TVT-O治疗女性压力性尿失禁的解剖研究

发布时间：2018-01-08 17:25

本文关键词：TVT-O治疗女性压力性尿失禁的解剖研究　出处：《郑州大学》2007年硕士论文　论文类型：学位论文

【摘要】： 目的：通过尸体解剖研究由内向外经闭孔阴道无张力吊带术(TVT-O)治疗女性压力性尿失禁的精确性、安全性和可操作性，并报道吊带的路径以及它与周围器官、组织、结构关系的解剖学结果。材料和方法： 1．材料 1．1吊带材料：TVT-O装置为美国强生医疗有限公司产品。TVT-O装置包括螺旋穿刺针，蝶形导引器，和一条带有倒钩的聚丙烯网状吊带。 1．2尸体：解剖教研室提供的15具新鲜冰冻尸体，未做特殊防腐处理。所有的尸体为年龄在40～75岁之间，没有骨盆和会阴损伤的女性。 2．方法 2．1 TVT-O手术：14具尸体分成两组，分别由不同的外科医生在女尸上依照标准进行：取过度截石位，于阴道前壁中线处距尿道外口约1cm起做一矢状切口，长约1.5cm，尿道外口上2cm水平线、大腿内侧皱褶外2cm处行0.5cm皮肤切口。组织钳夹持阴道前壁切口边缘，游离两侧阴道粘膜，用弯组织剪采用“边推边分”的钝性方法分离两侧阴道黏膜，分离的角度应与正中线呈45°夹角，，剪刀保持在水平面或者尖端略抬高，继续向着耻骨体和耻骨下支连接处分离。当到达耻骨体和耻骨下支连接处时，刺穿闭孔膜。插入蝶形导引器且越过耻骨下支，沿着蝶形导引器的轨迹插入螺旋穿刺针，并向前轻轻推进，使其穿过闭孔膜。拔除蝶形导引器，使螺旋穿刺针从大腿内侧皱褶皮肤切口处穿出。拔除螺旋穿刺针，拉出吊带。同法穿刺对侧。 2．2解剖方法：15具尸体中的一具不行TVT-O吊带置入而直接进行解剖，来明确闭孔动脉前支以及其它组织结构在置入吊带后是否有所改变。其它尸体的解剖从股三角开始，将大腿、闭孔和骨盆区域进行解剖，对重要的血管、神经进行标注，并将吊带经过的路径进行记录。结果：吊带位于从尿道下方到会阴区的有限的空间内，其走行是依据严格的路径的，吊带所处的区域是坐骨直肠窝最前端的隐窝处，内侧界和上界为肛提肌，下界为会阴膜，闭孔内肌组成其外侧界。吊带然后穿过闭孔膜和闭孔肌，穿透内收肌群和皮下组织，最后从皮肤穿出。吊带远离了：1)阴蒂背神经。阴蒂背神经处于会阴膜下更表浅的位置。2)闭孔神经和闭孔血管。3)大隐静脉和股动、静脉。结论：这些发现充分证明TVT-O吊带技术治疗女性压力性尿失禁是高度精确的、可操控的，而且是安全的，术中不需要进行膀胱镜检查。
[Abstract]:Objective: to study the accuracy, safety and maneuverability of TVT-O in the treatment of female stress urinary incontinence. The anatomical results of the path of the sling and its relationship with the surrounding organs, tissues and structures are also reported. Materials and methods: 1. Materials 1.1 suspension material: TVT-O device is a product of Johnson Medical Co., Ltd., USA. TVT-O device includes a spiral needle, a butterfly guide, and a polypropylene mesh strap with barbs. 1.2 cadavers: 15 fresh frozen cadavers provided by the Department of Anatomy without special embalming. All corpses are women aged 40 to 75 years without pelvic and perineal injuries. 2. Methodology 2.1 TVT-O: 14 cadavers were divided into two groups and were performed by different surgeons on female cadavers in accordance with the standard: excessive lithotomy. A sagittal incision was made at the midline of the anterior wall of the vagina about 1 cm from the external urethral orifice. The length of the incision was about 1.5 cm, and the horizontal line was 2 cm above the external orifice of the urethra. A 0.5 cm skin incision was made 2 cm outside the medial fold of the thigh. The margin of the incision was clamped by tissue pliers and the vagina mucosa was free on both sides. The blunt method of "pushing and dividing" was used to separate the vaginal mucous membrane of both sides. The angle of separation should be 45 掳with the median line, and the scissors should be kept in the horizontal plane or slightly raised at the tip. Continue to separate toward the junction of the pubic body and the inferior pubic branch. When reaching the junction between the pubic body and the subpubic branch, puncture the obturator membrane. Insert the butterfly guide and cross the inferior pubic branch. Insert the spiral needle along the trajectory of the butterfly guide and gently push it forward through the closed hole film. Remove the butterfly guide. Let the screw puncture needle through the skin incision of the inner thigh fold. Pull out the screw needle, pull out the sling. Puncture the opposite side of the same method. 2.2 Anatomy: one of the 15 cadavers was dissected directly by placing a TVT-O sling. To determine whether the anterior branches of the obturator artery and other tissue structures have changed after placing the sling. Other cadavers are dissected from the femoral triangle, dissecting the thigh, obturator and pelvic regions, and dissecting important blood vessels. The nerve is labeled and the path through which the sling passes is recorded. Results: the sling was located in a limited space from the lower urethra to the perineal area. The traversing of the sling was based on a strict path. The region in which the sling was located was the anterior rectum of the sciatic rectum and the medial and upper margin of the levator ani muscle. The lower boundary is the perineal membrane and the internal obturator muscle forms its lateral boundary. The sling band then passes through the obturator membrane and the obturator muscle and penetrates the adductor muscle group and the subcutaneous tissue. The saphenous vein, femoral vein and femoral vein were located in the superficial position of the clitoris nerve and obturator nerve and obturator vessel. 3) the superior saphenous vein and femoral artery and vein were removed from the saphenous vein of the clitoris and the superficial position of the dorsal clitoral nerve in the perineum. Conclusion: these findings fully demonstrate that the treatment of female stress urinary incontinence with TVT-O sling technique is highly accurate, controllable, and safe, and no cystoscopy is required during the operation.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R694.54;R322

【参考文献】