發(fā)布時(shí)間：2018-09-14 14:19

【摘要】： 目的：測(cè)量Prolift全盆底重建手術(shù)時(shí)6根穿刺針與周圍主要血管、神經(jīng)之間的距離,為降低在臨床上開(kāi)展女性Prolift全盆底重建手術(shù)時(shí)可能發(fā)生的手術(shù)并發(fā)癥提供解剖學(xué)基礎(chǔ)。 方法：取10具經(jīng)10%福爾馬林防腐固定的成年女性尸體標(biāo)本,模擬Prolift全盆底重建手術(shù)6根穿刺針的穿刺路徑進(jìn)行穿刺,然后進(jìn)行逐層解剖,測(cè)量穿刺針與周圍主要血管、神經(jīng)之間的最小距離。 1.模擬臨床進(jìn)行前盆底重建術(shù)時(shí)穿刺針的穿刺過(guò)程,測(cè)量穿刺針與盆腔內(nèi)、外閉孔血管,神經(jīng)之間的最小距離。 2.模擬臨床進(jìn)行后盆底重建術(shù)時(shí)穿刺針的穿刺過(guò)程,測(cè)量穿刺針與陰部?jī)?nèi)動(dòng)脈、神經(jīng)頭端(包括肛神經(jīng)、陰蒂背神經(jīng)、會(huì)陰神經(jīng))之間的最小距離。 結(jié)果： 1.模擬Prolift全盆底重建術(shù)前盆底重建時(shí)穿刺針淺帶與盆內(nèi)段閉孔動(dòng)脈的最小距離左、右各為2.97±0.57(cm)、3.16±0.75(cm),深帶的最小距離左、右各為2.57±0.52(cm)、2.67±0.64(cm)；穿刺針淺帶與盆內(nèi)段閉孔神經(jīng)的最小距離左、右各為3.21±0.59(cm)、3.03±0.32(cm),深帶的最小距離左、右各為2.69±0.47(cm)、2.52±0.43(cm)。 2.模擬Prolift全盆底重建術(shù)前盆底重建時(shí)穿刺針淺帶與閉孔膜外閉孔動(dòng)脈干的最小距離左、右各為1.65±0.36(cm)、1.54±0.42(cm),深帶的最小距離左、右各為1.57±0.40(cm)、1.47±0.45(cm)；穿刺針淺帶與閉孔膜外閉孔動(dòng)脈前支的最小距離左、右各為1.54±0.39(cm)、1.50±0.47(cm),深帶的最小距離左、右各為1.22±0.38 (cm)、1.17±0.44 (cm)；穿刺針淺帶與閉孔膜外閉孔動(dòng)脈后支的最小距離左、右各為1.81±0.35(cm)、1.67±0.50(cm),深帶的最小距離左、右各為1.45±0.43(cm)、1.43±0.42(cm)。 3.模擬Prolift全盆底重建術(shù)前盆底重建時(shí)穿刺針淺帶與閉孔膜外閉孔神經(jīng)前支的最小距離左、右各為1.79±0.46(cm)、1.77±0.44(cm),深帶的最小距離左、右各為1.64±0.50(cm)、1.51±0.42(cm)；穿刺針淺帶與閉孔膜外閉孔神經(jīng)后支的最小距離左、右各為1.80±0.45(cm)、1.72±0.40(cm),深帶的最小距離左、右各為1.59±0.44(cm)、1.58±0.42(cm)。 4.模擬Prolift全盆底重建術(shù)后盆底重建時(shí)穿刺針穿經(jīng)骶棘韌帶時(shí)穿刺針與陰部?jī)?nèi)動(dòng)脈頭端的最小距離左、右各為1.10±0.19(cm)、1.14±0.22(cm)；與肛神經(jīng)頭端的最小距離左、右各為0.79±0.44(cm)、0.69±0.39(cm)；與會(huì)陰神經(jīng)頭端的最小距離左、右各為1.26±050(cm)、1.21±0.37(cm)；與陰蒂背神經(jīng)頭端的最小距離左、右各為1.20±0.28(cm)、1.21±0.26(cm)。 結(jié)論： 1.進(jìn)行前盆底重建術(shù)時(shí),按照規(guī)范手術(shù)路徑進(jìn)行穿刺進(jìn)入盆腔并固定在盆筋膜腱弓的正確位置上可避免損傷盆內(nèi)段閉孔血管、神經(jīng)。 2.前盆底重建時(shí),與閉孔區(qū)淺帶穿刺路徑相比,深帶更容易損傷閉孔血管、神經(jīng)。 3.進(jìn)行后盆底重建穿經(jīng)骶棘韌帶時(shí),穿刺針與坐骨棘的距離2 cm時(shí)有可能損傷陰部?jī)?nèi)血管、神經(jīng)。
[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 鹵0.57 (cm) / min, the minimum distance of the deep band of 3.16 鹵0.75 (cm), on the right was 2.57 鹵0.52 (cm) / 0. 67 鹵0.64 (cm); respectively, and the minimum distance between the superficial band and the inner segment of the obturator nerve was 2.57 鹵0.52 (cm) / 0.67 鹵0.64 (cm); respectively. The minimum distance between the right and the right was 3.21 鹵0.59 (cm) / L 3.03 鹵0.32 (cm), and 2.69 鹵0.47 (cm) / 2.52 鹵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 鹵0.36 (cm) / min, 1.54 鹵0.42 (cm), on the right and 1.57 鹵0.40 (cm) / 1.47 鹵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 鹵0.39 (cm) and 1.50 鹵0.47 (cm), on the right, and the minimum distance of 1.22 鹵0.38 (cm) and 1.17 鹵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 鹵0.38 (cm) and 1.17 鹵0.44 (cm); respectively. The minimum distance between right and right was 1.81 鹵0.35 (cm), 1.67 鹵0.50 (cm), 1.45 鹵0.43 (cm) and 1.43 鹵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 鹵0.46 (cm) / 1.77 鹵0.44 (cm), on the right and 1.64 鹵0.50 (cm) / 0.51 鹵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 鹵0.46 (cm) / 1.77 鹵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 鹵0.45 (cm) and 1.72 鹵0.40 (cm), respectively, and that of the right side was 1.59 鹵0.44 (cm) and 1.58 鹵0.42 (cm)., respectively. The minimum distance between the puncture needle and the head of the internal pudendal artery was 1.10 鹵0.19 (cm) / min, 1.14 鹵0.22 (cm); and 0.79 鹵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 鹵0.19 (cm) / 0.22 (cm); and 0.79 鹵0.44 (cm) / 0.39 (cm);, respectively. The minimum distance to the head of perineal nerve was 1.26 鹵0.50 (cm) / min and 1.21 鹵0.37 (cm);, respectively, and 1.20 鹵0.28 (cm) / 0.26 (cm). To the right and 1.20 鹵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.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R322;R713

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