两种个体化经肛提肌外腹会阴联合切除术对女性盆底影响的有限元分析  

Finite element analysis of the effects of two kinds of individual extralevator abdominalperineal excision on female pelvic floor

作　　者：王捷夫[1] 王伟达[2] 刘嘉[1] 陈昱彤[3] 喻经纬 赵鹏[1] 柳建中[1] 

机构地区：[1]天津医科大学肿瘤医院结直肠肿瘤科,国家肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,300060 [2]安世亚太科技股份有限公司北京分公司技术部 [3]天津大学管理与经济学部 [4]天津医科大学肿瘤医院淋巴瘤内科

出　　处：《中华医学杂志》2016年第8期629-633,共5页National Medical Journal of China

摘　　要：目的应用有限元分析探讨2种个体化经肛提肌外腹会阴联合切除术（ELAPE）对于女性盆底生物力学的影响。 方法建立4种女性盆底有限元模型：正常模型、ELAPE模型和2种个体化ELAPE模型，测量4种模型在相同载荷作用下的各组织最大应力，并观察应力分布。 结果单侧肛提肌切除平面靠近直肠的ELAPE模型的肛提肌部分保留侧和完整切除侧非肛提肌组织内最大应力分别为（3.114±0.129）和（4.856±0.128）MPa，前者低于后者，二者均低于ELAPE模型，为（5.127±0.070）MPa，均高于正常模型，为（1.963±0.061）MPa（均P〈0.01）；单侧肛提肌切除平面靠近盆壁的ELAPE模型的双侧非肛提肌组织内的最大应力均为（5.131 ±0.067）MPa，与ELAPE模型比较差异无统计学意义（P〉0.05）。 结论单侧肛提肌切除平面靠近直肠的ELAPE术对于盆底双侧非肛提肌组织内的应力均有降低作用，在肛提肌部分保留侧更为明显；单侧肛提肌切除平面靠近盆壁的ELAPE术对于盆底双侧非肛提肌组织内的应力无明显降低作用。ObjectiveTo evaluate the effects of two kinds of individual extralevator abdominalperineal excision（ELAPE） on female pelvic floor biomechanics. MethodsFour kinds of finite element model were developed： intact models, ELAPE models and two kinds of individual ELAPE models. The maximal stress and stress distributions of each model under the same pressure were analyzed and compared. ResultsIn the individual ELAPE models of dissection plane close to rectum on one side, non-levator ani tissue＇s maximal stress on levator ani partly reserved side and totally removed side were （3.114±0.129） and （4.856 ±0.128） MPa. The former were lower than the latter （P〈0.01）. They were both lower than those in ELAPE models which were （5.127±0.070） MPa （P〈0.01）, and were higher than those in intact model which were （1.963±0.061） MPa （P〈0.01）. In the individual ELAPE models of dissection plane close to pelvic on one side, non-levator ani tissue＇s maximal stress on both sides, which were （5.131±0.067） MPa, were similar to those in ELAPE models （P〉0.05）. ConclusionELAPE of dissection plane close to rectum on one side is able to reduce the stress of non-levator ani tissue on both sides, especially on levator ani partly reserved side; conversely, ELAPE of dissection plane close to pelvic on one side may not reduce the stress of non-levator ani tissue on either side.

关 键 词：直肠肿瘤 ELAPE术 盆底 生物力学 有限元分析 

分 类 号：R735.37[医药卫生—肿瘤]