Chentanez V, Nateniyom N, Huanmanop T, Agthong S
Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Rama 4 Road, 10330 Bangkok, Thailand.
Folia Morphol (Warsz). 2018;77(1):151-155. doi: 10.5603/FM.a2017.0074. Epub 2017 Aug 23.
Variations of the arterial and venous system of the abdomen and pelvis have important clinical significance in hepatobiliary surgery, abdominal laparoscopy, and radiological intervention. A case of double inferior vena cava (IVC) with complex interiliac communication and variation of the common hepatic artery (CHA) arising from superior mesenteric artery (SMA) in a 79-year-old male cadaver is presented. Both IVCs ascended on either side of the abdominal aorta. The left-sided IVC crossed anterior to the aorta at the level of the left renal vein. The union of both IVCs was at the level just above the right renal vein. The diameter of right-sided IVC, left-sided IVC and the common IVC were 16.73 mm, 21.57 mm and 28.75 mm, respectively. In the pelvic cavity, the right common iliac vein was formed by a union of right external and internal iliac veins while the formation of left common iliac vein was from the external iliac vein and two internal iliac veins. An interiliac vein ran from right internal iliac vein to left common iliac vein with an additional communicating vein running from the middle of this interiliac vein to the right common iliac vein. Another co-existence variation in this case was the origin of the CHA arising from the SMA with a suprapancreatic retroportal course. Clinical importance of double IVC are observed in retroperitoneal surgery, whole organ transplantation or radical nephrectomy, surgical ligation of the IVC or the placement of an IVC filter for thromboembolic disease. The variation of CHA has an important clinical significance in liver transplantation, abdominal laparoscopy and radiological abdominal intervention. (Folia Morphol 2018; 77, 1: 151-155).
腹部和盆腔动静脉系统的变异在肝胆外科手术、腹部腹腔镜检查及放射介入治疗中具有重要的临床意义。本文报道了一例79岁男性尸体中出现的双下腔静脉(IVC),伴有复杂的髂间交通以及肠系膜上动脉(SMA)发出的肝总动脉(CHA)变异。两条下腔静脉分别在腹主动脉两侧上行。左侧下腔静脉在左肾静脉水平经腹主动脉前方交叉。两条下腔静脉在右肾静脉上方水平汇合。右侧下腔静脉、左侧下腔静脉及汇合后的下腔静脉直径分别为16.73mm、21.57mm和28.75mm。在盆腔内,右侧髂总静脉由右髂外静脉和右髂内静脉汇合而成,而左侧髂总静脉由髂外静脉和两条髂内静脉汇合而成。一条髂间静脉从右髂内静脉延伸至左髂总静脉,另有一条交通静脉从这条髂间静脉中部延伸至右髂总静脉。该病例中另一个并存的变异是肝总动脉起源于肠系膜上动脉,并走行于胰上后方门静脉后。双下腔静脉在腹膜后手术、全器官移植或根治性肾切除、下腔静脉手术结扎或放置下腔静脉滤器治疗血栓栓塞性疾病中具有临床意义。肝总动脉变异在肝移植、腹部腹腔镜检查及腹部放射介入治疗中具有重要的临床意义。(《形态学杂志》2018年;77卷,第1期:151 - 155页)