[Vascular relationships of the right great splanchnic nerve in the thorax]. 2015

J-M Ndoye, and O Hamel, and A Hamel, and S Ploteau, and O Armstrong, and J Le Borgne, and J-M Rogez, and R Robert
Laboratoire d'anatomie, UFR de médecine, 1, rue Gaston-Veil, 44035 Nantes, France; Laboratoire d'anatomie et d'organogenèse, faculté de médecine, Dakar, Sénégal. Electronic address: jmndoye04@yahoo.fr.

OBJECTIVE The surgical assumption of responsibility of the pancreatic pain requires either a truncular coelioscopic or radicular neurectomy of greater splanchnic nerves (gsn). The goal of our work is to describe the way and relations of the right gsn which are variable and rarely described. This constitutes an undeniable peroperational hemorrhagic risk during splanchnicectomy. METHODS After a double side thoracotomy and a bilateral sterno-clavicular desarticulation on 15 adult cadaveric subjects preserved by method of Winckler we removed the sterno-costal drill plate as well as the ventral rib arch and proceeded to a mediastinal evisceration of the thorax. Then we respected only the thoracic aorta and the oesophagus, the azygos venous system, the thoracic duct and the thoracic sympathetic chain. In some of the subjects, the azygos vein was injected (after catheterization of its stick) using gelatine coloured with blue paint. We studied the way and vascular relations of the right gsn. We measured the transverse distances between the origin of the gsn on one hand and the longitudinal axes of the azygos vein and the thoracic duct on the other hand. RESULTS The relations of the right gsn trunk during its way related to the azygos vein in particular its constitutive origin and its affluents: ascending lumbar vein and twelfth intercostal vein. Sometimes the thoracic duct even a lymphatic node was near the gsn in the posterior infra-mediastinal space. A classification of the way and vascular relations of the right gsn in the thorax identified 3 anatomical types. The average distances separating the right gsn on one hand from the azygos vein and the thoracic duct on the other hand were respectively 5.7 mm and 11.2 mm. CONCLUSIONS The vascular relations of the right gsn are very variable from one subject to another but primarily venous, sometimes lymphatic. They concerned the great thoracic vessels whose respect is essential in particular at the time of mini-invasive access procedure for a cœlioscopic splanchnicectomy.

UI MeSH Term Description Entries
D008482 Mediastinum A membrane in the midline of the THORAX of mammals. It separates the lungs between the STERNUM in front and the VERTEBRAL COLUMN behind. It also surrounds the HEART, TRACHEA, ESOPHAGUS, THYMUS, and LYMPH NODES.
D002102 Cadaver A dead body, usually a human body. Corpse,Cadavers,Corpses
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D001013 Aorta, Thoracic The portion of the descending aorta proceeding from the arch of the aorta and extending to the DIAPHRAGM, eventually connecting to the ABDOMINAL AORTA. Aorta, Ascending,Aorta, Descending,Aortic Arch,Aortic Root,Arch of the Aorta,Descending Aorta,Sinotubular Junction,Ascending Aorta,Thoracic Aorta,Aortic Roots,Arch, Aortic,Ascending Aortas,Junction, Sinotubular,Root, Aortic,Sinotubular Junctions
D001401 Azygos Vein A vein which arises from the right ascending lumbar vein or the vena cava, enters the thorax through the aortic orifice in the diaphragm, and terminates in the superior vena cava. Azygos Veins,Vein, Azygos,Veins, Azygos
D013153 Splanchnic Nerves The major nerves supplying sympathetic innervation to the abdomen. The greater, lesser, and lowest (or smallest) splanchnic nerves are formed by preganglionic fibers from the spinal cord which pass through the paravertebral ganglia and then to the celiac ganglia and plexuses. The lumbar splanchnic nerves carry fibers which pass through the lumbar paravertebral ganglia to the mesenteric and hypogastric ganglia. Nerve, Splanchnic,Nerves, Splanchnic,Splanchnic Nerve
D013897 Thoracic Duct The largest lymphatic vessel that passes through the chest and drains into the SUBCLAVIAN VEIN. Cisterna Chyli,Chyli, Cisterna,Chylus, Cisterna,Cisterna Chylus,Duct, Thoracic,Ducts, Thoracic,Thoracic Ducts
D013906 Thoracoscopy Endoscopic examination, therapy or surgery of the pleural cavity. Endoscopy, Pleural,Pleural Endoscopy,Pleuroscopy,Surgical Procedures, Thoracoscopic,Thoracoscopic Surgical Procedures,Surgery, Thoracoscopic,Thoracoscopic Surgery,Endoscopies, Pleural,Pleural Endoscopies,Pleuroscopies,Surgeries, Thoracoscopic,Surgical Procedure, Thoracoscopic,Thoracoscopic Surgeries,Thoracoscopic Surgical Procedure,Thoracoscopies
D013908 Thoracotomy Surgical incision into the chest wall. Thoracotomies

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