Department of Obstetrics and Gynecology, Vanderbilt University Medical Center (Drs. Chaves, Johnson, Jesse, and Yunker), and Vanderbilt University School of Medicine (Ms. Apple), Nashville, TN..
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center (Drs. Chaves, Johnson, Jesse, and Yunker), and Vanderbilt University School of Medicine (Ms. Apple), Nashville, TN.
J Minim Invasive Gynecol. 2022 Jul;29(7):848-854. doi: 10.1016/j.jmig.2022.03.007. Epub 2022 Mar 17.
Studies delineating left upper quadrant (LUQ) anatomy across a range of body mass indices are lacking. We aimed primarily to compare, between nonobese and obese women, abdominal wall thickness and the distance from the LUQ to key structures. In addition, we aimed to characterize LUQ anatomy in underweight women.
A retrospective cohort study.
A tertiary academic medical institution.
Sixty women (30 nonobese, 30 obese) aged 18 years and older who underwent abdominal imaging from October 1, 2018, to December 31, 2018.
Computed tomography imaging of the chest, abdomen, and pelvis.
Abdominal wall thickness at the LUQ was significantly greater in obese (4.3 ± 1.7 cm) than nonobese patients (2.4 ± 1.7 cm) (p <.001), as were distances to all key structures (aorta, vena cava, spleen, stomach, pancreas, liver, left kidney, and pelvis) (p ≤.02). On average, all structures, with the exception of stomach and liver, were >10 cm (the length of a typical insufflation needle) away from the LUQ insertion point in obese women. In underweight women, the aorta, spleen, stomach, pancreas, and liver were all within 10 cm of the LUQ insertion point. Within the obese and nonobese group, abdominal wall thickness at the LUQ was significantly greater than at the umbilicus (p <.001). Body mass index was more strongly correlated with abdominal wall thickness at the LUQ (r = 0.84; p <.001) than at the umbilicus (r = 0.69; p <.001) (p = .007 for comparison).
This study highlights special anatomic considerations for LUQ access in obese and underweight patients. In obese women, abdominal wall thickness may be greater at this site than at the umbilicus and the liver and stomach remain within reach of an insufflation needle. The increased working distance from the LUQ to the pelvis in obese patients may necessitate specialized instruments if this site is used during surgery. In underweight women, the aorta, in addition to many other structures, is within reach of commonly used entry devices.
缺乏对不同身体质量指数（BMI）范围内左上象限（LUQ）解剖结构的研究。我们的主要目的是比较非肥胖和肥胖女性之间的腹壁厚度以及 LUQ 与关键结构之间的距离。此外，我们旨在描述体重不足女性的 LUQ 解剖结构。
回顾性队列研究。
一家三级学术医疗中心。
2018 年 10 月 1 日至 2018 年 12 月 31 日期间接受腹部成像检查的 60 名年龄在 18 岁及以上的女性（30 名非肥胖者，30 名肥胖者）。
胸部、腹部和骨盆的计算机断层扫描成像。
肥胖患者 LUQ 处的腹壁厚度（4.3±1.7cm）明显大于非肥胖患者（2.4±1.7cm）（p<.001），所有关键结构（主动脉、腔静脉、脾脏、胃、胰腺、肝脏、左肾和骨盆）的距离也均较大（p≤.02）。平均而言，除胃和肝脏外，所有结构都距离肥胖女性 LUQ 插入点超过 10cm（典型注气针的长度）。在体重不足的女性中，主动脉、脾脏、胃、胰腺和肝脏均在 LUQ 插入点的 10cm 范围内。在肥胖和非肥胖组中，LUQ 处的腹壁厚度明显大于脐部（p<.001）。BMI 与 LUQ 处腹壁厚度的相关性明显强于脐部（r=0.84;p<.001）（r=0.69;p<.001）（p=.007 比较）。
本研究强调了肥胖和体重不足患者 LUQ 入路的特殊解剖考虑因素。在肥胖女性中，该部位的腹壁厚度可能大于脐部，肝脏和胃仍在注气针的可触及范围内。肥胖患者从 LUQ 到骨盆的工作距离增加，如果在手术中使用该部位，则可能需要特殊的器械。在体重不足的女性中，除其他许多结构外，主动脉也在常用的进入装置可触及的范围内。
