Di Marino V, Coppens R, Brunet C, Bonnoit J, Nazarian S
Laboratoire d'Anatomie, Faculté de Médecine Timone, Marseille, France.
Bull Assoc Anat (Nancy). 1990 Sep;74(226):5-13.
The abdominal organs removals, with a view to transplants, are complex surgical operations which require a perfect knowledge of visceral vascular anatomy. The common point of these removals is the "birenal en bloc excision", whose we have codified the development. This removal has induced us to revise many points of surgical anatomy and particulary: the connections between the liver and the right kidney; the importance of the mesoduodenum; the relative orientations of the portal vein and inferior vena cava axis; the ureteral vascularisation; the topography and the number of renal arteries; the connections between renal arteries orifices and superior mesenteric arterial orifice. When we have to remove, besides the kidneys, the liver or the pancreas or even the small intestine, surgical problems are the same, but then, the dissections concern also the celiac axis and the superior mesenteric artery. These multiple removals raise also many questions to the anatomist, the most interesting concerning: the multiple hepatic arteries; the connections between celiac branches of the abdominal aorta. All these notions are envisaged not only by the light of the anatomical preparations but also by reference to the clinical experience of the authors.
为了进行移植而进行的腹部器官切除是复杂的外科手术，需要对内脏血管解剖有透彻的了解。这些切除手术的共同点是“双侧肾脏整块切除”，我们已经对其操作过程进行了编纂。这种切除促使我们对许多外科解剖学要点进行了修订，特别是：肝脏与右肾之间的连接；十二指肠系膜的重要性；门静脉和下腔静脉轴的相对方向；输尿管的血管供应；肾动脉的位置和数量；肾动脉开口与肠系膜上动脉开口之间的连接。当除了肾脏之外还必须切除肝脏、胰腺甚至小肠时，手术问题是相同的，但此时的解剖还涉及腹腔干和肠系膜上动脉。这些多次切除也给解剖学家提出了许多问题，其中最有趣的是：多条肝动脉；腹主动脉腹腔分支之间的连接。所有这些概念不仅根据解剖标本进行了设想，还参考了作者的临床经验。
