经闭孔尿道中段悬吊治疗女性压力性尿失禁两种术式的解剖学对比研究

目的:探讨由内向外经闭孔阴道无张力吊带术(TVT-O)和由外向内经闭孔阴道无张力吊带术(TOT)治疗女性压力性尿失禁(SUI)穿刺入路的安全性.方法:在8具新鲜冰冻、未做防腐处理的女尸上 ,分别做TVT-O和(或)TOT;吊带置人后,分别沿吊带穿刺路径逐层进行局部解剖,观察并比较各个解剖层次的吊带与血管、神经及其他器官的关系.结果:闭孔血管束与吊带的平均距离TVT-O组为13 mm(3～34 mm),TOT组35 mm(32～41 mm);吊带和闭孔神经后支平均距离TVT-O组为11 mm(3～15 mm).TOT组26 mm(20～32mm),吊带与闭孔管的平均距离TVT-O组为21 mm(18～24 mm),TOT组38 mm(32～43 mm).两组比较,差异均有统计学意义(P＜0.01).结论:TVT-O路径中吊带与闭孔各结构的距离比TOT近,提示术中损伤血管神经的风险较大;SUI的治疗中采用TOT相对要安全些,可能减少血管和神经等器官损伤的潜在危险性.

Transobturator surgery for female stress incontinence:a comparative anatomical study of outside-in vs inside-out techniques

Objective:To evaluate the effect of specific risks of injury to neural and vascular structures inherent of outside-in vs inside-out techniques for female stress urinary incontinence.Methods:The study comprised eight freshly frozen, unembalmed female cadavers kept in a cold room. All specimens had a tape inserted outside-in and/or a tape inside-out. After tape insertion, the cadavers were dissected, and the anatomical location of the track of each tape and the relationship between the tape and vascular and b...