摘要
目的明确女性前盆底重建术治疗女性阴道前壁脱垂的穿刺路径,降低术中并发症的发生率。方法应用红色乳胶分别对3具新鲜女性尸体标本进行桡动脉血管灌注,5d后对标本进行手术穿刺和路径解剖,同时测量穿刺针与相关血管、神经和处女膜之间的距离。结果所有穿刺均未发生副损伤,1号穿刺针与闭孔神经后支、闭孔动脉前支、闭孔动脉后支、闭膜管、阴部内血管神经、处女膜的距离分别是(2.6±0.2)cm、(2.1±0.3)cm、(1.4±0.1)cm、(2.1±0.2)cm、(1.2±0.2)cm和(2.0±0.2)cm;2号穿刺针与闭孔神经后支、闭孔动脉前支、闭孔动脉后支、闭膜管、阴部内血管神经、处女膜的距离分别是(3.0±0.3)cm、(2.9±0.2)cm、(0.6±0.2)cm、(2.5±0.3)cm、(0.8±0.2)cm和(6.1±0.4)cm。结论女性前盆底重建术通过加强女性盆底Ⅰ和Ⅱ水平的支撑作用来治疗阴道前壁脱垂,术中取膀胱截石位,大腿充分外展,选择恰当的进针点进行由外向内的穿刺,能够大大降低术中损伤重要血管神经的风险。
Objective To identify the route of the female anterior pelvic floor reconstruction which is applied to treat anterior vaginal wall prolapse(AVWP),and to decrease the complication of procedure.Methods Three fresh cadavers were injected colored latex into radial artery.After 5 days,the anterior pelvic floor reconstruction were performed respectively when lactoprene had solidified.The distances between the trocars and related vascular,nerves and hymen were measured.Results There was no complication during all procedures.The distances between No.1 needle and the posterior branch of the obturator nerve,anterior branch of the obturator artery,posterior branch of the obturator artery,obturator canal,internal pudendal vessels and nerves,and hymen were(2.6±0.2)cm,(2.1±0.3)cm,(1.4±0.1)cm,(2.1±0.2)cm,(1.2±0.2)cm and(2.0±0.2)cm respectively.The distances between No.2 needle and the posterior branch of the obturator nerve,anterior branch of the obturator artery,posterior branch of the obturator artery,obturator canal,internal pudendal vessels and nerves,and hymen were(3.0±0.3)cm,(2.9±0.2)cm,(0.6±0.2)cm,(2.5±0.3)cm,(0.8±0.2)cm and(6.1±0.4)cm respectively.Conclusion The AVWP can be treated with female anterior pelvic floor reconstruction by enhancing the supporting functions of levelⅠandⅡ.In order to reduce the injury of important vascular and nerve,the patients should be placed in lithotomy position and fully abduct thighs,and the appropriate position to insert and perform outside-in procedure should be selected.
作者
艾贵海
成佳景
李怀芳
童晓文
程忠平
AI Gui-hai;CHENG Jia-jing;LI Huai-fang;TONG Xiao-wen;CHENG Zhong-ping(Department of Obstetrics and Gynecology,Shanghai Tenth People′s Hospital,Tongji University School of Medicine,Shanghai 200072,China;Department of Obstetrics and Gynecology,Tongji Hospital,Tongji University School of Medicine,Shanghai 200065,China)
出处
《局解手术学杂志》
2019年第6期425-428,共4页
Journal of Regional Anatomy and Operative Surgery
基金
国家自然科学基金面上项目(81771560)
关键词
前盆底重建术
阴道前壁脱垂
网片修补术
阴道前壁修补术
尸体解剖
anterior pelvic floor reconstruction
anterior vaginal wall prolapse
transabdominal preperitoneal prosthesis
anterior vaginal wall repair
autopsy
