摘要
目的探讨在腹腔镜下经腹膜或腹膜后治疗腰椎间盘疾病的可行性及安全有效入路。方法解剖10例成人尸体标本（男女各5例）,对腰椎前主要的血管等解剖学参数进行详细记录。同时取20只家猪,分为腹腔镜下经腹膜和腹膜后入路两组,给予不同治疗,比较两种入路的有效性和安全性。结果通过解剖尸体发现腹主动脉的分叉点相对变异较多,而髂总静脉的汇合点则相对稳定;女性腹主动脉分叉角度大于男性,分别为（59.0±1.6）°和（54.9±2.1）°;在髂总静脉汇合角度上,女性和男性为（64.9±1.8）°和（61.4±1.9）°;腹主动脉分叉点与L5椎体下缘的距离分别为男性（3.5±0.8）cm,女性（3.6±0.7）cm;髂总静脉汇合点与L5椎体下缘的距离分别为男性（2.2±0.6）cm,女性（2.4±0.4）cm;L5/S1椎间隙手术窗大小分别为男性（3.7±1.2）cm,女性为（3.4±0.8）cm。动物实验表明,经腹膜入路显露L6/S1较为满意,而显露L2～L5选择腹膜后入路较为满意。结论使用腹腔镜技术对椎间盘疾病进行治疗是可行的,要依据不同的椎间盘节段合理选用经腹膜或腹膜后入路。
【Objective】To explore the feasibility and safety of transperitoneal or retroperitoneal laparoscopic approach in treatment of lumbar intervertebral disc protrusion. 【Methods】Ten cases of adult cadavers were dissected（five cases each for men and women）, anterior major blood vessels and other anatomical lumbar parameters were recorded in detail; at the same time 20 pigs were taken and divided into intraperitoneal approach and retroperitoneal approach groups, different treatment methods were given, and the effectiveness and safety of the two approaches were compared.【Results】The autopsy result showed that the bifurcation of the abdominal aorta was relatively more variational, the confluence of the common iliac vein was relatively stable; the abdominal aortic bifurcation angle of women was lager than that of men, which were（59.0 ±1.6）° and（54.9 ±2.1）° respectively. In the perspective of the common iliac vein confluence, women and men were（64.9±1.8）° and（61.4±1.9）°; the distance from aortic bifurcation point to the lower edge of the L5 vertebral body was（3.5 ±0.8） cm for males and（3.6 ±0.7） cm for females, respectively; the distance from the confluence point of common iliac vein to the lower edge of L5 vertebra was（2.2±0.6） cm for males and（2.4±0.4） cm for females; the width of the operation window of L5/S1 disc was（3.7±1.2）cm for males and（3.4 ±0.8） cm for females. Animal experiments showed transperitoneal approach for L6/S1 and retroperitoneal approach for L2～L5were satisfactory. 【Conclusion】Treatment of lumbar vertebral disc protrusion by laparoscopic technique is feasible, and the selection of transperitoneal approach or retroperitoneal approach mainly accords with different segments.
出处
《中国内镜杂志》
北大核心
2015年第9期923-925,共3页
China Journal of Endoscopy
基金
湖南省人民医院仁术科研发展基金人才创新项目(No:2012-6)
关键词
腹腔镜
椎间盘
解剖
手术入路
laparoscopy
disc
anatomy
surgical approach
