后入路顯露右腎外動脈主干的一級分支和腹側(cè)二級分支處的相關(guān)解剖研究
發(fā)布時間：2019-05-21 14:56
【摘要】： 目的: 通過觀察測量右腎外動脈一級分支處與腎門和下腔靜脈之間距離的解剖、右腎腹側(cè)支二級分支處與腎門的關(guān)系,探討后入路顯露右腎外動脈主干的可行性及注意事項。 材料與方法: 1.解剖標(biāo)本來源與觀測指標(biāo) 選取經(jīng)常規(guī)防腐處理的成年尸體解剖教學(xué)標(biāo)本30具(男性27具,女性3具)全部標(biāo)本由昆明醫(yī)學(xué)院解剖教研室提供,腹部各個臟器按常規(guī)解剖都已暴露(全部標(biāo)本為解剖教研室制成的解剖教學(xué)標(biāo)本和為外院制作的解剖教學(xué)標(biāo)本)標(biāo)本右腎外血管無破壞、下腔靜脈無破壞、后腹膜右側(cè)腎臟位置未變動納入本研究對象。觀測指標(biāo):1)觀察每具標(biāo)本的右腎動脈的支數(shù)、副腎動脈的存在與否。2)一級分支處分別距下腔靜脈、腎門的距離、腎門到下腔靜脈距離之間的腎動脈的長度。3)一級分支處在下腔靜脈右側(cè)緣內(nèi)和外—0.5cm、＞0.5 cm區(qū)段例數(shù)和比例。4)腹側(cè)支二級分支處與腎門的關(guān)系。 2.DSA動脈造影資料來源與觀測指標(biāo) 收集2003年—2007年昆明醫(yī)學(xué)院附屬二院介入DSA造影室提供的臨床右腎動脈血管造影的影像資料(男性21例、女性9例),所有研究對象均為或懷疑腎臟、腎動脈或腎上腺疾病而行腎動脈造影。術(shù)后DSA動脈造影診斷:右腎癌5例(病變未侵及右腎外動脈)、右腎炎性病變1例、右腎上腺病變3例、右腎動脈狹窄2例;左腎病癌3例、左腎動脈狹窄2例、左腎萎縮2例、左腎上腺病變2例,左腎病變的病例同時行右腎外動脈主干顯像;術(shù)前診斷動脈狹窄術(shù)后未見雙腎動脈異常10例。觀測指標(biāo):1)觀測右腎動脈的支數(shù)、副腎動脈的存在與否;2)右腎動脈一級分支與腎門和下腔靜脈的關(guān)系即:一級分支處在下腔靜脈右側(cè)緣的內(nèi)或外;一級分支處在腎門的內(nèi)或外。3)腹側(cè)支二級分支處在腎門內(nèi)或外。 結(jié)果: 1.解剖標(biāo)本觀測結(jié)果 1)右腎動脈支數(shù)1支型28具尸體(93.3%)、2支型2具尸體(6.7%)。副腎動脈出現(xiàn)的尸體有4具(13.3%),副腎動脈均進(jìn)入腎上極。2) 20例右腎動脈一級分支處位于下腔靜脈右側(cè)緣外距腎門的距離為2.4±0.11 cm、距下腔靜脈距離為0.7+0.59;20例右腎動脈一級分支處位于下腔靜脈右側(cè)緣外的腎門到下腔靜脈距離之間腎動脈長度為2.7±0.74。10例右腎動脈一級分支處位于下腔靜脈后段距下腔靜脈右側(cè)緣的距離為-0.7±0.41cm;10例右腎動脈一級分支處位于下腔靜脈后段,下腔靜脈到腎門之間腎動脈的長度為2.2±0.24。3)右腎動脈一級分支處位于下腔靜脈右側(cè)緣外的有20例(66.7%):右側(cè)緣外到0.5cm段13例(43.3%)、＞0.5cm段7例(23.3%):右腎動脈一級分支處位于下腔靜脈右側(cè)緣內(nèi)的有10例(33.3%)(包括兩只型動脈的解剖標(biāo)本)。4)腹側(cè)支二級分支處在腎門內(nèi)10例(33.3%);腹側(cè)支二級分支處在腎門外20例(66.7%)。 2.DSA動脈造影觀測結(jié)果 1) DSA動脈造影資料1支動脈型30例:存在副腎動脈有5例(16.7%),副腎動脈均進(jìn)入腎上極。2)腎動脈一級分支處在各段間例數(shù)和比例為:一級分支部位在腎門內(nèi)側(cè)9例(30.0%);腎門到腔靜脈段15例(50.0%);下腔靜脈右側(cè)緣內(nèi)6例(20.0%)。3)腹側(cè)支二級分支處在腎門內(nèi)12例(40.0%);腹側(cè)支二級分支處在腎門外18例(60.0%)。 結(jié)論: 1.右側(cè)下腔靜脈外可顯露2/3研究對象腎動脈主干,越靠近腎門則越易顯露腎動脈段支而不易顯露腎動脈主干。 2.13.3%--16.6%腎上極存在副腎動脈當(dāng)分離腎上極時,應(yīng)高度警惕,避免損傷。 3.當(dāng)一級分支處位于下腔靜脈后或太接近下腔靜脈,前后入路結(jié)合分離前、后支是更合理的選擇。
[Abstract]:Purpose: The feasibility and attention of the posterior approach to the main trunk of the right kidney were discussed by observing the anatomy of the distance between the primary branch of the right kidney and the inferior vena cava, the relationship between the secondary branch of the right and the ventral branch and the renal hilum. (b) Matters. Materials and Methods:1. Anatomy 30 (27 male and 3 female) specimens of adult cadaveric anatomy were selected from the source of specimen and the observation index. The anatomic teaching and research room of the Ming Medical College is provided. Each organ of the abdomen has been exposed according to the routine anatomy (all the specimens are the anatomical teaching specimen made of the anatomical study chamber and the anatomic teaching specimen made for the external hospital). The right kidney external blood vessel is not damaged, the inferior vena cava is not damaged, and the right kidney position on the right side of the retroperitoneum No change was included in the study object. Observation index:1) The number of right renal artery and the presence or absence of the secondary renal artery were observed for each specimen. The distance from the inferior vena cava, the renal gate, the length of the renal artery between the renal gate and the inferior vena cava.3) The primary branch is located in the right margin of the inferior vena cava and the outer diameter of 0.5 cm, the number and the proportion of the 0.5 cm section, and 4) the ventral branch The relationship between the secondary branch and the kidney. The image data of the clinical right renal artery angiography (n = 21, female) provided by the interventional DSA in the second hospital of Kunming Medical College in 2003 and 2007 were collected from the data source and the observation index of the SA arteriography. 9), all study subjects were or suspected of the kidney There were 5 cases of right renal cell carcinoma (non-invasion of right and right renal artery),1 case of right nephritis,3 cases of right adrenal lesion,2 cases of right renal artery stenosis,3 cases of left renal disease and 2 cases of left renal artery stenosis. 2 cases of left renal atrophy,2 cases of left adrenal gland,2 cases of left renal disease, and right renal artery trunk imaging at the same time; pre-operative diagnosis No 10 cases of double renal artery were found in the operation of the artery stenosis. The observation index:1) The number of the right renal artery and the presence or absence of the secondary renal artery were observed;2) The relationship between the branch of the right renal artery and the renal and inferior vena cava was as follows: The internal or external of the right margin of the inferior vena cava; the primary branch is in or out of the kidney. .3) The secondary branch of the ventral branch is in the kidney Inside or outside of the door. Results:1.1) Right renal artery count 1 supported by the anatomical specimen (1) 28 cadavers (93.3%) and 2 cadavers (6.7%). The body of the secondary renal artery was 4 (13.3%) and the secondary renal arteries were all in the suprarenal pole.2) The distance between the right margin of the right renal artery and the right edge of the inferior vena cava was 2. .4-11cm, the distance from the inferior vena cava was 0.7 + 0.59; the length of the renal artery located outside the right edge of the inferior vena cava to the inferior vena cava at the first-stage branch of the right renal artery was 2.7-0.74.10, and the branch of the right renal artery was located in the lower cavity. The distance of the posterior segment from the right margin of the inferior vena cava was-0.7 to 0.41 cm;10 cases of the right renal artery were located at the posterior segment of the inferior vena cava, the length of the renal artery between the inferior vena cava and the renal gate was 2.2 (0.24.3), and there were 20 cases (66 .7%):13 (43.3%),> 0.5 cm,7 (23.3%) in the right margin to 0.5 cm,10 (33.3%) in the right margin of the inferior vena cava at the right renal artery (33.3%) (including the anatomy of the two arteries) ).4) The secondary branch of the ventral branch was located in 10 (33) cases of the inside of the kidney. 3%); the secondary branch of the ventral branch 20 cases (66.7%) of the outside of the kidney (66.7%).2. DSA arteriography (1) DSA arteriography (1) DSA arteriography (30 cases): there were 5 cases (16.7%) of the secondary renal artery, and the subrenal artery both entered the suprarenal pole. (2) The branch of the renal artery The number and proportion in each segment were:9 (30.0%) of the first-grade branch in the inside of the kidney-door;15 (50.0%) of the kidney-door to the vena cava;6 (20.0%) in the right margin of the inferior vena cava; and 3) the secondary branch of the ventral branch was in the renal door 1. 2 ( Conclusion:1. The right inferior vena cava can be exposed. 2/3 The main artery of the renal artery of the study object, the closer to the renal gate, the more easily the renal artery segment is exposed, and the renal artery trunk is not easy to be exposed. 2.13.3%--16.6% of the upper and lower renal arteries of the kidney, when separating the upper pole of the kidney, should be highly alert to avoid injury.
【學(xué)位授予單位】：昆明醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2009
【分類號】：R699;R322
本文編號：2482177
[Abstract]:Purpose: The feasibility and attention of the posterior approach to the main trunk of the right kidney were discussed by observing the anatomy of the distance between the primary branch of the right kidney and the inferior vena cava, the relationship between the secondary branch of the right and the ventral branch and the renal hilum. (b) Matters. Materials and Methods:1. Anatomy 30 (27 male and 3 female) specimens of adult cadaveric anatomy were selected from the source of specimen and the observation index. The anatomic teaching and research room of the Ming Medical College is provided. Each organ of the abdomen has been exposed according to the routine anatomy (all the specimens are the anatomical teaching specimen made of the anatomical study chamber and the anatomic teaching specimen made for the external hospital). The right kidney external blood vessel is not damaged, the inferior vena cava is not damaged, and the right kidney position on the right side of the retroperitoneum No change was included in the study object. Observation index:1) The number of right renal artery and the presence or absence of the secondary renal artery were observed for each specimen. The distance from the inferior vena cava, the renal gate, the length of the renal artery between the renal gate and the inferior vena cava.3) The primary branch is located in the right margin of the inferior vena cava and the outer diameter of 0.5 cm, the number and the proportion of the 0.5 cm section, and 4) the ventral branch The relationship between the secondary branch and the kidney. The image data of the clinical right renal artery angiography (n = 21, female) provided by the interventional DSA in the second hospital of Kunming Medical College in 2003 and 2007 were collected from the data source and the observation index of the SA arteriography. 9), all study subjects were or suspected of the kidney There were 5 cases of right renal cell carcinoma (non-invasion of right and right renal artery),1 case of right nephritis,3 cases of right adrenal lesion,2 cases of right renal artery stenosis,3 cases of left renal disease and 2 cases of left renal artery stenosis. 2 cases of left renal atrophy,2 cases of left adrenal gland,2 cases of left renal disease, and right renal artery trunk imaging at the same time; pre-operative diagnosis No 10 cases of double renal artery were found in the operation of the artery stenosis. The observation index:1) The number of the right renal artery and the presence or absence of the secondary renal artery were observed;2) The relationship between the branch of the right renal artery and the renal and inferior vena cava was as follows: The internal or external of the right margin of the inferior vena cava; the primary branch is in or out of the kidney. .3) The secondary branch of the ventral branch is in the kidney Inside or outside of the door. Results:1.1) Right renal artery count 1 supported by the anatomical specimen (1) 28 cadavers (93.3%) and 2 cadavers (6.7%). The body of the secondary renal artery was 4 (13.3%) and the secondary renal arteries were all in the suprarenal pole.2) The distance between the right margin of the right renal artery and the right edge of the inferior vena cava was 2. .4-11cm, the distance from the inferior vena cava was 0.7 + 0.59; the length of the renal artery located outside the right edge of the inferior vena cava to the inferior vena cava at the first-stage branch of the right renal artery was 2.7-0.74.10, and the branch of the right renal artery was located in the lower cavity. The distance of the posterior segment from the right margin of the inferior vena cava was-0.7 to 0.41 cm;10 cases of the right renal artery were located at the posterior segment of the inferior vena cava, the length of the renal artery between the inferior vena cava and the renal gate was 2.2 (0.24.3), and there were 20 cases (66 .7%):13 (43.3%),> 0.5 cm,7 (23.3%) in the right margin to 0.5 cm,10 (33.3%) in the right margin of the inferior vena cava at the right renal artery (33.3%) (including the anatomy of the two arteries) ).4) The secondary branch of the ventral branch was located in 10 (33) cases of the inside of the kidney. 3%); the secondary branch of the ventral branch 20 cases (66.7%) of the outside of the kidney (66.7%).2. DSA arteriography (1) DSA arteriography (1) DSA arteriography (30 cases): there were 5 cases (16.7%) of the secondary renal artery, and the subrenal artery both entered the suprarenal pole. (2) The branch of the renal artery The number and proportion in each segment were:9 (30.0%) of the first-grade branch in the inside of the kidney-door;15 (50.0%) of the kidney-door to the vena cava;6 (20.0%) in the right margin of the inferior vena cava; and 3) the secondary branch of the ventral branch was in the renal door 1. 2 ( Conclusion:1. The right inferior vena cava can be exposed. 2/3 The main artery of the renal artery of the study object, the closer to the renal gate, the more easily the renal artery segment is exposed, and the renal artery trunk is not easy to be exposed. 2.13.3%--16.6% of the upper and lower renal arteries of the kidney, when separating the upper pole of the kidney, should be highly alert to avoid injury.
【學(xué)位授予單位】：昆明醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2009
【分類號】：R699;R322
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