摘要
目的探讨髂腹股沟入路腹膜后间隙的解剖要点及在抢救骨盆骨折大出血中的应用。方法37具国人尸体标本左右两侧髂腹股沟入路显露腹膜后间隙,观测血管、输尿管走行关系及肠系膜下动脉和输尿管、睾丸(卵巢)动静脉的前移距离。并临床应用该入路抢救12例骨盆骨折大出血患者,男10例,女2例。结果腹膜后间隙内腹主动脉、下腔静脉、髂总动静脉等紧贴盆壁与壁腹膜间有腹膜外脂肪相隔;肠系膜下动脉、睾丸(卵巢)动静脉与壁腹膜之间有致密结缔组织连接,易随壁腹膜掀起,输尿管上部与壁腹膜有连接,下部连接松弛;在L4椎体平面肠系膜下动脉可前移19.3 mm,睾丸(卵巢)动静脉可前移26.4 mm(右)和28.0 mm(左);输尿管可前移37.0 mm(左)和41.0 mm(右)。临床应用该入路抢救12例骨盆骨折大出血患者,术中对腹主动脉临时压迫阻断控制出血,抢救休克,修复或结扎损伤血管,复位固定骨折。11例成功,1例死亡;无血管、神经再损伤发生。结论经髂腹股沟腹膜后间隙入路手术可充分显露盆腔大血管,对腹主动脉临时压迫阻断可快速控制出血,纠正休克,提高了骨盆骨折大出血抢救成功率,是救治骨盆骨折大出血的理想入路。
Objective To study clinical anatomy and application of ilioinguinal approach through retroperitoneal space in the management of massive hemorrhage from pelvic fractures. Methods The retroperitoneal space was exposed by both left and right ilioinguinal approaches on 37cadaver specimens, and parameters as follows were measured：the route and relationship of vessels and ureters;the anterior translation of inferior mesenteric artery, ureters, and testicular or ovarian artery and vena. The ilioinguinal approach was clinically performed for 12 cases of massive hemorrhage from pelvic fractures, 10 males and 2 females. Results The abdominal aorta, inferior vena cava, and common iliac artery and vena, in the retroperitoneal space, were firmly attached to the pelvic wall, and separated from the peritoneum with extraperitoneal fat;inferior mesenteric artery, testicular or ovarian artery and vena and parietal peritoneum are connected with each other by dense connective tissue, and could be lifted with parietal peritoneum with ease;the upper end of ureter has connection with parietal peritoneum, with the lower end loosely connected to it. The inferior mesenteric artery could be anteriorly translated by 19.3 mm on the plane of L4, while the testicular or ovarian artery and vena could be anteriorly translated by 26.4 mm（right） and 28.0 mm（left）, and the ureters 37.0 mm （left） and 41.0 mm（right）. The ilioinguinal approach was clinically performed for 12 cases of massive hemorrhage from pelvic fractures, through the procedure of which the abdominal aorta compression was conducted to temporarily control the massive hemorrhage, with the shock rescued and corrected, the damaged vessels ligated and repaired, and the fractures fixed. There were 11cases of success and 1 case of death;on the whole, no vascular, nerve and vascular intimal injuries occurred. Conclusions The ilioinguinal approach through retroperitoneal space can completely expose major vessels in pelvis; temporary abdominal aorta compression is a rapid and an effective way to control massive hemorrhage and correct shock, increasing the success rate in treatment of massive hemorrhage from pelvic fractures. This operative approach proves effective in rescuing patients with pelvic fractures complicated with large blood vessel injury.
出处
《中国临床解剖学杂志》
CSCD
北大核心
2014年第3期275-279,共5页
Chinese Journal of Clinical Anatomy
关键词
骨盆骨折
盆腔大出血
髂腹股沟入路
腹膜后间隙
Pelvic fracture
Pelvic hemorrhage
Ilioinguinal approach
Retroperitoneal space
