Department of Gynecology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China.
Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guang Zhou Northern Avenue, GuangZhou, 510515, China.
Int Urogynecol J. 2023 Sep;34(9):2257-2263. doi: 10.1007/s00192-023-05500-w. Epub 2023 Apr 22.
The area around the sacral promontory (SP) is the targeted location of various pelvic operations. We examined the internal iliac vein (IIV) configurations around the SP by computed tomography angiography (CTA) three-dimensional (3D) reconstruction to describe its anatomy and provide accurate anatomical parameters for relevant operations to reduce intraoperative vascular injury.
We retrospectively studied 2078 CTA 3D model datasets from Nanfang Hospital patients examined for gynecological diseases from December 2009 to October 2020. The IIVs of the above cases were divided into standard and variant IIVs, and variant IIVs were subdivided into different subtypes. To compare the size of the avascular area around the SP between standard and variant IIVs, we selected the two subtypes with the highest variation rate for comparison with the standard IIV type.
The most common types of variant IIVs were 5a (5.15%) and 3a (5.05%). The results showed larger values in the standard group than in the 3a and 5a groups for the confluence of common iliac vein (CCIV) height (37.73±12.05 vs. 28.93±10.17 vs. 27.27±7.58 mm, P < 0.05), distance between the iliac vessels (49.47±9.47 mm vs. 37.08±9.36 vs. 37.73±8.94 mm, P < 0.05), and SP exposure width (44.94±6.39 mm vs. 36.83±8.29 vs. 36.93±7.91, P < 0.05).
Variant IIVs may increase the risk of surgery by reducing the avascular area compared with standard IIVs. Therefore, when operating around the SP, special attention should be given to variant IIVs and avoiding vascular injury.
骶骨岬（SP）周围区域是各种骨盆手术的目标位置。我们通过计算机断层血管造影（CTA）三维（3D）重建检查 SP 周围的髂内静脉（IIV）结构，描述其解剖结构，并为相关手术提供准确的解剖参数，以减少术中血管损伤。
我们回顾性研究了 2078 例 2009 年 12 月至 2020 年 10 月在南方医院因妇科疾病接受检查的患者的 CTA 3D 模型数据集。将上述病例的 IIV 分为标准型和变异型 IIV，并将变异型 IIV 进一步分为不同亚型。为了比较 SP 周围无血管区在标准型和变异型 IIV 之间的大小，我们选择了两种变异率最高的亚型与标准 IIV 型进行比较。
最常见的变异型 IIV 类型为 5a（5.15%）和 3a（5.05%）。结果显示，在 CCIV 汇合高度（37.73±12.05 比 28.93±10.17 比 27.27±7.58mm，P<0.05）、髂血管之间的距离（49.47±9.47mm 比 37.08±9.36 比 37.73±8.94mm，P<0.05）和 SP 暴露宽度（44.94±6.39mm 比 36.83±8.29 比 36.93±7.91mm，P<0.05）方面，标准组的值均大于 3a 和 5a 组。
与标准型 IIV 相比，变异型 IIV 可能会通过减少无血管区来增加手术风险。因此，在 SP 周围手术时，应特别注意变异型 IIV 并避免血管损伤。
