异常闭孔动脉的形态特点及其临床意义

Morphological characteristics of abnormal obturator arteries and its clinical significance

目的观察异常闭孔动脉的走形、分布,并对其盆内段进行测量和定位,为腹股沟区相关手术提供可靠的解剖学基础。方法解剖研究37侧成人骨盆标本,对闭孔动脉进行观测和分类,并测量闭孔动脉盆内段长度,起始端外径,闭孔管处外径,以及闭孔动脉入闭孔处和髂前上棘与耻骨联合连线中点的距离。结果在37侧标本中,异常闭孔动脉出现率为18.92%。异常闭孔动脉与腹壁下动脉共干（1.57±0.12）cm发出,盆内段平均长度（4.05±0.49）cm,起始处平均外径（2.52±0.87）mm,闭膜管处闭孔动脉平均外径（2.14±0.72）mm,入闭孔处和连线中点的距离（3.63±1.29）cm。异常闭孔动脉多与腹壁下动脉共干,之后绕股环或跨过股环,紧贴盆壁下降至闭孔处。结论正是由于异常闭孔动脉的特殊性质,在腹股沟区及骨盆、髋区骨折固定手术,甚至肿瘤治疗、淋巴结清除术中,术者当引起重视。

Objective To investigate the shape, distribution and variation of abnormal obturator artery and vein in the pelvic wall, and to measure the length of the segment of obturator artery in the pelvic cavity, in order to provide a reliable anatomical reference of etiology to the strange bleeding around the area.Methods There were 37 specimens of adult corpses fixed by the formaldehyde solution the pelvic dissection. According to the obturator artery classification method, these specimens were investigated and classified. The length of the segment of the obturator artery in the pelvic cavity, and the external diameter of it at the origin and at the obturator foramen, and the distance between the obturator foramen and the midpoint of the line connecting anterosuperior iliac spine and the pubic symphysis were explored. Results In these 37 specimens, the occurrence rate of abnormal obturator arteries was 18.92%. A common trunk of abnormal obturator arteries and inferior epigastric artery, length of which was（1.57 ± 0.12）cm, originated from the external iliac artery. The length of the abnormal obturator artery was（4.05±0.49）cm, and the external diameter of it at its origin and at the obturation foramen was（2.52 ± 0.87）mm and（2.14 ± 0.72）mm, respectively. The average distance between the obturator foramen and the midpoint of the line connecting anterosuperior iliac spine and the pubic symphysis was（3.63±1.29）cm. Conclusion The obturator artery is relatively thicker and longer in the pelvis, and has a high variation rate. Abnormal obturator arteries originate from inferior epigastric artery, and then bypasses or crosses, and vertically accesses into obturator foramen. It is due to the special characteristics and distribution of obturator arteries, the surgeon should pay attention to its existence in inguinal surgery and pelvic fracture fixation operation, or even in oncotherapy and clearance of lymph nodes.In addition, it is better for learning about the obturator area in advance by proper usage of angiography and to apply the lateral rectus approach in the abdominal surgery. Besides, minimally invasive surgery might be another choice.