Department of Anesthesiology and Pain Medicine, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Grand Concourse, Bronx, NY 10457, USA.
Reg Anesth Pain Med. 2011 Jan-Feb;36(1):21-5. doi: 10.1097/AAP.0b013e318203067f.
The celiac plexus is a dense autonomic network surrounding the celiac trunk. To block this plexus, the celiac trunk is a landmark for needle placement. Needles inserted at a distance from the midline, "walking off" the vertebra, may penetrate surrounding organs. We reviewed 200 computed tomography images to investigate the celiac trunk topography relating to the block.
Two hundred computed tomography images across the celiac trunk were displayed. The celiac emergence level and celiac-aortic-vertebral anatomies were examined. On each image, 2 needle trajectories imitating walking-off technique were placed tangential to the vertebral body passing through the crus of the diaphragm on both sides: L-9s and L-4.5s (9 and 4.5 cm from the midline, respectively). The vital organs traversed by these lines were noted and analyzed.
Celiac emergence levels: T11-12, 6.5%; T12, 34%; T12-L1, 31%; L1, 28.5%. Aortic locations: 70% were anterior-left to and 29% were anterior-middle to the vertebra. Celiac runoffs: 63.5% from the aorta anterolaterally on the left, 36% from the midportion. Celiac-aortic-vertebral correlations showed a various distribution in groups; 88% L-9s and 64% L-4.5s on the right side, and 96% L-9s and 88% L-4.5s on the left side traversed different vital organs with various frequencies.
The celiac trunk anatomy varies. Blocking needles walking off the vertebra from a fixed distance frequently traverse vital organs. Previewing celiac-aortic-vertebral topography with a simulating block on individual patient's computed tomography (CT) image for accordant needle placement subsequently is warranted.
腹腔神经丛是围绕腹腔干的密集自主神经网络。为了阻断该丛，腹腔干是针尖放置的标志。从中线距离插入的针，“偏离”椎体，可能会穿透周围器官。我们回顾了 200 例 CT 图像，以研究与阻滞相关的腹腔干解剖结构。
共展示了 200 例腹腔干 CT 图像。检查了腹腔干出现水平和腹腔干-主动脉-椎体解剖结构。在每张图像上，模仿走行技术，分别在两侧膈的弓状缘穿过，模拟两条针尖轨迹：L-9s 和 L-4.5s（分别距中线 9cm 和 4.5cm）。记录并分析这些线穿过的重要器官。
腹腔干出现水平：T11-12，6.5%；T12，34%；T12-L1，31%；L1，28.5%。主动脉位置：70%位于椎体前左方，29%位于前中方。腹腔干流出：63.5%从主动脉前外侧左侧，36%从中段左侧。腹腔干-主动脉-椎体的相关性显示出不同的分布：右侧 88%的 L-9s 和 64%的 L-4.5s，左侧 96%的 L-9s 和 88%的 L-4.5s，穿过不同的重要器官，频率各不相同。
腹腔干解剖结构多变。从固定距离偏离椎体的阻滞针经常穿过重要器官。在个体化患者的 CT 图像上进行模拟阻滞，预先查看腹腔干-主动脉-椎体的解剖结构，以便随后放置一致的针尖，这是有必要的。
