腹腔镜L5～S1前入路的血管影像解剖学观察及其临床意义  

The vascular radioanatiomical study of laparoscopic anterior lumbar approach in L_5～S_1 disc

作　　者：刘金伟[1] 宋磊[2] 丁自海[1] 吴涛[1] 

机构地区：[1]南方医科大学微创外科解剖学研究所,广东省创伤救治科研中心,广州510515 [2]解放军89医院骨科,山东潍坊261000

出　　处：《中国临床解剖学杂志》2008年第3期300-303,共4页Chinese Journal of Clinical Anatomy

基　　金：广东省科技厅重大专项基金(2006A36001003)

摘　　要：目的:为腹腔镜下L5～S1椎间盘前入路提供血管影像学依据。方法:对248例磁共振成像(MRI)轴位图像进行观察与测量,并依据L5～S1椎间盘前方"血管间隙"占椎间盘宽度的比例将其分为3型:标准型、狭窄型和阻挡型。结果:(1)左髂血管(LIV)内侧到正中线的距离为(1.48±0.83)cm;(2)右髂血管(RIV)内侧到正中线的距离为(1.68±0.61)cm;(3)L5～S1椎间盘前方血管间隙为(3.18±1.20)cm;(4)L5～S1椎间盘前方血管间隙与椎间盘宽度的比值(R)为(55.77±22.18)%。标准型占46.78%;狭窄型占14.11%;阻挡型占39.11%。血管间隙左侧内面为静脉者占98.79%,且有4.84%位于正中线的右侧。R值随年龄的增大而减小,且在女性较男性为大。结论:应用MRI轴位图像进行观察、分型,可以较好的进行术前评估。本文结果显示,60.89%可以较安全地从前方进入L5～S1椎间盘区,完成腹腔镜下前路L5～S1椎间盘手术。Objective： To supply the imaging information for the laparoscopic anterior lumbar approach in L5-S1 disc. Methods： The study data collected from 248 patients who underwent MRI of the lumbosacral disc, and a classification system which contained 3 different types was devised based on the ratio of the vascular space in front of lumbosacral disc to its width. Results： The distance from left iliac vessel （LW） to median line was about （1.48±0.83）cm, from right iliac vessel（RIV） to median line （1.68±0.61）cm. The vessel space in front of lumbosacral disc was （3.18±1.20） cm, and the ratio of the vascular space in front of lumbosacral disc to its width was （55.77±22.18） %. According to morphologic classification, 46.78% （116 cases） were found to be Standard （the exposure ratio more than 60%）, 14.11% （35 cases） Narrow （the ratio between 50% and 60%）, and 39.11% （97 cases） Barrier （the ratio less than 50%）. For 98.79% cases, veins accounted for the left side of the vascular space, and for 4.84% （12 cases）, in the midline of the right. The R-value showed a highly significant downward shift with increasing age, and the shift was more pronounced in women. Conclusions： By investigation and morphologic classification using MRI axial images, we can better to carry out the preoperative evaluation of surgical operations and to provide valuable information. The research shows that there are 60.89% of the patients can be safely and effectively reached to the front of the lumbosacral disc, and to accomplish laparoscopic anterior lumbar surgery.

关 键 词：腹腔镜 MRI L5-S1椎间盘 分型 

分 类 号：R322.12[医药卫生—人体解剖和组织胚胎学] R445.2[医药卫生—基础医学]