腹盆腔段输尿管及其周围结构的数字化解剖研究

Digital three-dimensional anatomy of abdominopelvic ureter and adjacent structures

目的探讨输尿管腹盆腔段与周围结构的解剖学特征,为广泛性子宫切除术中安全游离输尿管提供解剖学依据。方法收集2017年4月至2018年12月女性盆腔CTA数据65例,对盆部动脉、输尿管、子宫进行三维重建,测量输尿管到盆腔动脉、子宫的间距,观察输尿管腹盆段与周围结构的毗邻关系。结果输尿管跨越髂动脉有3种类型:左侧:髂总动脉(33.84%)、髂总动脉分叉处(13.85%)、髂外动脉(55.38%);右侧:髂总动脉(27.69%)、髂总动脉分叉处(20.00%)、髂外动脉(52.30%)。"输尿管隧道"入口处对应宫颈旁占66.15%,输尿管进入膀胱处对应阴道占70.7%。腹主动脉分叉处与输尿管间距:左侧(32.45±6.24)mm,右侧(39.3±5.78)mm;髂总动脉分叉处与输尿管间距:左侧(10.55±4.85)mm,右侧(13.34±5.49)mm;输尿管隧道入口处与宫体间距:左侧(16.94±6.83)mm,右侧(18.11±6.53)mm;输尿管与宫颈内口外侧缘间距:左侧(19.26±7.62)mm,右侧(22.5±7.41)mm;输尿管与宫颈外口外侧缘间距左侧(17.06±6.19)mm,右侧(22.49±4.94)mm。以上左右两侧的比较均具有统计学差异(P<0.05)。结论熟悉腹盆段输尿管与周围结构的解剖关系,对广泛性全子宫切除术中预防输尿管损伤十分重要。

Objective To provide the anatomic basis for ureteral dissociation in radical hysterectomy by studying the anatomical characters of ureter in abdominopelvic cavity. Methods The CTA data of 65 female pelvic patients were collected from Apr.2017 to Dec.2018. Through the 3 D reconstruction with ureters,pelvic artery and uterus, the pathway of abdominopelvic ureters was observed. We measured the distance from the ureter to the pelvic artery and the ureter to uterus, then observed the adjacent structures around ureters.Results There were three types of the iliac artery across the ureter. On the left side, the common iliac artery(33.84%), the bifurcation of common iliac artery(13.85%) and the external iliac vein(55.38%) crossed with the ureter;on the right side, the common iliac artery(27.69%) the bifurcation of the common iliac artery(20.00%), and the external iliac vein(52.30%) crossed with the ureter. The entrance of the"ureteric tunnel"corresponded to the cervix(66.15%) and the entrance of the ureter into the bladder corresponded to the vagina(70.7%). The distance between the bifurcation of the abdominal aorta and the ureter was(32.45±6.24) mm on the left and(39.3±5.78) mm on the right. The distance between the bifurcation of the common iliac artery and the ureter was(10.55 ± 4.85) mm on the left and(13.34 ± 5.49) mm on the right. The distance between the ureteric tunnel entrance and the uterine was(16.94±6.83) mm on the left and(18.11±6.53) mm on the right.The distance between the ureter and the lateral margin of the inner cervical was(19.26±7.62) mm on the left and(22.5 ± 7.41) mm on the right. The distance between the ureter and the lateral margin of the external cervical was(17.06±6.19) mm on the left and(22.49±4.94) mm on the right. There were statistical differences between the above mentioned two sides(P<0.05). Conclusion These findings provide novel and important references to the anatomic relationship of the ureter in abdominopelvic cavity and adjacent structures. It may help surgeons reduce the risk of ureteric injury in radical hysterectomy.