Institute of Academic Anaesthesia, University of Dundee, Dundee, United Kingdom.
Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom.
Clin Anat. 2020 Apr;33(3):350-354. doi: 10.1002/ca.23463. Epub 2019 Sep 8.
Multiple medical interventions require percutaneous instrumentation of the anterior abdominal wall, all of which carry a potential for vascular trauma. We assessed the presence, position, and size of the anterior abdominal wall superior and inferior (deep) epigastric arteries to determine the safest site with respect to vascular anatomy of the rectus sheath. In a review of 100 arterial phase, contrast-enhanced abdominal computed tomography scans, anterior abdominal wall arteries were assessed bilaterally at three axial planes: transpyloric, umbilicus, and anterior superior iliac spine (ASIS). The mean age of patients was 69.2 years (SD ± 15), with 62 male and 38 female. An artery was visible least frequently at the transpyloric plane (5%), compared with the umbilicus (72-79%) and ASIS (93-96%), on the left (χ (4) = 207.272; P < 0.001) and right (χ (4) = 198.553; P < 0.001), with a moderate strength association (Cramer's V = 0.588 (left) and 0.575 (right)). The arteries were most commonly observed within the rectus abdominis muscle at the level of the umbilicus and ASIS on both sides (62-68%). The inferior epigastric artery was observed to be larger in diameter, start more laterally, and move medially as it travelled superiorly. These data suggest that the safest site to instrument the rectus sheath, with respect to vascular anatomy, is at the transpyloric plane. This information on anatomical variation of the anterior abdominal wall vasculature may be of particular interest to anesthetists performing rectus sheath block and surgeons during laparoscopic port insertion. Clin. Anat. 33:350-354, 2020. © 2019 Wiley Periodicals, Inc.
多种医学干预措施需要经皮在前腹壁进行仪器操作，所有这些操作都有潜在的血管创伤风险。我们评估了前腹壁上、下（深部）腹直肌血管的存在、位置和大小，以确定在鞘血管解剖方面最安全的部位。在对 100 例动脉期增强腹部 CT 扫描进行回顾性研究中，我们在三个轴位平面（幽门平面、脐平面和前上髂嵴平面）评估了双侧前腹壁动脉：幽门平面、脐平面和前上髂嵴平面。患者的平均年龄为 69.2 岁（标准差 ± 15），其中 62 名男性和 38 名女性。与脐平面（72-79%）和前上髂嵴平面（93-96%）相比，左侧（χ (4) = 207.272；P < 0.001）和右侧（χ (4) = 198.553；P < 0.001）的幽门平面最不容易观察到动脉，存在中度关联（左侧 Cramer's V = 0.588，右侧 Cramer's V = 0.575）。在左右两侧，动脉最常观察到在脐平面和前上髂嵴平面位于腹直肌内（62-68%）。下腹部动脉的直径较大，起始位置更靠外侧，随着向近侧移动而向内侧移动。这些数据表明，就血管解剖而言，在幽门平面进行鞘内器械操作最安全。这些关于前腹壁血管解剖变异的信息可能对进行鞘内阻滞的麻醉师和进行腹腔镜端口插入的外科医生特别感兴趣。临床解剖学 33:350-354, 2020。版权所有© 2019 威利父子公司。
