Hurd W W, Bude R O, DeLancey J O, Newman J S
Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor.
Am J Obstet Gynecol. 1994 Sep;171(3):642-6. doi: 10.1016/0002-9378(94)90076-0.
Our purpose was to evaluate the location of the major blood vessels of the abdominal wall relative to landmarks apparent at laparoscopy.
Abdominal computed tomographic images of 21 reproductive-aged women at an academic center were retrospectively reviewed to determine the location of the inferior epigastric, superficial epigastric, and superficial circumflex iliac arteries and the lateral rectus muscle margins in relation to the symphysis pubis, the umbilicus, and the abdominal midline. These locations were correlated with each other and with body mass index using Pearson's correlation coefficient.
Above the symphysis the inferior and superficial epigastric arteries were 5.6 +/- 1.0 cm (mean +/- SD) and 5.5 +/- 2.0 cm from the midline, respectively. Although the location of these two vessels correlated (r = 0.6, p = 0.02), the mean difference in their location was 1.4 +/- 1.1 cm. Near the level of the umbilicus the superficial epigastric and circumflex iliac arteries and the lateral rectus muscle margin were 4.6 +/- 1.4 cm, 10.7 +/- 1.7 cm, and 7.6 +/- 1.5 from the midline, respectively. Only the lateral rectus muscle margin correlated with body mass index (r = 0.65, p = 0.004).
When laparoscopic landmarks are not visible to guide placement, lateral trocars should be placed approximately 8 cm from the midline and at least 5 cm above the symphysis to minimize the risk of vessel injury.
我们的目的是评估腹壁主要血管相对于腹腔镜检查时明显可见的标志的位置。
回顾性分析了一所学术中心21名育龄妇女的腹部计算机断层扫描图像，以确定腹壁下动脉、腹壁浅动脉和旋髂浅动脉以及腹直肌外侧缘相对于耻骨联合、脐部和腹中线的位置。使用Pearson相关系数对这些位置进行相互关联以及与体重指数进行关联分析。
在耻骨联合上方，腹壁下动脉和腹壁浅动脉分别距离中线5.6±1.0厘米（平均值±标准差）和5.5±2.0厘米。虽然这两条血管的位置相关（r = 0.6，p = 0.02），但它们位置的平均差异为1.4±1.1厘米。在脐部水平附近，腹壁浅动脉、旋髂浅动脉和腹直肌外侧缘分别距离中线4.6±1.4厘米、10.7±1.7厘米和7.6±1.5厘米。只有腹直肌外侧缘与体重指数相关（r = 0.65，p = 0.004）。
当无法看到腹腔镜标志来指导穿刺针放置时，外侧穿刺套管应放置在距离中线约8厘米且在耻骨联合上方至少5厘米处，以尽量减少血管损伤的风险。
