经耻骨后无张力阴道吊带术的临床解剖研究  

Clinical Anatomic Study on the Procedure of the Retropubic Tension-Free Vaginal Tape

作　　者：艾贵海[1] 李怀芳[2] 王建军[2] 孙静[1] 童晓文[2] 

机构地区：[1]同济大学附属第一妇婴保健院,上海200040 [2]同济大学附属同济医院,上海200065

出　　处：《实用妇产科杂志》2011年第9期661-664,共4页Journal of Practical Obstetrics and Gynecology

基　　金：上海市科学技术委员会医学重大课题(编号:09DZ1950300)

摘　　要：目的:明确经耻骨后无张力阴道吊带术的穿刺路径,并探讨其在治疗女性压力性尿失禁时的安全操作范围。方法:2009年10月至2010年10月应用红色乳胶分别对2具新鲜女性尸体标本进行桡动脉血管灌注,将灌注好的标本保存在1℃～3℃的冰柜里等待乳胶凝固,5天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、神经和脏器之间的空间距离,最后分析并计算出该术式的安全操作范围。结果:实验中所有穿刺均未发生副损伤,穿刺针与膀胱、闭孔血管神经、髂外血管、腹壁下血管和腹壁浅血管的距离分别是0.5±0.1cm、4.2±0.2cm、4.7±0.1cm、4.4±0.6cm和2.7±0.4cm。结论:术中穿刺针有失控导致穿刺方向旋转而损伤上述重要血管、神经和脏器的可能,但是只要在穿刺前正确定位好腹壁穿出点的位置,就可最大程度地减少术中并发症。Objective：To identify the route of the retropubic tension-free vaginal tape（TVT） procedure which is applied to treat stress urinary incontinence（SUI）,and to explore the safety range.Methods：From October 2009 to October 2010,two fresh female cadavers were injected colored latex from radial artery;After 5 days,TVT procedure was performed when lactoprene solidified;Then,a clinical anatomic study and measurements between the trocar locations and related vassels,nerves or organs were carried out;In the end,the safety ranges were calculated for the procedure.Results：There was no complication during all procedures.The distance between TVT trocar and the bladder,obturator vessels and nerves,external iliac vessels,inferior epigastric vessels and superficial epigastric vessels were 0.5±0.1 cm、4.2±0.2 cm、4.7±0.1 cm、4.4±0.6 cm and 2.7±0.4 cm respectively.Conclusions：Out of control of TVT trocar,the deflection of TVT handle could injure the important vessels or nerves and organs in pelvis,but the correct localization in abdominal wall before TVT procedure is helpful to reduce injury.

关 键 词：无张力阴道吊带术 压力性尿失禁 尸体 解剖 

分 类 号：R699.7[医药卫生—泌尿科学]