男性单侧腹直肌罕见缺失变异1例

A rare case of unilateral complete absence of rectus abdominis in adult male

目的报道1例罕见的右侧腹直肌完全缺失并不伴有其他器官系统变异尸体的腹部解剖过程,腹壁肌群及其供血情况。方法解剖并观察尸体腹壁肌、血供、神经支配,对比两侧腹直肌发育和形态差异。结果该尸体右侧腹直肌缺失,腹直肌鞘完好,腹壁上动脉和腹壁下动脉仍在腹直肌鞘内走行并相吻合,肋间神经及肋下神经(T7~T12)由鞘内穿出达皮下。左侧腹直肌发育正常并有代偿性增生。男尸腹壁未见疤痕和手术切痕,腹内器官无缺失,腹膜除肝区外无黏连。结论该尸体右侧腹直肌缺失可能是胚胎发育第6周之前出现异常所导致。目前腹直肌肌皮瓣常用于多项外科重建手术,全面了解腹直肌的相关变异,对于扩展重建手术的应用范围和作好术前准备,确保手术成功均具有指导意义。

Objective To report a rare case of unilateral complete absence of rectus abdominis muscle in an adult male without any other malformations,and reveal the abdominal dissection process,abdominal wall muscles and their blood supplies. Methods The abdominal wall muscles,their blood supplies,and innervations were dissected and observed. The development and morphology of rectus abdominis on both sides were compared. Results The cadaver had no rectus abdominis muscle on the right side. The superior and inferior epigastric arteries met with each other and remained intact in the substitutional connective tissue within the rectus sheath. The intercostal and subcostal nerves（ T7-T12） pierced the sheath and reach the superficial fascia. The left rectus abdominis muscle was complete with compensatory hypertrophy. No scar or signs of surgery were found on the skin. No abdominal organ was absent,and no adhesion was found in the peritoneum except the liver area. Conclusion The absence of right rectus abdominis may result from abnormal embryonic development before the 6 th week. Rectus abdominis flaps are used in many surgical reconstruction surgeries. The knowledge of the related mutations is clinically significant for preoperative preparation and the use of rectus abdominis flap.