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. |
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