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Андрология и генитальная хирургия. 2014; 15: 52-61

Клиническое значение вариантов строения нижней полой вены и брюшного отдела аорты в хирургии забрюшинного пространства

Мухтарулина Светлана Валерьевна, Каприн А. Д., Асташов В. Л., Бобин А. Н., Асеева И. А.

https://doi.org/10.17650/2070-9781-2014-3-52-61

Аннотация

Цель: изучить варианты строения нижней полой вены (НПВ) и ее притоков, аорты и ее ветвей ниже уровня левой почечной вены (ЛПВ) и их клиническое значение в хирургии забрюшинного пространства у больных раком шейки матки (РШМ) IA–IIB стадии.

Материалы и методы. В исследование включена 101 больная РШМ IA–IIB стадии, которым были выполнены парааортальная лимфаденэктомия, тазовая лимфаденэктомия. К основной группе отнесено 10 пациенток с наличием вариантов развития сосудов забрюшинного пространства, 91 пациентка без особенностей развития сосудов составили контрольную группу.

Результаты. Варианты строения сосудов забрюшинного пространства были выявлены у 10 (9,9 %) пациенток. Одностороннее удвоение правой или левой почечной артерии и правой почечной вены отмечено у 5 (4,9 %) пациенток, ретроаортальная ЛПВ I или II типов – у 3 (3,0 %) больных и удвоение НПВ – у 1 (1,0 %) пациентки. Оперативное вмешательство, выполненное у 10 пациенток основной группы, не сопровождалось ятрогенным повреждением сосудов забрюшинного пространства. При проведении анализа объема интраоперационной кровопотери, уровня гемоглобина, частоты трансфузии эритроцитарной массы во время операции и количества удаленных парааортальных лимфатических узлов не было выявлено достоверных различий у пациенток сравниваемых групп. Факторы риска развития интраоперационного кровотечения у больных РШМ в зависимости от наличия или отсутствия вариантов развития сосудов забрюшинного пространства не имели достоверного различия.

Выводы. Несмотря на тот факт, что с вариантами строения сосудов забрюшинного пространства мы сталкиваемся редко (9,9 % случаев), успех хирургии забрюшинного пространства неразрывно связан со знаниями особенностей развития сосудов, способствующими снижению риска возникновения серьезных, жизнеугрожающих осложнений.

Список литературы

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3. Klemm P., Fröber R., Köhler C., Schneider A. Vascular anomalies in the paraaortic region diagnosed by laparoscopy in patients with gynaecologic malignancies. Gynecol Oncol 2005;96(2):278–82.

4. Kose M.F., Turan T., Karasu Y. et al. Anomalies of major retroperitoneal vascular structure. Int J Gynecol Cancer 2011;21(7):1312–19.

5. Gyimadu A., Salman M.C., Karcaaltincaba M.,Yuce K. Retroperitoneal vascular aberrations increase the risk of vascular injury during lymphadenectomy in gynecologic cancers. Arch Gynecol Obstet 2012;286 (2):449–55.

6. Matsuura T., Morimoto Y., Nose K. et al. Venous abnormalities incidentally accompanied by renal tumors. Urol Int 2004;73(2):163–8.

7. Koc Z., Ulusan S., Oguzkurt L., Tokmak N. Venous variants and anomalies on routine abdominal multi-detector row CT. Eur J Radiol 2007;61(2):267–78.

8. Aljabri B., MacDonald P.S., Satin R. et al. Incidence of major venous and renal anomalies relevant to aortoiliac surgery as demonstrated by computed tomography. Ann Vasc Surg 2001;15(6):615–8.

9. Gupta A., Gupta R., Singhla R.K. Phylogenetic basis of accessory renal artery and its clinical significance. J Clin Diagn Res 2011;5(5):970–3.

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13. Janschek E.C., Rothe A.U., Hölzenbein T.J. et al. Anatomic basis of right renal vein extension for cadaveric kidney transplantation. Urology 2004;63(4):660–4.

14. Nayak B.S. Multiple variations of the right renal vessels. Singapore Med J 2008;49(6):153–5.

15. Lee Y.S., Lee J.H., Choi J.S. et al. Accessory polar renal artery encountered in transperitoneal systemic laparoscopic paraaortic lymphadenectomy. Eur J Gynaecol Oncol 2011;32(1):87–90.

16. Özkan U., Oguzkurt L., Tercan F. et al. Renal artery origins and variations: angiography evaluation of 855 consecutive patients. Diagn Interv Radiol 2006;12(4):183–86.

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22. Karaman B., Koplay M., Ozturk E. et al. Retroaortic left renal vein: multidetector computed tomography angiography findings and its clinical importance. Acta Radiol 2007;48(3):355–60.

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25. Kraus G.J., Goerzer H.G. MRangiographic diagnosis of an aberrant retroaortic left renal vein and review of the literature. Clin Imaging 2003;27(2):132–4.

26. Trigaux J.P., Vandroogenbroek S., De Wispelaere J.F. et al. Congenital anomalies of the inferior vena cava and left renal vein: evaluation with spiral CT. J Vasc Interv Radiol 1998;9(2):339–45.

27. Reed M.D., Friedman A.C., Nealey P. Anomalies of the left renal vein: analysis of 433 CT scans. J Comput Assist Tomogr 1982;6(6):1124–6.

28. Dilli A., Ayaz U.Y., Kaplanoglu H. et al. Evaluation on the left renal vein variations and inferior vena cava variations by means of helical computed tomography. Clin Imaging 2013;37(3):530–5.

29. Holt P.J., Adshead J.M., Filiadis I., Christmas T.J. Retroperitoneal anomalies in men with testicular germ cell tumours. BJU Int 2007;99(2):344–6.

30. Izumiyama M., Horiguchi M. Two cases of the retroaortic left renal vein and a morphogenetic consideration of the anomalous vein. Kaibogaku Zasshi 1997;72(6):535–43.

31. Koc Z., Ulusan S., Tokmak N. et al. Double retroaortic left renal veins as a possible cause of pelvic congestion syndrome: imaging findings in two patients. Br J Radiol 2006;79(946):e152–5.

32. Ciçekcibaşi A.E., Salbacak A., Seker M. et al. The origin of gonadal arteries in human fetuses: Anatomical variations. Ann Anat 2002;184(3):275–9.

33. Chen H., Emura S., Nagasaki S., Kubo K.Y. Double inferior vena cava with interiliac vein: a case report and literature review. Okajimas Folia Anat Jpn 2012;88(4):147–51.

34. Benedetti Panici P., Basile S., Angioli R. Pelvic and aortic lymphadenectomy in cervical cancer: the standardization of surgical procedure and its clinical impact. Gynecol Oncol 2009;113(2):284–90.

35. Lotz P.R., Seeger J.F. Normal variations in iliac venous anatomy. AJR Am J Roentgenol 1982;138(4):735–8.

36. Edwards E.A. Clinical anatomy of lesser variations of the inferior vena cava; and a proposal for classifying the anomalies of this vessel. Angiology 1951;2(2):85–99.

37. Benedetti Panici P., Scambia G., Baiocchi G. et al. Technique and feasibility of radical para-aortic and pelvic lymphadenectomy for gynecologic malignancies: a prospective study. Int J Gynecol Cancer 1991;1:133–40.

38. Oktar G.L. Iatrogenic major venous injuries incurred during cancer surgery. Surg Today 2007;37(5):366–9.

39. Rudström H., Bergqvist D., Ogren M., Björck M. Iatrogenic vascular injuries in Sweden. A nationwide study 1987–2005. Eur J Vasc Endovasc Surg 2008;35(2):131–8.

Andrology and Genital Surgery. 2014; 15: 52-61

The clinical implications of variants of vena cava inferior and aorta on retroperitoneal surgery

Mukhtarulina S. V., Kaprin A. D., Astashov V. L., Bobin A. N., Aseeva I. A.

https://doi.org/10.17650/2070-9781-2014-3-52-61

Abstract

Objective: to study variants of retroperitoneal vascular structure and its clinical implications on retroperitoneal surgery in patients with cervical cancer IA–IIB stage.

Materials and methods. 101 patients who underwent paraaortic and bilateral pelvic lymphadenectomy were included in this study. 10 patients of the first group with anomalies of inferior vena cava, renal arteries and veins, common iliac vein and ovarian vessels were compared with 91 patients of the second group without anomalies.

Results. Variants of major retroperitoneal vascular structure were present in 10 (9.9 %) patients. Supernumerary renal arteries and veins observed in 5 (4.9 %) patients; retroaortic left renal vein type I and II – in 3 (3.0 %) patients. Double vena cava inferior detected in 1 (1.0 %) patient. Patients with variants of retroperitoneal vascular structures hadn’t vessel injury. There was no difference in intraoperative hemorrhage, transfusion red blood cell, rate of intraoperative hemoglobin and removed paraaortic lymph nodes between the groups. Risk factors for intraoperative bleeding in patients with cervical cancer, depending on the presence or absence of anomalies of retroperitoneal vessels had no significant difference.

Conclusion. Despite the fact that the variants of retroperitoneal vascular structures are rare (9.9 %), the success of retroperitoneal surgery is associated with the knowledge of vascular variations which decrease serious, life-threatening complications.

References

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3. Klemm P., Fröber R., Köhler C., Schneider A. Vascular anomalies in the paraaortic region diagnosed by laparoscopy in patients with gynaecologic malignancies. Gynecol Oncol 2005;96(2):278–82.

4. Kose M.F., Turan T., Karasu Y. et al. Anomalies of major retroperitoneal vascular structure. Int J Gynecol Cancer 2011;21(7):1312–19.

5. Gyimadu A., Salman M.C., Karcaaltincaba M.,Yuce K. Retroperitoneal vascular aberrations increase the risk of vascular injury during lymphadenectomy in gynecologic cancers. Arch Gynecol Obstet 2012;286 (2):449–55.

6. Matsuura T., Morimoto Y., Nose K. et al. Venous abnormalities incidentally accompanied by renal tumors. Urol Int 2004;73(2):163–8.

7. Koc Z., Ulusan S., Oguzkurt L., Tokmak N. Venous variants and anomalies on routine abdominal multi-detector row CT. Eur J Radiol 2007;61(2):267–78.

8. Aljabri B., MacDonald P.S., Satin R. et al. Incidence of major venous and renal anomalies relevant to aortoiliac surgery as demonstrated by computed tomography. Ann Vasc Surg 2001;15(6):615–8.

9. Gupta A., Gupta R., Singhla R.K. Phylogenetic basis of accessory renal artery and its clinical significance. J Clin Diagn Res 2011;5(5):970–3.

10. Banowsky L.N.W. Surgical anatomy. In: Stewart’s operative urology. A.C. Novick, S.B. Streem, J.E. Pontes (eds.). Baltimore: Williams&Wilkins, 1989.

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13. Janschek E.C., Rothe A.U., Hölzenbein T.J. et al. Anatomic basis of right renal vein extension for cadaveric kidney transplantation. Urology 2004;63(4):660–4.

14. Nayak B.S. Multiple variations of the right renal vessels. Singapore Med J 2008;49(6):153–5.

15. Lee Y.S., Lee J.H., Choi J.S. et al. Accessory polar renal artery encountered in transperitoneal systemic laparoscopic paraaortic lymphadenectomy. Eur J Gynaecol Oncol 2011;32(1):87–90.

16. Özkan U., Oguzkurt L., Tercan F. et al. Renal artery origins and variations: angiography evaluation of 855 consecutive patients. Diagn Interv Radiol 2006;12(4):183–86.

17. Satyapal K.S., Haffejee A.A., Singh B. et al. Additional renal arteries: incidence and morphometry. Surg Radiol Anat 2001;23(1):33–38.

18. Urban B.A., Ratner L.E., Fishman E.K. Three-dimensional volume-rendered CT angiography of renal arteries and veins: normal anatomy, variants, and clinical applications. Radiographics 2001;21(2):373–86.

19. Hlaing K.P., Das S., Sulaiman I.M. et al. Accessory renal vessels at the upper and lower pole of the kidney: a cadaveric study with clinical implications. Bratisl Lek Listy 2010;111(5):308–10.

20. Skinner D.G., Melamud A., Lieskovsky G. Complications of thoracoabdominal retroperitoneal lymph node dissection. J Urol 1982;127(6):1107–10.

21. Jimenez R., Morant F. The importance of venous and renal anomalies for surgical repair of abdominal aortic aneurysms. In: Grundmann R. Diagnosis, screening and treatment of abdominal, thoracoabdominal and thoracic aortic aneurysms. InTech, 2011. P. 269–92.

22. Karaman B., Koplay M., Ozturk E. et al. Retroaortic left renal vein: multidetector computed tomography angiography findings and its clinical importance. Acta Radiol 2007;48(3):355–60.

23. Shindo S., Kubota K., Kojima A. et al. Anomalies of inferior vena cava and left renal vein: risks in aortic surgery. Ann Vasc Surg 2000;14(4):393–6.

24. Karkos C.D., Bruce I.A., Thomson G.J.L., Lambert M.E. Retroaortic left renal vein and its implications in abdominal aortic surgery. Ann Vasc Surg 2001;15(6):703–8.

25. Kraus G.J., Goerzer H.G. MRangiographic diagnosis of an aberrant retroaortic left renal vein and review of the literature. Clin Imaging 2003;27(2):132–4.

26. Trigaux J.P., Vandroogenbroek S., De Wispelaere J.F. et al. Congenital anomalies of the inferior vena cava and left renal vein: evaluation with spiral CT. J Vasc Interv Radiol 1998;9(2):339–45.

27. Reed M.D., Friedman A.C., Nealey P. Anomalies of the left renal vein: analysis of 433 CT scans. J Comput Assist Tomogr 1982;6(6):1124–6.

28. Dilli A., Ayaz U.Y., Kaplanoglu H. et al. Evaluation on the left renal vein variations and inferior vena cava variations by means of helical computed tomography. Clin Imaging 2013;37(3):530–5.

29. Holt P.J., Adshead J.M., Filiadis I., Christmas T.J. Retroperitoneal anomalies in men with testicular germ cell tumours. BJU Int 2007;99(2):344–6.

30. Izumiyama M., Horiguchi M. Two cases of the retroaortic left renal vein and a morphogenetic consideration of the anomalous vein. Kaibogaku Zasshi 1997;72(6):535–43.

31. Koc Z., Ulusan S., Tokmak N. et al. Double retroaortic left renal veins as a possible cause of pelvic congestion syndrome: imaging findings in two patients. Br J Radiol 2006;79(946):e152–5.

32. Ciçekcibaşi A.E., Salbacak A., Seker M. et al. The origin of gonadal arteries in human fetuses: Anatomical variations. Ann Anat 2002;184(3):275–9.

33. Chen H., Emura S., Nagasaki S., Kubo K.Y. Double inferior vena cava with interiliac vein: a case report and literature review. Okajimas Folia Anat Jpn 2012;88(4):147–51.

34. Benedetti Panici P., Basile S., Angioli R. Pelvic and aortic lymphadenectomy in cervical cancer: the standardization of surgical procedure and its clinical impact. Gynecol Oncol 2009;113(2):284–90.

35. Lotz P.R., Seeger J.F. Normal variations in iliac venous anatomy. AJR Am J Roentgenol 1982;138(4):735–8.

36. Edwards E.A. Clinical anatomy of lesser variations of the inferior vena cava; and a proposal for classifying the anomalies of this vessel. Angiology 1951;2(2):85–99.

37. Benedetti Panici P., Scambia G., Baiocchi G. et al. Technique and feasibility of radical para-aortic and pelvic lymphadenectomy for gynecologic malignancies: a prospective study. Int J Gynecol Cancer 1991;1:133–40.

38. Oktar G.L. Iatrogenic major venous injuries incurred during cancer surgery. Surg Today 2007;37(5):366–9.

39. Rudström H., Bergqvist D., Ogren M., Björck M. Iatrogenic vascular injuries in Sweden. A nationwide study 1987–2005. Eur J Vasc Endovasc Surg 2008;35(2):131–8.