腹腔入路腹腔镜根治性肾切除术中左肾静脉复合体的应用解剖  

The clinical anatomy of left renal venous-complex in transperitoneal-laparoscopic radical nephrectomy

作　　者：张玉豪 付硕涵 李腾飞 陶金[3] 张雪培[3] 任选义 Zhang Yuhao;Fu Shuohan;Li Tengfei;Tao Jin;Zhang Xuepei;Ren Xuanyi(Xinxiang Medical College,Xinxiang 453003,China;Department of Urology,Kaifeng Central Hospital,Kaifeng 475000,China;Department of Urology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]新乡医学院,新乡453003 [2]开封市中心医院泌尿外科,开封475000 [3]郑州大学第一附属医院泌尿外科,郑州450052

出　　处：《中华实验外科杂志》2023年第12期2481-2483,共3页Chinese Journal of Experimental Surgery

基　　金：开封市科技创新人才计划项目(2007009)。

摘　　要：目的探讨经腹腔入路腹腔镜根治性肾切除术(T-LRN)中左肾静脉复合体的解剖特征及其应用价值。方法2012年1月至2022年12月,对有手术指征的左肾肿瘤患者实施T-LRN并全程录像。观察左肾动脉定位过程,记录左肾静脉的位置、数目及其属支结构,包括左生殖静脉、肾上腺中央静脉和腰静脉的呈现、走行及终止点,目测血管径宽,记录相关的手术并发症。结果男114例、女72例入组,186例T-LRN手术均顺利。左肾动脉的定位过程中,检出左肾静脉189支(183例1支,3例2支),径宽中位数12.1(7.8~16.3)mm,位于肾动脉主干前方;左生殖静脉192支(180例1支,6例2支),血管径宽2.6(1.3~4.9)mm,直行汇入左肾静脉;左肾上腺中央静脉189支(183例1支,3例2支),径宽2.5(1.6~3.1)mm,直行汇入左肾静脉;检出179支(58例0支,128例为1~4支)腰静脉,径宽2.8(0.8~6.2)mm,多止点斜行汇入左肾静脉。静脉复合体血管损伤10例,含7例腰静脉出血,予以夹闭或缝扎。结论左肾静脉复合体是左侧T-LRN术中定位肾动脉的重要标志。左肾静脉位于肾动脉主干前方,常为单支;左生殖静脉和肾上腺中央静脉直行止于左肾静脉,多为单支;汇入左肾静脉的腰静脉支数和止点多变,血管斜行易撕裂。Objective To investigate the anatomical features and clinical value of left renal venous-complex in transperitoneal-laparoscopic radical nephrectomy(T-LRN).Methods From January 2012 to December 2022,T-LRN was applied for patients of left kidney tumor with surgical indications,and the operation were recorded on video.The process of renal artery localization were observed,the number and anatomical position of left renal vein and its genus branches,including the presentation,route and end site of left genital vein,central adrenal vein and lumbar vein,visual diameter of those venous vessels,and the related complications were recorded.Results A total of 186 cases were enrolled and left T-LRN were completed successfully,included 112 males and 72 females.During the operation of left renal artery localization,189 branches of left renal vein that located anterior to the renal artery trunk were detected(1 in 183 cases,2 in 3 cases),the median vessel diameter was 12.1(7.8-16.3)mm.192 branches of left genital vein(1 in 180 cases,2 in 6 cases)merged into left renal vein vertically,and its diameter was 2.6(1.3-4.9)mm.189 branches of left central adrenal veins(1 in 183 cases,2 in 3 cases)merged into left renal vein vertically,and its diameter was 2.5(1.6-3.1)mm.179 branches of lumbar veins(0 in 58 cases,1-4 branches in 128 cases)merged into left renal vein obliquely with variable insertions,and its diameter was 2.8(0.8-6.2)mm.10 cases of venous-complex related vascular injury occurred that including 7 cases of lumbar vein bleeding were clipped or sutured respectively.Conclusion The left renal venous-complex is an important marker for renal artery localization in left T-LRN.Left renal vein is located anterior to renal artery and is often single,left genital vein and central adrenal vein are mostly single and vertically merged into left renal vein.The branches and end sites of lumbar vein merged into left renal vein are variable and prone to tearing with obliquely vessels.

关 键 词：肾肿瘤 腹腔镜手术 肾静脉 解剖 

分 类 号：R737.11[医药卫生—肿瘤]