摘要
目的探讨3种盆底微创吊带手术的正确通路，并评价其安全性。方法2005年9月—2006年2月，应用血管颜料灌注的方法在5具新鲜尸体上依次进行经耻骨后途径阴道无张力吊带（TVT）手术、经闭孔途径TVT（TVT—O）手术以及经阴道后路悬吊带（P—IVS）手术穿刺，穿刺后以4％甲醛防腐处理，随后进行手术通路解剖，并测量穿刺针至相关血管、神经、脏器和骨边缘的最短距离。结果所有穿刺均未产生副损伤，TVT穿刺针距耻骨血管、膀胱壁、髂外血管及闭孔血管的平均最短距离分别为0．6、0．6、4．2及4．3cm，穿刺针侧偏或轴向旋转可能产生副损伤；由内向外的TVT—O穿刺未进入耻骨后问隙，距闭孔血管神经束的平均最短距离为2．6cm，穿刺点深入尿道外口内平均2．2cm可能进入盆腔，翼状挡板与尿道轴夹角小至平均35。时可能损伤闭孔血管神经束；P—IVS助推器针距直肠浆膜的平均最短距离为0．5cm，不易损伤阴部内血管神经。结论TVT穿刺针经耻骨后间隙有副损伤可能；TVT—O由内向外穿刺通路稳定，不经过耻骨后间隙；P—IVS钝头穿刺针以及术中向对侧推开直肠降低了损伤风险。
Objective To investigate the route of minimal invasive sling procedures and evaluate their safety. Methods Tension-free vaginal tape （TVT）, TVT-obturator （TVT-O） and posterior intravaginal sling （P-IVS） procedure were performed on five fresh pelvis. 4% formaldehyde was used to preserve the cadavers and colored latex was injected into the vessels. An anatomic study and measurements between the trocars and related vessels or organs were carried out. Results There was no complication during all injections. The distance between TVT trocar and pubic vessels, the bladder, external iliac vessels and obturator vessels were 0. 6, 0.6, 4. 2 and 4. 3 cm, respectively. Out of control of TVT trocar, the axial rotation or lateral diversion of TVT handle could injure these structures. We found during TVT-O operation, the retropubic space was not violated. The right placement of introducer was very important. When the beginning point was too deep into the anterior vaginal wall, 2. 2 cm proximal to urethral meatus or on a horizontal plane with a 35~ angle relative to the urethral sagittal plane, the introducer would enter the retropubic space or perforate the upper posterior zone of the obturator membrane, where the obturator vessels and nerves exit the obturator canal. Based on our study, the diversion of P-IVS trocar would damage the rectum, and the pudendal vessels and nerves were relatively safe. Conclusions The TVT trocar passes the retropubic space and may injure the important vessels or organs. The route of TVT-O inside-out operation is stable and the retropubic space is not violated. The blunt design in the P-IVS trocar tips is helpful to reduce injury.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2008年第9期657-661,共5页
Chinese Journal of Obstetrics and Gynecology
关键词
尸体解剖
骨盆底
外科手术
微创性
Autopsy
Pelvic floor
Surgical procedures, minimally invasive
