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髂腹下神经、髂腹股沟神经和生殖股神经的腹膜后走行:一项旨在改善三联神经切除术时识别和切除的研究。

Retroperitoneal course of iliohypogastric, ilioinguinal, and genitofemoral nerves: A study to improve identification and excision during triple neurectomy.

作者信息

Geh Ndi, Schultz Mike, Yang Lynda, Zeller John

机构信息

University of Michigan Medical School, Ann Arbor, Michigan.

Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan.

出版信息

Clin Anat. 2015 Oct;28(7):903-9. doi: 10.1002/ca.22592. Epub 2015 Jul 16.

Abstract

Triple neurectomy of the iliohypogastric (IHN), ilioinguinal (IIN), and genitofemoral (GFN) nerves is an available treatment option for chronic groin pain when conservative measures are ineffective. This research study attempted to define the variability of IHN, IIN, and GFN by categorizing variation and establishing a relationship to clinically significant landmarks. 22 cadavers (43 specimens) were dissected. Age, gender, ethnicity, BMI, and pertinent medical history were recorded for each specimen. Nerve emergence, insertion, and split points were measured in relation to clinically significant landmarks. Retroperitoneal trajectories of IHN, IIN, and GFN were analyzed and categorized based on nerve branching patterns. IIN and IHN had three branching patterns - type A (47%) in which the IIH and IIN exit as separate branches; type B (26%) in which the IIH and IIN exit as a single bundle and split; and type C (28%) in which the IIH and IIN exit and do not split. The GFN had three branching patterns--type 1 (50%) in which the GFN exited from the psoas major and then split into the genital and femoral branches; type 2 (30%) in which the GFN exited and did not split; and type 3 (20%) in which the GFN exited the psoas major already split into the genital and femoral branches. Variations in the IHN, IIN, and GFN nerves outlined in this study will provide surgeons with clinically useful information aiding in successful and efficient localization of these nerves during retroperitoneal procedures, including laparoscopic triple neurectomy.

摘要

当保守治疗无效时,对髂腹下神经(IHN)、髂腹股沟神经(IIN)和生殖股神经(GFN)进行三联神经切除术是治疗慢性腹股沟疼痛的一种可行选择。本研究试图通过对变异进行分类并建立与临床重要标志的关系来确定IHN、IIN和GFN的变异性。解剖了22具尸体(43个标本)。记录每个标本的年龄、性别、种族、体重指数和相关病史。测量神经的穿出点、入肌点和分支点与临床重要标志的关系。根据神经分支模式对IHN、IIN和GFN的腹膜后走行进行分析和分类。IIN和IHN有三种分支模式——A型(47%),即髂腹下神经和髂腹股沟神经作为独立分支穿出;B型(26%),即髂腹下神经和髂腹股沟神经作为单一束穿出并分支;C型(28%),即髂腹下神经和髂腹股沟神经穿出后不分支。GFN有三种分支模式——1型(50%),即生殖股神经从腰大肌穿出后再分为生殖支和股支;2型(30%),即生殖股神经穿出后不分支;3型(20%),即生殖股神经从腰大肌穿出时已分为生殖支和股支。本研究中概述的IHN、IIN和GFN神经的变异将为外科医生提供临床有用信息,有助于在腹膜后手术(包括腹腔镜三联神经切除术)中成功、有效地定位这些神经。

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