Hamabe Atsushi, Harino Takashi, Ogino Takayuki, Tanida Tsukasa, Noura Shingo, Morita Shunji, Dono Keizo
Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan.
BMC Surg. 2020 Mar 16;20(1):47. doi: 10.1186/s12893-020-00711-0.
In pelvic surgery, it is important to anticipate potential anatomic variations, which may be unknown, and inter-relationships among intrapelvic vessels. Here, we comprehensively analyzed intrapelvic vessel patterns.
This retrospective analysis included 81 patients that underwent colorectal surgery in our institution in 2016. A total of 162 half-pelvises were imaged with contrast-enhanced computed tomography. We scrutinized thin-slice images.
We found variations in the number of internal iliac veins. In 47.5% of cases, one internal iliac vein drained into the ipsilateral common iliac vein in both halves of the pelvis. In the other cases, several internal iliac veins were observed in one or both halves of the pelvis. We analyzed the inter-relationships between the superior gluteal artery and the sacral nerve plexus in pelvic halves. Superior gluteal arteries ran between the 5th lumbar nerve and 1st sacral nerves, in 82% of halves, and lateral to the 5th lumbar nerve, in 17% of halves. Dorsally, the superior gluteal artery ran on the medial side of the internal iliac vein in 15% of halves. In 28% of half-pelvises, two superior gluteal veins were observed. Superior gluteal veins passed through the sacral nerve plexus lateral to 5th lumbar, between 5th lumbar and 1st sacral, and between 1st and 2nd sacral nerve, in 42.0, 47.5, and 37.7% of halves, respectively. We evaluated the rate of symmetric pelvic anatomies, and found that all anatomic variations formed symmetrically, except the number of internal iliac veins.
This study clarified the anatomical variations of intrapelvic vessels and their inter-relationships. These findings will benefit our understanding of pelvic anatomy and enhance the safety of radical surgery for treating pelvic diseases.
在盆腔手术中，预测可能未知的潜在解剖变异以及盆腔内血管之间的相互关系非常重要。在此，我们全面分析了盆腔内血管模式。
这项回顾性分析纳入了2016年在我们机构接受结直肠手术的81例患者。总共对162个半侧骨盆进行了增强CT成像。我们仔细检查了薄层图像。
我们发现髂内静脉数量存在变异。在47.5%的病例中，两侧骨盆的髂内静脉均汇入同侧的髂总静脉。在其他病例中，一侧或两侧骨盆中观察到多条髂内静脉。我们分析了半侧骨盆中臀上动脉与骶神经丛之间的相互关系。82%的半侧骨盆中，臀上动脉走行于第5腰神经和第1骶神经之间，17%的半侧骨盆中，臀上动脉走行于第5腰神经外侧。在背侧，15%的半侧骨盆中，臀上动脉走行于髂内静脉内侧。在28%的半侧骨盆中，观察到两条臀上静脉。臀上静脉分别在42.0%、47.5%和37.7%的半侧骨盆中穿过第5腰神经外侧、第5腰神经与第1骶神经之间以及第1骶神经与第2骶神经之间的骶神经丛。我们评估了盆腔解剖结构的对称率，发现除了髂内静脉数量外，所有解剖变异均呈对称形成。
本研究阐明了盆腔内血管的解剖变异及其相互关系。这些发现将有助于我们理解盆腔解剖结构，并提高盆腔疾病根治性手术的安全性。
