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目的对下腰椎椎前自主神经丛进行解剖观察,了解该区域自主神经丛的形态、位置特点,为下腰椎前入路手术中自主神经的保护提供解剖学依据。方法对19具成人尸体标本进行解剖观测,男15例、女4例;年龄44~78岁,平均64岁。确定腹中线(胸骨上窝中点和耻骨联合中点的连线)后,观察腹主动脉丛(abdominal aortic plexus,AAP)、肠系膜下丛(inferior mesenteric plexus,IMP)、上腹下丛(superior hypogastric plexus,SHP)的走行、其神经纤维的分布特点及其与腹中线的位置关系。结果 AAP、IMP主要呈网状分布于腹主动脉前方,两神经丛的神经纤维在腹主动脉左侧较右侧更加密集。SHP主干形态变异较大,分为4种类型。SHP主干长度为(59.38±12.86)mm、宽度(11.25±2.92)mm。SHP主干主要位于腹中线左侧(10具,52.6%)、下腰椎前(13具,68.4%),主干向下延续为左、右腹下神经。结论行下腰椎前入路手术时,可以考虑从椎体右侧进行显露,将自主神经和血管作为一整体移动,不必单独分离解剖神经丛,从而最大限度避免神经损伤。
Objective To anatomize the autonomic plexus of the lower lumbar spine to understand the morphology and location of the autonomic plexus in this region and to provide anatomical evidence for the protection of the autonomic nerve during anterior lumbar surgery. Methods Nineteen adult cadaver specimens were dissected and observed. There were 15 males and 4 females, aged 44-78 years, with an average of 64 years. After confirming the midline (the connection between the midpoint of the suprasternal fossa and the midpoint of the pubic symphysis), abdominal aortic plexus (AAP), inferior mesenteric plexus (IMP) and superior inferior plexus hypogastric plexus, SHP), its distribution of nerve fibers and its relationship with the location of the midline. Results AAP and IMP were mainly distributed in the anterior network of the abdominal aorta. The nerve fibers of the two nerve plexus were more dense on the left side of the abdominal aorta than the right side. SHP main trunk morphological variation is divided into four types. SHP trunk length (59.38 ± 12.86) mm, width (11.25 ± 2.92) mm. SHP trunk is mainly located in the left side of the midline abdomen (10, 52.6%), anterior lower lumbar (13, 68.4%), the main trunk down to the left and right inferior hypoglossal nerve. Conclusions When performing anterior lumbar surgery, it is considered to expose the right side of the vertebral body and move the autonomic nerves and blood vessels as a whole. There is no need to separately dissect the anatomic nerve plexus so as to avoid nerve injury to the maximum extent.