女性Prolift全盆底重建术的临床应用解剖学研究

发布时间：2018-09-14 14:19

【摘要】： 目的：测量Prolift全盆底重建手术时6根穿刺针与周围主要血管、神经之间的距离,为降低在临床上开展女性Prolift全盆底重建手术时可能发生的手术并发症提供解剖学基础。方法：取10具经10%福尔马林防腐固定的成年女性尸体标本,模拟Prolift全盆底重建手术6根穿刺针的穿刺路径进行穿刺,然后进行逐层解剖,测量穿刺针与周围主要血管、神经之间的最小距离。 1.模拟临床进行前盆底重建术时穿刺针的穿刺过程,测量穿刺针与盆腔内、外闭孔血管,神经之间的最小距离。 2.模拟临床进行后盆底重建术时穿刺针的穿刺过程,测量穿刺针与阴部内动脉、神经头端(包括肛神经、阴蒂背神经、会阴神经)之间的最小距离。结果： 1.模拟Prolift全盆底重建术前盆底重建时穿刺针浅带与盆内段闭孔动脉的最小距离左、右各为2.97±0.57(cm)、3.16±0.75(cm),深带的最小距离左、右各为2.57±0.52(cm)、2.67±0.64(cm)；穿刺针浅带与盆内段闭孔神经的最小距离左、右各为3.21±0.59(cm)、3.03±0.32(cm),深带的最小距离左、右各为2.69±0.47(cm)、2.52±0.43(cm)。 2.模拟Prolift全盆底重建术前盆底重建时穿刺针浅带与闭孔膜外闭孔动脉干的最小距离左、右各为1.65±0.36(cm)、1.54±0.42(cm),深带的最小距离左、右各为1.57±0.40(cm)、1.47±0.45(cm)；穿刺针浅带与闭孔膜外闭孔动脉前支的最小距离左、右各为1.54±0.39(cm)、1.50±0.47(cm),深带的最小距离左、右各为1.22±0.38 (cm)、1.17±0.44 (cm)；穿刺针浅带与闭孔膜外闭孔动脉后支的最小距离左、右各为1.81±0.35(cm)、1.67±0.50(cm),深带的最小距离左、右各为1.45±0.43(cm)、1.43±0.42(cm)。 3.模拟Prolift全盆底重建术前盆底重建时穿刺针浅带与闭孔膜外闭孔神经前支的最小距离左、右各为1.79±0.46(cm)、1.77±0.44(cm),深带的最小距离左、右各为1.64±0.50(cm)、1.51±0.42(cm)；穿刺针浅带与闭孔膜外闭孔神经后支的最小距离左、右各为1.80±0.45(cm)、1.72±0.40(cm),深带的最小距离左、右各为1.59±0.44(cm)、1.58±0.42(cm)。 4.模拟Prolift全盆底重建术后盆底重建时穿刺针穿经骶棘韧带时穿刺针与阴部内动脉头端的最小距离左、右各为1.10±0.19(cm)、1.14±0.22(cm)；与肛神经头端的最小距离左、右各为0.79±0.44(cm)、0.69±0.39(cm)；与会阴神经头端的最小距离左、右各为1.26±050(cm)、1.21±0.37(cm)；与阴蒂背神经头端的最小距离左、右各为1.20±0.28(cm)、1.21±0.26(cm)。结论： 1.进行前盆底重建术时,按照规范手术路径进行穿刺进入盆腔并固定在盆筋膜腱弓的正确位置上可避免损伤盆内段闭孔血管、神经。 2.前盆底重建时,与闭孔区浅带穿刺路径相比,深带更容易损伤闭孔血管、神经。 3.进行后盆底重建穿经骶棘韧带时,穿刺针与坐骨棘的距离2 cm时有可能损伤阴部内血管、神经。
[Abstract]:Objective: to measure the distance between the six puncture needles and the peripheral main vessels and nerves during Prolift total pelvic floor reconstruction so as to provide anatomic basis for reducing the possible complications of female Prolift total pelvic floor reconstruction. Methods: ten adult female cadavers fixed with 10% formalin were selected, and the puncture paths of 6 puncture needles were simulated for reconstruction of the whole pelvic floor by Prolift. Then the puncture needles and the main blood vessels around them were dissected layer by layer. Minimum distance between nerves. 1. To simulate the puncture process of puncture needle in clinical reconstruction of anterior pelvic floor, and measure the minimum distance between puncture needle and intrapelvic, external obturator vessels, nerve. 2. The minimal distance between the puncture needle and the internal pudendal artery and head (including anal nerve, dorsal clitoral nerve and perineal nerve) was measured by simulating the puncture process of the puncture needle during the reconstruction of the posterior pelvic floor. Results: 1. The minimum distance between the superficial band of the puncture needle and the obturator artery of the intrapelvic segment was 2.97 卤0.57 (cm) / min, the minimum distance of the deep band of 3.16 卤0.75 (cm), on the right was 2.57 卤0.52 (cm) / 0. 67 卤0.64 (cm); respectively, and the minimum distance between the superficial band and the inner segment of the obturator nerve was 2.57 卤0.52 (cm) / 0.67 卤0.64 (cm); respectively. The minimum distance between the right and the right was 3.21 卤0.59 (cm) / L 3.03 卤0.32 (cm), and 2.69 卤0.47 (cm) / 2.52 卤0.43 (cm). / 2, respectively. The minimum distance between the superficial band of puncture needle and the artery trunk of the obturator adventitia obturator was 1.65 卤0.36 (cm) / min, 1.54 卤0.42 (cm), on the right and 1.57 卤0.40 (cm) / 1.47 卤0.45 (cm); on the right, respectively, during the reconstruction of the pelvic floor before simulated Prolift total pelvic floor reconstruction. The minimum distance between the superficial band of puncture needle and the anterior branch of the obturator artery was left, the minimum distance of the deep band of 1.54 卤0.39 (cm) and 1.50 卤0.47 (cm), on the right, and the minimum distance of 1.22 卤0.38 (cm) and 1.17 卤0.44 (cm); on the right, respectively, between the superficial band and the posterior branch of the extracellular obturator foramen obturator artery, and the minimum distance between the superficial band and the posterior branch of the obturator artery were 1.22 卤0.38 (cm) and 1.17 卤0.44 (cm); respectively. The minimum distance between right and right was 1.81 卤0.35 (cm), 1.67 卤0.50 (cm), 1.45 卤0.43 (cm) and 1.43 卤0.42 (cm)., respectively. The minimum distance between the superficial band of puncture needle and the anterior branch of the obturator nerve was 1.79 卤0.46 (cm) / 1.77 卤0.44 (cm), on the right and 1.64 卤0.50 (cm) / 0.51 卤0.42 (cm); on the right, respectively, in the reconstruction of the pelvic floor before simulated Prolift total pelvic floor reconstruction. The minimum distance between the superficial band and the anterior branch of the obturator nerve was 1.79 卤0.46 (cm) / 1.77 卤0.44 (cm), respectively. The minimum distance between the superficial band of puncture needle and the posterior branch of the obturator nerve was 1.80 卤0.45 (cm) and 1.72 卤0.40 (cm), respectively, and that of the right side was 1.59 卤0.44 (cm) and 1.58 卤0.42 (cm)., respectively. The minimum distance between the puncture needle and the head of the internal pudendal artery was 1.10 卤0.19 (cm) / min, 1.14 卤0.22 (cm); and 0.79 卤0.44 (cm) / 0.39 (cm);, respectively, when the puncture needle was punctured through the sacrospinous ligament during the pelvic floor reconstruction of simulated Prolift, and the minimum distance between the puncture needle and the head of the pudendal artery was 1.10 卤0.19 (cm) / 0.22 (cm); and 0.79 卤0.44 (cm) / 0.39 (cm);, respectively. The minimum distance to the head of perineal nerve was 1.26 卤0.50 (cm) / min and 1.21 卤0.37 (cm);, respectively, and 1.20 卤0.28 (cm) / 0.26 (cm). To the right and 1.20 卤0.28 (cm) / min to the head of the dorsal clitoral nerve, respectively. Conclusion: 1. In anterior pelvic floor reconstruction, puncture into the pelvic cavity according to the standard operation path and fixation in the correct position of the pelvic fascia tendon arch can avoid the injury of the obturator vessels and nerves in the pelvic segment. 2. In anterior pelvic floor reconstruction, the deep band was more likely to damage the obturator vessels and nerves than the superficial obturator region. When the posterior pelvic floor was reconstructed through the sacral spine ligaments, the distance between the puncture needle and the sciatic spine was 2 cm, which might damage the blood vessels and nerves of the pudendal region.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322;R713

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