腹后区下腔静脉及其属支的解剖及意义

The inferior vena cava and its tributaries:an applied anatomical study

目的 :为临床腹膜后手术中下腔静脉的定位和保护提供解剖学基础。方法 :解剖 5 0具成人尸体标本 ,在下腔静脉起始段 (左右髂总静脉汇合处至左肾静脉上缘之间 )对下腔静脉及其属支进行定位观测。结果 :(1)该段下腔静脉长 13.12± 1.5 1cm ,管径 2 .2 5± 0 .2 4cm。静脉属支 8.75± 2 .0 2支 ,6 6 .3%开口于该段静脉后壁 ,6 6 .4 %位于肾段。 (2 )静脉属支 :①右睾丸 (卵巢 )静脉 (84 .9% ) ,距左肾静脉上缘 3.5 6± 0 .85cm ,汇入该段下腔静脉前壁 ;②腰静脉 (10 0 % ) ,变异大 ,均不成对 ,左腰静脉 (3～ 4支 )较右侧 (2～ 3支 )多 ;③肠系膜外科静脉 (86 % ) ,距左肾静脉上缘 6 .5 4± 1.2 1cm ,从下腔静脉前壁左侧汇入 ;④右肾上腺静脉 (2 0 % ) ;⑤右付肾静脉 (2 5 % ) ;⑥右肾周静脉 (36 % ) ;⑦右膈下静脉 (6 % )。结论 :以上对下腔静脉起始段及属支的观测结果 ,为临床腹膜后影像学及各类手术提供了新的解剖学基础。

Objective:To provide anatomic basis for the location and protection of the tributaries of the inferior vena cava (IVC) in the retroperitoneal surgery.Methods:Fifty adult cadavers fixed with formalin were collected at random for study.The IVC and its tributaries were dissected,observed and measured in the region from the confluence of the left and right common iliac vein to the superior border of left renal vein(the initiative segment of IVC).Results:(1)The length of this segment of IVC was 13.12+1.51cm,and outer-diameter was 2.25±0.24cm.The number of vein tributaries from this segment was 8.75±2.02,66.3% of the tributaries entered the IVC posteriorly,and 66.4% of the tributaries entered the IVC on renal region(renal segment of IVC i.e.segment from the inferior end of right kidney to the superior border of left renal vein).(2)Vein tributaries:①Right gonad vein:84.9% of these veins entered the IVC anteriorly.The average distance from the point where the right gonad vein entering the anterior wall of IVC was approximately 3.56±0.85cm away from the superior border of left renal vein.②Lumbar vein(100%):The location of the lumbar veins in the infrarenal portion of the IVC was highly variable.A great number of veins was noted on the left(3～4)than on the right side(2～3). The veins tended to enter the IVC at different levels and not in pairs.③Surgical vein of mesentery(86%):The average distance from the point where the surgical vein entered the left side of anterior wall of IVC to the superior border of left renal vein was approximatately 6.94±1.21cm.④Right suprarenal vein(20%).⑤Right assistant renal vein (25%)⑥Right vein around kidney (36%).⑦Right inferior phrenic vein (6%).Conclusion:The result provides further morphological basis for retroperitoneal surgery.