Vascular and ureteral anatomy relative to the midsacral promontory
Vascular and ureteral anatomy relative to the midsacral promontory
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DOI：
10.1016/j.ajog.2013.02.039
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发表时间：
2013-06-01
影响因子：
9.8
通讯作者：
Corton, Marlene M.
中科院分区：
文献类型：
--
作者：
Good, Meadow M.;Abele, Travis A.;Corton, Marlene M.
目的：本研究的目的是进一步了解与骶中角相关的血管和输尿管的解剖结构，并提出避免并发症的策略。研究设计：在25具未防腐的女性身体和100例CT研究中，对右侧输尿管、主动脉分叉和髂动脉之间的距离进行了研究。用Pearson chi(2)、非配对t检验和协方差分析进行统计学处理。结果：在身体标本上，右侧输尿管至骶中隆点的距离平均为2.7 cm(1.6~3.8 cm)，CT上为2.9 cm(1.7~5.0 cm)(P=.209)。距海角最近的头侧血管为左侧髂总静脉，身体平均距离2.7 cm(0.95~4.75 cm)，CT平均3.0 cm(1.0~6.1 cm)(P=0.289)。离海角右侧最近的血管为髂内动脉，身体平均距离2.5 cm(1.4~3.9 cm)，CT平均2.2 cm(1.2~3.9 cm)(P=0.015)。从海角到主动脉分叉的距离，身体平均5.3 cm(2.8~9.7 cm)，CT平均6.6 cm(3.1~10.1 cm)(P<；.001)。腹主动脉分叉至左髂总静脉下缘的距离，身体平均2.3 cm(1.2~3.9 cm)，CT平均3.5 cm(1.7~5.6 cm)。结论：右侧输尿管、右侧髂总动脉和左侧髂总静脉均位于距骶中角3 cm的范围内。透彻地了解相对于骶中角的血管和输尿管解剖的广泛差异，应该有助于避免在固定术中出现严重的术中并发症。
OBJECTIVE: The objective of the study was to further characterize the vascular and ureteral anatomy relative to the midsacral promontory, a landmark often used during sacrocolpopexy, and suggest strategies to avoid complications.STUDY DESIGN: Distances between the right ureter, aortic bifurcation, and iliac vessels to the midsacral promontory were examined in 25 unembalmed female cadavers and 100 computed tomography (CT) studies. Data were analyzed using Pearson chi(2), unpaired Student t test, and analysis of covariance.RESULTS: The average distance between the midsacral promontory and right ureter was 2.7 cm (range, 1.6-3.8 cm) in cadavers and 2.9 cm (range, 1.7-5.0 cm) on CT (P = .209). The closest cephalad vessel to the promontory was the left common iliac vein, the average distance being 2.7 cm (range, 0.95-4.75 cm) in cadavers and 3.0 cm (range, 1.0-6.1 cm) on CT (P = .289). The closest vessel to the right of the promontory was the internal iliac artery, with the average distance of 2.5 cm (range, 1.4-3.9 cm) in cadavers and 2.2 cm (range, 1.2-3.9 cm) on CT (P = .015). The average distance from the promontory to the aortic bifurcation was 5.3 cm (range, 2.8-9.7 cm) in cadavers and 6.6 cm (range, 3.1-10.1 cm) on CT (P < .001). The average distance from the aortic bifurcation to the inferior margin of the left common iliac vein was 2.3 cm (range, 1.2-3.9 cm) in cadavers and 3.5 cm (range, 1.7-5.6 cm) on CT (P < .001).CONCLUSION: The right ureter, right common iliac artery, and left common iliac vein are found within 3 cm from the midsacral promontory. A thorough understanding of the extensive variability in vascular and ureteral anatomy relative to the midsacral promontory should help avoid serious intraoperative complications during sacrocolpopexy.