文献笔记（472）桥上流水：输尿管和子宫动脉的异常位置关系|全球视点

It is engraved in stone:"the ureter crosses beneath the uterine artery." We want to share that this is not the case in all women.

有一条定律：“输尿管在子宫动脉下方穿过”。我们希望分享，这并不适用于所有女性。

During a fresh cadaveric dissection, an unusual crossing of the ureter with the uterine artery was noted as well as a different relationship to the obliterated umbilical artery. An in-depth understanding of pelvic anatomy is a requirement of an advanced gynecologic surgeon, and remaining mindful of the location of the ureter is particularly important during dissection of the retroperitoneal space. Typically, the ureter enters the pelvis over the common iliac artery and medial to its bifurcation at the pelvic brim. It then descends medially toward the cardinal ligament and courses beneath the uterine artery at approximately 2 cm lateral to the cervix.

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在一次新鲜尸体解剖中，观察到输尿管和子宫动脉的异常交叉，以及和闭锁脐动脉的异常关系。对盆腔解剖的深刻理解是高级妇科医生的必备要求。在后腹膜空间解剖时，注意输尿管的位置非常重要。典型地，输尿管跨过子宫动脉进入盆腔，在盆腔边缘位于交叉内侧。然后向内向下朝着主韧带，在子宫动脉侧方2cm在子宫动脉下方穿过。

Although the expected location of the ureter may be altered owing to adhesions, fibrosis, or pelvic masses, these factors do not modify its crossing beneath the uterine artery or inferior to the obliterated umbilical artery.

尽管子宫动脉的预期位置可能因为粘连、纤维化或者盆腔肿物而改变，但这些因素并不改变其在子宫动脉下方穿行或者低于闭锁脐动脉的 解剖。

In the accompanying images, the left ureter is visible coursing over the common iliac artery at the pelvic brim before descending on the pelvic side wall lateral to the internal iliac artery. It then courses medially crossing over the obliterated umbilical and uterine arteries, at a point distal to their origin from the internal iliac artery. Obliteration of the cul-de-sac from endometriosis was noted, but it was not present elsewhere. The contralateral ureter had a normal pelvic course.

在附图中，可见左侧输尿管在盆腔入口缘跨过髂总动脉，然后在髂内动脉外侧沿着盆侧壁下降。然后向内穿过闭锁脐动脉和子宫动脉，远离其从髂内动脉的发出点。内异症造成了后陷凹闭锁，但是其它部位未见。对侧输尿管盆腔走行正常。

A thorough literature search has suggested that this is the first reported case of this aberrant anatomic relationship.

文献全面搜索提示这是这种解剖变异的首次报道。

来源：Water over the Bridge: An Unusual Relationship between the Ureter and the Uterine Artery McKee, Dana et al. Journal of Minimally Invasive Gynecology, Volume 28, Issue 7, 1269 - 1270

点评：少见的子宫变异，但是印象中这不是首次报道，记得在广州南方医读博期间，曾经读到一篇解剖文献，是肯尼亚的一个尸体解剖，就提到了“桥上流水”这个异常解剖。

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