Nezhat F, Brill A I, Nezhat C H, Nezhat A, Seidman D S, Nezhat C
Departments of Obstetrics and Gynecology, Standford University School Medicine, California, USA.
J Am Assoc Gynecol Laparosc. 1998 May;5(2):135-40. doi: 10.1016/s1074-3804(98)80079-0.
To determine the cephalocaudal relationship among the umbilicus, aortic bifurcation, and iliac vessels by direct measurement during laparoscopy.
Prospective, consecutive study (Canadian Task Force classification II-1).
Tertiary referral center.
Ninety-seven women undergoing operative laparoscopy.
The distance from the aortic bifurcation relative to the umbilicus was measured in both the supine and Trendelenburg positions with a marked suction-irrigator probe. Patients were stratified into three groups based on body mass index (kg/m2). The anatomic location of the common iliac vessels and course of the left common iliac vein were identified in 68 women.
The position of the aortic bifurcation ranged from 5 cm cephalad to 3 cm caudal to the umbilicus in the supine position, and from 3 cm cephalad to 3 cm caudal in the Trendelenburg position. In the supine position, the aortic bifurcation was located caudal to the umbilicus in only 11% of patients compared with 33% in the Trendelenburg position. This difference was statistically significant for the total study population (p <0.0001) and for the nonoverweight group (p <0.01). In both positions no significant correlation was found between the distance from the aortic bifurcation to the umbilicus and body mass index. Mean +/- SD distance of the aortic bifurcation from the umbilicus in the supine position was 0.1 +/- 1.2 cm for the nonoverweight group, 0.7 +/- 1.5 cm for the overweight group, and 1. 2 +/- 1.5 cm for the very overweight group. Respective values in Trendelenburg position were 1.0 +/- 1.1, -0.4 +/- 1.2, and -0.2 +/- 1.3 cm. The common iliac artery was caudal to the umbilicus in four women. The space between common iliac arteries was always at least partly occupied by the left common iliac vein, and was completely filled in 19 women (28%).
The cephalocaudal relationship between the aortic bifurcation and umbilicus varies widely and is not related to body mass index in anesthetized patients. Regardless of body mass index, the aortic bifurcation is more likely to be located caudal to the umbilicus in the Trendelenburg compared with the supine position. Its presumed location can be misleading during Veress needle or primary cannula insertion, and a more reliable guide is necessary for this procedure to avoid major retroperitoneal vascular injury.
通过腹腔镜手术中的直接测量，确定脐、主动脉分叉和髂血管之间的头尾关系。
前瞻性连续研究（加拿大工作组分类II-1）。
三级转诊中心。
97例行手术腹腔镜检查的女性。
使用带标记的吸引冲洗探头，在仰卧位和头低脚高位测量主动脉分叉相对于脐的距离。根据体重指数（kg/m²）将患者分为三组。在68名女性中确定了髂总血管的解剖位置和左髂总静脉的走行。
仰卧位时，主动脉分叉的位置在脐上方5 cm至下方3 cm之间，头低脚高位时在脐上方3 cm至下方3 cm之间。在仰卧位时，仅11%的患者主动脉分叉位于脐下方，而在头低脚高位时为33%。这一差异在整个研究人群中具有统计学意义（p<0.0001），在非超重组中也具有统计学意义（p<0.01）。在两个体位下，主动脉分叉到脐的距离与体重指数之间均未发现显著相关性。非超重组仰卧位时主动脉分叉到脐的平均±标准差距离为0.1±1.2 cm，超重组为0.7±1.5 cm，极度超重组为1.2±1.5 cm。头低脚高位时的相应值分别为1.0±1.1、-0.4±1.2和-0.2±1.3 cm。4名女性的髂总动脉位于脐下方。髂总动脉之间的间隙总是至少部分被左髂总静脉占据，19名女性（28%）的间隙被完全填满。
麻醉患者中，主动脉分叉与脐之间的头尾关系差异很大，且与体重指数无关。无论体重指数如何，与仰卧位相比，头低脚高位时主动脉分叉更可能位于脐下方。在插入韦雷斯针或主套管时，其假定位置可能会产生误导，因此该操作需要更可靠的引导以避免严重的腹膜后血管损伤。
