供参考。方法在福尔马林固定的教学38具（男性21具,女性17具）成人尸体标本上,观察和测量髂腹下神经及髂腹沟神经。结果髂腹下神经在腹内斜肌与腹横肌之间经过者占63.2%（24例）,在腹外斜肌腱膜与腹内斜肌之间经过者占10.5%（4例）,在腹内斜肌肌层内经过者占26.3%（10例）,髂腹下神经距髂前上棘内侧1~40mm的范围内通过脐-右髂前上棘连线的占97.7%;距麦氏点外侧11~50mm的范围内通过脐-右髂前上棘连线的也占到97.7%;髂腹下神经与脐-右髂前上棘连线的向外上的夹角约为83.45°±6.23°（66°~89°）,近乎垂直。结论选择阑尾切口时,应在脐-右髂前上棘连线上距髂前上棘不低于40 mm外进行,或选在麦氏点外侧1 cm以内;在分离时也应注意不要扰及距髂前上棘内侧1~40 mm的范围;切口应与脐-右髂前上棘连线垂直,且作切口时不易向下延长超过两髂前上棘连线。

Objective To study the anatomical relationship between iliohypogastric nerve（IHN）,ilioinguinal nerve（IPN） and incision of appendectomy,to provide reference for the clinical application.Methods IHN and IPN of 38 cases（male 21,female 17）were observed and measured.Results Out of 38 cases,IHN was obeserved between the obliquus internus abdominis and transversus abdominis in 24 cases （63.2%）,between the obliquus externus abdominis tendon membrane and obliquus internus abdominis in 4 cases（10.5%）,while deep to the obliquus internus abdominis muscularis in 10 cases（26.3%）.In 97.7% cases,IHN crossed the line from umbilicus to right anterior superior iliac spine in the range of 1~40 mm,also crossed the line in the range of 11~50 mm laterally to Mcburney＇s point.The angle between IHN and the line from umbilicus to right anterior superior iliac spine line was 83.45°±6.23°（66°~89°）,almost vertical with each other.Conclusions The incision for appendicitis is superior to the line from umbilicus to the right anterior superior iliac spine,no less than 40mm lateral to right anterior superior iliac spine,or lateral to McBurney＇s point within 1cm.The range of separation is within 1~40mm medial to right anterior superior iliac spine.The direction of incision must be vertical to the line from umbilicus to the right anterior superior iliac spine,the downward incision must not extend beyond the line between two anterior superior iliac spines.