腹腔镜结直肠癌术中避免输尿管损伤的解剖学因素探讨:Toldt筋膜的分离和显露

The investigation to avoid ureter injured from anatomical factors in the laparoscpic radical resection for colorectal cancer-separate and expose toldt's fascia

目的从解剖学层面探讨腹腔镜结直肠癌手术中如何减少发生输尿管损伤的风险。方法回顾分析2006年12月至2008年12月80例腹腔镜结直肠癌的手术录像资料,观察术中主要的手术进路以及输尿管与Toldt筋膜的关系,探讨避免腹腔镜下结直肠癌手术中输尿管损伤的方法。结果80例均完成腹腔镜手术,术中主要采用结肠系膜进路和侧腹膜进路,有12例术中因解剖过深突破Toldt筋膜或过分游离输尿管出现输尿管损伤的风险,两种手术进路均存在此风险(7例对5例,P=0.75)。结论腹腔镜结直肠癌手术中结肠系膜进路和侧腹膜进路各有特点,无论采用哪种手术进路,熟知输尿管解剖关系、术中准确寻找Toldt筋膜都是避免输尿管损伤的关键。

Objective To investigate how to decrease the risk of ureteral injured in the laparoscopic radical resection for colorectal cancer from the anatomical level.Methods Video information of 80 cases of laparoscopic radical resection for colorectal cancer from December 2006 to December 2008 were analyzed retrospectively,Observation of the main surgical approachs,and the relationship between ureter and Toldt＇s fascia,Investigate the method avoid ureter injured in the laparoscopic radical resection for colorectal cancer.Results 80 cases of laparoscopic radical resection for colorectal cancer were successfully completed surgery.The main use of Mesocolon approach and Lateral peritoneal approach,too much separation ureter and breakthrough Toldt＇s fascia are easy to injure the ureter both in two of surgical approach（7 vs.5 cases,P=0.75）.Conclusions Both two surgical approachs have their own characteristic,familiar with the ureter＇s dissection relations,and accurate search Toldt＇s fascia at intraoperative is the key to avoiding injure ureter.