Distribution of iliac veins posterior to the common iliac artery bifurcation related to pelvic lymphadenectomy: A digital in vivo anatomical study of 442 Chinese females.

OBJECTIVES: To investigate the distribution of iliac veins posterior to common iliac artery bifurcation (CIAB) for pelvic lymphadenectomy. METHODS: After IRB approval was obtained, computer tomography angiography data of 442 female pelvises were acquired. After vascular three-dimensional (3D) reconstructions, the structural types, frequencies and diameters of iliac veins immediately posterior to CIAB were investigated and measured. To quantify iliac vein courses, linear distances and their distances on sagittal, coronal and vertical axes from CIAB to external/internal iliac veins confluence (EIIVC) were geometrically measured. RESULTS: There were five structural types of iliac veins distribution immediately posterior to CIAB: common iliac vein (CIV, 13.8%), no occurrence of great vein (N, 71.27%, 0), EIIVC (1.58%) and external iliac vein (EIV, 13.35%) on the left side, while confluence of common iliac veins (CCIV, 8.82%), CIV (77.38%), N (1.58%, 0), EIIVC (6.11%), and EIV (6.11%) on right. The venous diameters immediately posterior to CIAB in "CCIV", "CIV" and "EIIVC" were significantly larger than that in "EIV" (P<0.05). Their linear distances and their distances on each axis from CIAB to external/internal iliac veins confluence (EIIVC) from CIAB to EIIVC were obtained. CONCLUSIONS: In this study, we presented new distribution of iliac veins posterior to CIAB, including structural types, frequencies, venous diameters immediately posterior to CIAB, and their quantified courses from CIAB to EIIVC. It could help surgeons reduce the risk of vascular injury, hemorrhage or transfusion in pelvic lymphadenectomy.

[Comparison of levator ani muscles in three-dimensional MRI-based models in women with and without pelvic organ prolapse at rest].

OBJECTIVE: Comparison of the levator ani muscles in three-dimensional (3D) MRI-based models in women with and without pelvic organ prolapse at rest to analyze the morphological characteristics of levator ani muscles in women with POP. METHODS: Twenty-five women with POP and 22 women with normal pelvic support were selected from Nanfang Hospital of Southern Medical University. Axial, sagittal, and coronal T2-weighted pelvic magnetic resonance scans were obtained with the women in the supine position.The 3D models were reconstructed from the source images. Morphological changes was compared within the two groups of levator ani muscles, and the 3D models were measured to determine the levator ani muscle volume (LVOL), levator plate angle (LPA), levator hiatus width (LH-W) and length (LH-L), distance between symphysis and levator sling muscle (LSG). RESULTS: There were no puborectalis avulsions in control, in POP, 3 cases of avulsions just in left, 3 cases of avulsions just in right, 7 cases in bilateral. The shape of iliococcygeus were all dome-shaped in control, 11 cases were U-shaped and 14 cases were dome-shaped in POP. The shape of levator hiatus were 7 cases of U-shape, 12 cases of V-shape, 3 cases of irregular in control; 5 cases of U-shape, 4 cases of V-shape, 16 cases of irregular in POP. POP versus control: LH-L: (68.0 ± 8.9) versus (61.6 ± 7.2) mm (P < 0.05); LH-W: (41.4 ± 3.9) versus (38.0 ± 3.2) mm (P < 0.05); LSG-L: (29.6 ± 7.4) versus (24.6 ± 3.7) mm (P < 0.05); LSG-R: (28.4 ± 6.8) versus (23.9 ± 3.2) mm (P < 0.05); LPA: (51.0 ± 11.3)° versus (40.6 ± 6.3)° (P < 0.05); LVOL: (23.7 ± 5.8) versus (24.6 ± 5.0) cm³ (P > 0.05). CONCLUSIONS: It is possible to assess the morphologic changes of levator ani by using 3D MRI models objectively, our 3D data demonstrate larger in LVOL, LPA, LH-W, LH-L, LSG, and the changes in shape. It is helpful to diagnose and assess the specific situation of patients POP in clinic.

[Value of multislice spiral CT scanning and three-dimensional reconstruction in selecting optimal length and shape of mandible internal fixation material].

OBJECTIVE: To investigate the value of multislice spiral CT (MSCT) scanning and three-dimensional reconstruction in selecting optimal length and shape of mandible internal fixation material. METHODS: Three-dimensional reconstruction of the mandible was performed in 5 cases by MSCT scanning and the length of the mandible for operation was measured. Some isometric points were chosen on the mandibular curve and the distance from these points to the two ends of the curve was measured to depict the mandibular curve using a self-designed skeletal curve-depicting software. The optimal length and shape of the material for internal fixation was then determined. RESULTS: After removal of the soft tissues and other irrelevant bones from the reconstructed three-dimensional mandible with clear view from any directions, the length of the mandible was accurately measured with the software. The physiological curve of the mandible was generated after determination of the distances from the chosen points on the mandibular curve and to the two ends of the curve for precise determination of the length and shape of the material for internal fixation. CONCLUSION: Three-dimensional mandible reconstruction with MSCT and measurement facilitates the determination of the optimal length and shape of the internal fixation material to enhance the attachment between the material and the bone surface and consequently the therapeutic effects.