摘要
目的:探讨腹腔镜下腰椎手术的可行性及腰椎不同节段安全有效的腹腔镜手术入路.方法:解剖30例成人尸体标本(男15例、女15例),记录腰椎前主要毗邻血管的解剖学参数;取家猪40只,均分为两组,采用腹腔镜下经腹膜后入路和经腹膜腔入路显露L2～S1椎体和椎间盘,比较两种入路的有效性、安全性.结果:尸体解剖发现腹主动脉分叉点变异较多,髂总静脉汇合点相对恒定;腹主动脉分叉角度男性平均54.9°,女性平均59.0°,髂总静脉汇合角度男性平均61.4°,女性平均64.9°;腹主动脉分叉点到L5椎体下缘距离男性平均3.5cm,女性平均3.6cm;髂总静脉汇合点到L5椎体下缘距离男性平均2.2cm,女性平均2.4cm;L5/S1椎间隙手术窗大小男性平均3.7cm,女性平均3.4cm.动物实验研究发现经腹腔显露L6/S1满意,而经腹膜后显露L2～L5满意.结论:应用腹腔镜技术进行腰椎手术是可行的,该技术具有重复性好,对组织损伤小,术野内解剖结构清晰,手术的安全性和有效性较高.显露下位腰骶椎以经腹腔入路为宜,而显露上位腰椎以经腹膜后间隙入路为宜.
Objective:To research the possibility of laparoscopic lumbar spine surgery through human cadav-ers and pigs to define the effect and operative approach safety in different parts of lumbar spine.Method:The anatomic data of main large vessels at the same level of lumbar verterbrae of30human cadavers(15males and15females)were investigated;In animal experiment,40pigs were divided into2groups:one for retroperi-toneal and the other for transperitoneal laparoscopic approaches to exposure L2~S1,to compare their simplicity and safety of the two operative methods.Result:The bifurcation level of the ventral aorta was quite variable in human cadavers,the confluence level of the common iliac vein was consistent;The bifurcation angle of the ventral aorta averaged male54.9°,female59.0°,the confluence angle averaged male61.4°,female64.9°,the distance from the bifurcation to the top of L5/S1disc averaged male3.5cm,female3.6cm;The distance from the confluence to the top of L5/S1disc averaged male2.2cm,female2.4cm,the width of the operation window of L5/S1disc averaged male3.7cm,female3.4cm.In animal experiment,it was satisfactory to expose the L6/S1in the group of transperitoneal,and retroperitoneal laparoscopic approach the L2~L5verterbrae.Conclusion:The technique of laparoscopic lumbar spine surgery is reliable,convenient,mininvasive and good replication.The retroperitoneal approach is safe,reasonable and effective for exposure of the L2~L5,while transperitoneal la-paroscopic approach is easy and reliable for exposure of lower lumbosacral vertebrae.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2003年第9期558-561,共4页
Chinese Journal of Spine and Spinal Cord
