网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
骶生殖襞作为解剖标志在全直肠系膜切除术中预防盆段输尿管损伤的研究
作者:梁天伟  易青群 
单位:广西柳州市柳铁中心医院 胃肠外科, 广西 柳州 545000
关键词:全直肠系膜切除术 骶生殖襞 盆段输尿管损伤 解剖标志 
分类号:R657.1
出版年·卷·期(页码):2018·46·第十一期(1227-1231)
摘要:

目的:探讨以骶生殖襞作为解剖标志在全直肠系膜切除术(TME)中预防盆段输尿管损伤的价值。方法:实验阶段(实验组)选取10例尸体,男5例,女5例,进行TME,解剖出骶生殖襞、输尿管,明确两者的位置关系、走行方向,测量多个层面直肠系膜-骶生殖襞-输尿管之间的距离;临床阶段(手术组)选取30例拟行腹腔镜TME的直肠癌患者,随机分为研究组和对照组。研究组术中以骶生殖襞为解剖标志预防盆段输尿管损伤,对照组以Toldt's间隙为解剖标志,统计两组术中损伤和术后并发症,并对比手术时间、住院时间和医疗费用等。结果:实验组和手术组均在术中清晰见到骶生殖襞。实验组测量骶生殖襞与直肠系膜的平均距离为(2.23±0.23)cm,与盆段输尿管的平均距离为(0.85±0.28)cm。研究组手术时间为(127.37±61.53)min,短于对照组(t=1.264,P<0.05);住院时间、住院费用分别为(12.54±2.46)d、(46 257.29±682.23)元,与对照组差异无统计学意义(P>0.05)。研究组术中无盆段输尿管损伤,对照组盆段输尿管损伤2例,两组术中并发症发生率(6.67% vs 33.33%)差异具有统计学意义(χ2=16.352,P<0.001),术后并发症发生率(6.67% vs 26.67%)差异也具有统计学意义(χ2=9.624,P<0.05)。结论:TME以骶生殖襞为解剖标志可有效避免损伤盆段输尿管,降低手术风险,且不增加手术费用,值得临床推广。

Objective:To investigate the prevention of pelvic ureteral injury in total mesorectal excision using the sputum genital warts as an anatomical landmark. Methods:The study was conducted in two phases.In the experimental stage, 10 cadaveric bodies (experimental group) were selected, 5 males and 5 females. The experimental group performed TME, the genital ridge was dissected from ureter. The positional relationship between the genital warts and the ureters was analyzed. The distance between multiple layers of the mesorectum-genital warts-ureters was measured. 30 patients with rectal cancer who were undergoing laparoscopic TME (surgery group) were randomly divided into two groups.In the study group, sputum genital warts were used as an anatomical landmark to prevent pelvic urethral injury.The Toldt's gap in the control was used as an anatomical landmark.The secondary injury and postoperative complications were counted, and the operation time, hospitalization time and medical expenses were compared. Results:Sacrogenital folds were clearly seen in both the experimental group and the operative group. In the experimental group, the average distance from sacrogenital fold to mesentery was(2.23±0.23) cm, to pelvic urete(0.85±0.28) cm. The operative time of the study group was(127.37±61.53) min, shorter than that of the control group (t=1.264, P<0.05), and the hospitalization time and the hospitalization cost were(12.54±2.46) d, (46 257.29±682.23) yuan, respectively. There was no significant difference between the control group and the control group(P>0.05). No pelvic urethral injury occurred in the study group. There was a statistically significant difference in intraoperative complications between the two groups (6.67% vs 33.33%, χ2=16.352, P<0.001).The difference in postoperative complications between the two groups was statistically significant(6.67% vs 26.67%, χ2=9.624, P<0.05). Conclusion:TME using the sputum genital warts as an anatomical landmark can effectively prevent pelvic ureter from injuring and reduce the risk of surgery without increasing the cost of surgery. It is worthy of clinical application.

参考文献:

[1] MAKIN G B,BREEN D J,MONSON J R.The impact of new technology on surgery for colorectal cancer[J].World J Gastroenterol,2001,7(5):612-621.
[2] 熊涛,郑斌,唐伟,等.26例医源性输尿管损伤的诊治分析[J].重庆医学,2015,44(25):3545-3546.
[3] 申占龙,叶颖江,王杉.直肠癌经肛全直肠系膜切除术的解剖学层面的辨识及其术中并发症的预防[J].中华胃肠外科杂志,2017,20(7):744-747.
[4] ANDERSON A,BERGDAHL L.Urologic complication following abdominoperineal resection of recturm[J].Arch Surg,1976,111(3):894-897.
[5] YONG L,DEANE M,MONSOON J R T,et al.Systematic review of laparoscopic surgery for colorectal malignancy[J].Surg Endosc,2001,15(5):1431-1439.
[6] 孙轶,卢永刚,梁天伟,等.全直肠系膜切除术中预防盆段输尿管损伤的解剖标志[J].世界华人消化杂志,2010,18(32):3489-3491.
[7] 中华人民共和国国家卫生和计划生育委员会医政医管局中华医学会肿瘤学分会.结直肠癌诊疗规范(2015年版)[J].中国实用外科杂志,2015,35(11):1177-1191.
[8] 张秀峰,王厚东,沈忠,等.手辅助腹腔镜与全腹腔镜治疗低位直肠癌早期临床疗效分析[J].肿瘤学杂志,2018,24(2):164-167.
[9] NETTERF H,王怀经.奈特人体解剖彩色图谱[M].北京:人民卫生出版社,2005:349-350.
[10] 吴阶平.吴阶平泌尿外科学[M].济南:山东科学技术出版社,2008:372.
[11] 叶志伟,陈远光,胡明,等.直肠癌经肛内镜全直肠系膜切除术对肛门功能影响的临床研究[J].中国普通外科杂志,2015,24(4):473-477.
[12] 张明庆,李会晨,张锡朋.直肠癌经肛门全直肠系膜切除术的临床应用[J].中国中西医结合外科杂志,2016,22(5):517-519.
[13] 王成龙,汤文浩.直肠癌术后吻合口漏影响因素的探讨分析[J].东南大学学报(医学版),2015,34(6):1033-1036.
[14] 汪晓东,甘志明,阳川华,等.预防性造口对超低位直肠/肛管癌患者保肛术后肛门功能及生存质量的影响[J].现代医学,2015,43(4):472-475.
[15] 渠浩,杜燕夫,李敏哲,等.腹腔镜结直肠癌手术中输尿管的保护[J].中华外科杂志,2009,47(24):1915-1916.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 256859 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541