肾动脉周围交感神经的显微解剖

Micro-anatomic distribution of peri-arterial renal sympathetic nerves

目的 探讨肾动脉周围交感神经的分布. 方法 选取行经腹膜后入路腹腔镜下肾脏切除术患者的肾动脉标本25例,同时留取7例尸检患者的双侧肾动脉,将其等分成肾动脉段,依次制作成石蜡切片,光学显微镜下观察并统计分析神经在肾动脉不同空间区域内的分布. 结果 制成258张切片,神经计数共3065条,98%的神经分布于肾动脉的外膜及其以外组织,手术标本中肾动脉腹侧、背侧、上面、下面分布的神经条数分别为（4.7±1.3）、（1.4±0.7）、（3.1±1.3）、（2.1±1.2）条,腹侧神经多于背侧（P=0.000）,上面的神经多于下面（P=0.005）,肾动脉中间部位的神经条数多于远端[（14.5±4.4）条和（8.3±3.0）条,P=0.000].尸检标本的肾动脉腹侧、背侧、上面、下面的神经条数分别为（5.4±1.4）、（1.5±0.7）、（3.1±0.8）、（2.8±1.0）条,腹侧的神经条数多于背侧（P=0.000）,上面与下面的神经条数相似,肾动脉近、中、远端分布的神经条数为（11.2±4.4）、（17.6±4.4）、（8.5±2.2）条,肾动脉中间部位的神经条数多于近端和远端（P=0.000）.左、右肾动脉周围分布的神经条数差异无统计学意义（P手术标本=0.100、P尸检标本=0.916）. 结论 数目较多的神经分布于肾动脉的外膜及其以外组织,肾动脉腹侧神经分布最多,而背侧最少.沿着肾动脉的走形,中间段神经分布相对较多,左、右肾动脉周围神经数目的分布无差异.

Objective To investigate the distribution of sympathetic nerves around human renal arteries.Methods We collected 25 renal arteries from the patients who had a retroperitoneal laparoscopic nephrectomy and bilateral renal arteries from 7 human autopsy subjects.Each artery was equally divided into segments, which were made into paraffin sections.We examined the distribution of nerves around renal arteries and manually counted nerves by using optical microscope.Results A total of 3 065 nerves were identified from 258 sections.About 98% of all nerves existed within the renal arterial adventitia and the outside tissue.The mean number of nerves between the ventral, doirsal, superior, and inferior region of surgical specimens was 4.7±1.3, 1.4±0.7, 3.1±1.3, and 2.1±1.2, respectively.The mean number of nerves in the ventral region was greater compared with the doirsal region （P=0.000）, the mean number of nerves in the superior region was also greater compared with the inferior region （P=0.005）.The mean number of nerves in the middle segments was obviously greater compared with the distal segments （14.5±4.4 and 8.3±3.0, P=0.000）.The mean number of nerves between the ventral, doirsal, superior, and inferior region of autopsy specimens was 5.4±1.4, 1.5±0.7, 3.1±0.8, and 2.8±1.0, respectively.The mean number of nerves in the ventral region was greater compared with the doirsal region（P=0.000）, whereas the mean number of nerves was similar between the superior and inferior region （P=0.440）.The mean number of nerves among the proximal, middle, and distal segments was 11.2±4.4, 17.6±4.4, and 8.5±2.2.It was obvious that the mean number of nerves in the middle segments was greater compared with the proximal and diatal segments （P=0.000）.The distribution of sympathetic nerves around the left renal arteries was not considerably different compared with the right renal arteries （Psurgical=0.100, Pautopsy=0.916）.Conclusion The mean number of nerves in the ventral region is greatest and least in the doirsal region.Along the renal artery, the distribution of nerves is relatively greater in the middle segments.Nerve anatomic distribution around the left renal arteries was not considerably different compared with the right renal arteries.