下腔静脉膈上段解剖特征及毗邻关系的尸体研究  

Anatomical characteristics of the superior segment of the inferior vena cava and its adjacent relationship: a cadaveric study

作　　者：喻垚 俞鸿凯[1] 黄庆波[1] 刘侃[1] 彭程[1] 杜松良 李炳根 李时祺 赵国栋[4] 王高飞[5] 张旭[1] 马鑫[1] 王保军[1] Yu Yao;Yu Hongkai;Huang Qingbo;Liu Kan;Peng Cheng;Du Songliang;Li Binggen;Li Shiqi;Zhao Guodong;Wang Gaofei;Zhang Xu;Ma Xin;Wang Baojun(Department of Urology,Third Medical Center,General Hospital of the People's Liberation Army of China,Beijing 100853,China;Department of General Surgery,Hexian Memorial Hospital,Southern Medical University,Guangzhou 511400,China;Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Hepatobiliary Surgery,First Medical Center,General Hospital of the People's Liberation Army of China,Beijing 100853,China;Department of Pathology,First Medical Center,General Hospital of the People's Liberation Army of China,Beijing 100853,China)

机构地区：[1]解放军总医院第三医学中心泌尿外科医学部,北京100853 [2]南方医科大学附属何贤纪念医院普通外科,广州511400 [3]南方医科大学南方医院普通外科,广州510515 [4]解放军总医院第一医学中心肝胆外二科,北京100853 [5]解放军总医院第一医学中心病理科,北京100853

出　　处：《中华泌尿外科杂志》2021年第3期214-219,共6页Chinese Journal of Urology

基　　金：国家自然科学基金(81970594)。

摘　　要：目的明确腹腔镜手术中下腔静脉膈上段的解剖特点及毗邻关系。方法2018年12月于南方医科大学基础医学院选取成人尸体、新鲜尸体各2例。对冰冻尸体进行解剖。沿双侧锁骨中线打开胸腔,翻开心包前壁,解剖分离上腔静脉、下腔静脉。沿腹正中线打开腹腔,翻左、右肝叶,显露肝后段下腔静脉、第二肝门,剖开腔静脉裂孔进入心包,观察下腔静脉膈上段的解剖特点及毗邻关系,测量下腔静脉膈上段长度。对新鲜尸体行腹腔镜手术试验,于脐旁、右侧腹直肌旁距脐约4 cm、腹正中线脐上约6 cm、右侧腋前线肝下缘下方约2 cm、左侧锁骨中线肝下缘下方约2 cm置入5个12 mm套管。腹腔镜辅助下翻左、右肝叶,显露肝后段下腔静脉、第二肝门,剖开腔静脉裂孔进入心包,观察下腔静脉膈上段的解剖特点及毗邻关系。结果2例尸体解剖中可见,下腔静脉经肝的腔静脉沟,穿膈的腔静脉孔进入胸腔,再穿纤维心包注入右心房。测量下腔静脉膈肌至右心房入口的长度分别为1.67 cm和2.57 cm。2例腹腔镜手术试验,可很好地显露肝后段下腔静脉、第二肝门、下腔静脉膈肌入口;沿腔静脉裂孔打开膈肌存在一个相对无血管的脂肪组织解剖层次;心包与右心房之间有较大的解剖间隙,可很好地显露下腔静脉、上腔静脉及右心房,可完整连续地显露整个膈下至右心房入口节段的下腔静脉。结论下腔静脉旁存在一个相对无血管的解剖层次,腹腔镜手术中经腹腔打开膈肌可较安全地进入心包,很好地显露下腔静脉、上腔静脉及右心房,为经该入路行MayoⅣ级下腔静脉癌栓取出术提供了可能。Objective To clarify the anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava during laparoscopic surgery.Methods In December 2018,two frozen and two fresh adult cadavers were dissected.The chest of the frozen cadavers was opened along the bilateral midline of the clavicle,the anterior pericardial wall was opened,and the superior vena cava and the inferior vena cava was dissected.The abdominal cavity was opened along the midline of the abdomen,the left and right hepatic lobes were turned over,the inferior vena cava and the second hilum of the posterior segment of the liver were exposed,and the hiatus of the inferior vena cava was opened and entered the pericardium.The anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava were observed,and the length of the superior segment of the inferior vena cava was measured.The fresh frozen cadaver patients underwent laparoscopic surgery.Five 12 mm trocars were placed at the side of umbilicus,right rectus abdominis about 4 cm from umbilicus,midline of abdomen about 6 cm above umbilicus,right axillary front about 2 cm below inferior edge of liver,left midline of clavicle about 2 cm below inferior edge of liver.Laparoscopic-assisted turning of the left and right hepatic lobes,exposing the posterior inferior vena cava and the second hilum of the liver,opening of the vena cava hiatus into the pericardium.The anatomical characteristics and adjacent relationship of the upper diaphragmatic segment of the inferior vena cava were observed.Results In two autopsies,the inferior vena cava entered the chest through the cava sulcus of the liver and the phrenic foramen cava,and then through the fibrous pericardium into the right atrium.The length from the diaphragm of inferior vena cava to the right atrium was 1.67 cm,2.57 cm.In laparoscopic operation,the diaphragm entrance of the posterior segment of the liver inferior vena cava,the second hepatic portal and the inferior vena cava could be we

关 键 词：腔静脉 下 膈肌 解剖学研究 尸体解剖 腹腔镜手术 下腔静脉癌栓 

分 类 号：R737.11[医药卫生—肿瘤]