目的 探讨阴道.骶骨固定术手术安全性的区域解剖依据.方法 2008年9月至2009年4月在广州医学院第一附属医院选用16具成年女性尸体,对其骶前区血管灌注后进行骶前区域的尸体解剖,观察骶前区域的结构,并测量骶前区与周围结构的距离.结果 骶正中血管解剖位置变异大,其中43.75%(7/16)穿过骶岬中点,56.25%(9/16)经骶骨中线偏右侧行走;第一横干静脉解剖位置变异大,可分为两型:Ⅰ型为解剖正常组,血管分布位于第一横线上,占73.33%,;Ⅱ型为解剖变异组,血管位于骶岬下方10mm之内,占26.67%.从S1～S5,骶椎高度、骶前孔间距、横干静脉间的间距递减,无血管区域面积递减;从S1～S5,骶正中血管到骶前孔的距离渐小;在骶岬和第一骶前孔平面与骶正中血管距离最近的血管是右髂内静脉.结论 S1椎体盆腔面无血管区域最大,是阴道一骶骨固定术相对安全的缝合固定区域.相对安全区域上界为骶岬下10mm、下界为骶岬下方40mm、宽度为15mm的(30ram×15mm)矩形区域.%Objective To supply applied anatomical data for the safety of sacrocolpopexy. Methods Detailed dissections of the presacral space were performed in 16 adult female cadavers after injection of different color perfusate into the inferior vena cava and lilac artery. Observe and measure the composition of presacral space, the presacral space and the distance around the main structure. Results The location of the median sacral vessels were various, 43.75% through the midpoint of sacral promontory while 56.25% through the midline of sacrum. The location of the first transverse veins were great various. The normal group(Ⅰ type)constituted 73.33%, located on the first transverse lines of sacrum. The group of variation(Ⅱ type) occupies 26.67% ,located 10ram below the sacral promontory. The height of sacral vertebral, the distance of anterior sacral foramina, the space between presacral transverse veins was declining from S1 ～ S5 (P < 0.05). The distance between median sacral vessel and the anterior sacral foramina was declining from S1 ～ S5 (P < 0.05) ; At the level of sacral promontory and the first anterior sacral foramina, the vessel which nearest to the median sa-cral were the fight internal iliac vein. Conclusion The presacral space of S, has the largest avascular zone,which is the relatively safe area of fixation position for sacrocolpopexy. The relative safety area is a rectangle which upper bound is 10mm under sacral promontory and lower bound is 40ram under with 15 mm in width, which rectangle is (30mm × 15 mm).
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