Liu Yan, Gu Bo-feng, Yang Li, Wang Chen-xi
Department of Obstetrics and Gynecology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Zhonghua Yi Xue Za Zhi. 2006 Feb 21;86(7):450-2.
To study the anatomic relationship of the umbilicus to the retroperitoneal major vessels and the characteristics of such relationships among the Chinese with different body weights so as to provide a clear reference to the operator of laparoscopy.
Eighty-nine patients without pelvic disease, 57 males and 32 females who accepted digital subtraction angiography (DSA) of aorta were randomly selected and divided into 3 groups: non-obese group, overweight group, and obese group according to body mass index (BMI). All the patients lied supine with a round block of lead 1 cm in diameter located on the umbilicus. Seldinger technique was used to puncture the right femoral artery so as to conduct DSA. Using the bifurcation of the abdominal aorta as reference point the vertical projection relationships of the umbilicus to the retroperitoneal major vessels, abdominal aorta, right common iliac artery, and left common iliac artery were evaluated and the distance from the umbilicus to the aortic bifurcation was measured. The distance was regarded as positive if the umbilicus was cephalic to the aortic bifurcation and as negative if the umbilicus was caudal to the aortic bifurcation
There were 32 patients in the normal body weight group, 35 in the overweight group, and 22 in the obese group with the mean distances from the umbilicus to the aortic bifurcation of (14.8 +/- 19.7) mm, (0.04 +/- 2.5) mm, and (-12.6 +/- 15.4) mm respectively. In 50 of the 89 patients (63.9%) the location of umbilicus corresponded to the retroperitoneal major vessels, among which the umbilicus of 47 patients (94%) projected vertically to the abdominal aorta or the right common iliac, and the umbilicus of 3 patients (6%) projected vertically to the left common iliac artery. Compared to the above-mentioned 50 patients, in the other 39 patients (36.1%) the location of umbilicus did not corresponded to the retroperitoneal major vessels (P < 0.05), among which the umbilicus of 32 patients (82.1%) projected vertically to the right side of the aorta or of the right common iliac artery, and the umbilicus of 7 patients (17.9%) projected vertically to the internal side of the right iliac common artery. Along with the increase of body weight the projection of umbilicus gradually moved downward to the inferior side of the bifurcation of the abdominal artery. For example, among the male subjects, the distance were (10.4 +/- 4.0) mm, (-0.51 +/- 5.5) mm, and (-13.1 +/- 2.2) mm respectively in the normal body weight group, overweight group, and obese group (all P < 0.05), and in the females, the distance were (13.7 +/- 2.8) mm, (-0.14 +/- 4.4) mm, and (-11.5 +/- 3.2) mm respectively in the normal body weight group, overweight group, and obese group (all P < 0.05).
The location of umbilicus was more caudal with the increase of BMI. So once the retroperitoneal major vessels are injured, the incidence of aorta or the right common iliac artery is higher than that of other vessels.
研究脐与腹膜后大血管的解剖关系以及不同体重中国人之间这种关系的特点，为腹腔镜手术操作者提供明确参考。
随机选取89例无盆腔疾病且接受主动脉数字减影血管造影（DSA）的患者，其中男性57例，女性32例，根据体重指数（BMI）分为3组：非肥胖组、超重组和肥胖组。所有患者仰卧位，脐部放置一块直径1cm的圆形铅块。采用Seldinger技术穿刺右股动脉进行DSA。以腹主动脉分叉为参考点，评估脐与腹膜后大血管、腹主动脉、右髂总动脉和左髂总动脉的垂直投影关系，并测量脐至主动脉分叉的距离。若脐位于主动脉分叉上方，则该距离为正；若脐位于主动脉分叉下方，则该距离为负。
正常体重组32例，超重组35例，肥胖组22例，脐至主动脉分叉的平均距离分别为（14.8±19.7）mm、（0.04±2.5）mm和（-12.6±15.4）mm。89例患者中50例（63.9%）脐的位置与腹膜后大血管相对应，其中47例（94%）患者的脐垂直投影于腹主动脉或右髂总动脉，3例（6%）患者的脐垂直投影于左髂总动脉。与上述50例患者相比，另外39例（36.1%）患者的脐位置与腹膜后大血管不相对应（P<0.05），其中32例（82.1%）患者的脐垂直投影于主动脉或右髂总动脉右侧，7例（17.9%）患者的脐垂直投影于右髂总动脉内侧。随着体重增加，脐的投影逐渐向下移至腹主动脉分叉下方。例如，男性患者中，正常体重组、超重组和肥胖组的距离分别为（10.4±4.0）mm、（-0.51±5.5）mm和（-13.1±2.2）mm（均P<0.05）；女性患者中，正常体重组、超重组和肥胖组的距离分别为（13.7±2.8）mm、（-0.14±4.4）mm和（-11.5±3.2）mm（均P<0.05）。
随着BMI增加，脐的位置更靠下。因此，一旦腹膜后大血管受损，主动脉或右髂总动脉损伤的发生率高于其他血管。
