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

Transobturator tension-free vaginal tape compared with transobturator tape for treatment of female stress urinary incontinence:anatomical consideration

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悬吊术(O-IVS)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)O-IVS;吊带置入后再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3～34(13.0±1.0)mm,O-IVS组33～42(37.0±0.3)mm;吊带与闭孔神经后支平均距离:TVT-O组3～15(11.0±0.7)mm,O-IVS组20～33(27.0±0.5)mm;吊带与闭孔管的平均距离:TVT-O组18～24(21.0±0.3)mm,O-IVS组33～44(40.0±0.4)mm.两组之间的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O-IVS近,提示术中损伤血管神经的风险较大;SUI的治疗中采用O-IVS的安全性较高,可以减少血管和神经等器官损伤的潜在危险性.

AIM：To evaluate the specific risks of injury to neural and vascular structures inherent of outside-in vs inside-out technique for treatment of the female stress urinary incontinence.METHODS：Eight freshly frozen,unembalmed female cadavers kept in a cold room were used.All specimens had a tape inserted from transobturator tension-free vaginal tape（TVT-O）and/or trans-obturator intra-vaginal slingplasty（O-IVS）.After tape insertion,the cadavers were dissected,and the anatomical location of the track of each tape and the distence between the tape and blood vessels or nerves were measured and recorded.RESULTS：The mean distance between the tape and the vascular bundle：TVT-O technique 13.0±1.0（3-34）mm,O-IVS technique 37.0±0.3（33-42）mm;The mean distance between the tape and the posterior branch of the obturator nerve：TVT-O technique 11.0±0.7（3-15）mm,O-IVS technique 27.0±0.5（20-33）mm;The mean distance between the tape and the obturator canal：TVT-O technique 21.0±0.3（18-24）mm,O-IVS technique 40.0±0.4（33～44）mm.There were signaificant differences among the all values between TVT-O technique and O-IVS technique（P〈0.01）;CONCLUSION：TVT-O technique has a higher risk of injury to vascular and nerve structures.O-IVS technique may be safer in treatment with SUI,and can reduce the potential risk of injury to vascular and nerve structures.