Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Am J Obstet Gynecol. 2010 Mar;202(3):234.e1-5. doi: 10.1016/j.ajog.2009.10.878. Epub 2009 Dec 22.
We sought to describe relationships of clinically relevant nerves and vessels of the anterior abdominal wall.
The ilioinguinal and iliohypogastric nerves and inferior epigastric vessels were dissected in 11 unembalmed female cadavers. Distances from surface landmarks and common incision sites were recorded. Additional surface measurements were taken in 7 other specimens with and without insufflation.
The ilioinguinal nerve emerged through the internal oblique: mean (range), 2.5 (1.1-5.1) cm medial and 2.4 (0-5.3) cm inferior to the anterior superior iliac spine (ASIS). The iliohypogastric emerged 2.5 (0-4.6) cm medial and 2.0 (0-4.6) cm inferior. Inferior epigastric vessels were 3.7 (2.6-5.5) cm from midline at the level of the ASIS and always lateral to the rectus muscles at a level 2 cm superior to the pubic symphysis.
Risk of anterior abdominal wall nerve and vessel injury is minimized when lateral trocars are placed superior to the ASISs and >6 cm from midline and low transverse fascial incisions are not extended beyond the lateral borders of the rectus muscles.
描述前腹壁相关临床神经和血管的关系。
在 11 具未经防腐处理的女性尸体中解剖了髂腹股沟神经和髂腹下神经以及下腹壁血管。记录了从体表标志和常见切口位置到这些神经和血管的距离。在另外 7 具带有和不带有充气的标本上进行了其他的体表测量。
髂腹股沟神经从腹内斜肌穿出，平均（范围）距离前上髂嵴（ASIS）内侧面 2.5（1.1-5.1）cm，下侧面 2.4（0-5.3）cm。髂腹下神经穿出距离内侧面 2.5（0-4.6）cm，下侧面 2.0（0-4.6）cm。下腹壁血管距离 ASIS 水平的中线 3.7（2.6-5.5）cm，始终位于腹直肌外侧，在耻骨联合上 2cm 处与腹直肌等高。
当侧方套管位于 ASIS 上方且距离中线 >6cm，以及横向筋膜切口不延伸超过腹直肌外侧边界时，可最大程度地降低前腹壁神经和血管损伤的风险。
