骶生殖襞作为解剖标志在全直肠系膜切除术中预防盆段输尿管损伤的研究

Prevention of pelvic ureteral injury in total mesorectal excision using the sputum genital warts as an anatomical landmark

目的:探讨以骶生殖襞作为解剖标志在全直肠系膜切除术(TME)中预防盆段输尿管损伤的价值。方法:实验阶段(实验组)选取10例尸体,男5例,女5例,进行TME,解剖出骶生殖襞、输尿管,明确两者的位置关系、走行方向,测量多个层面直肠系膜-骶生殖襞-输尿管之间的距离;临床阶段(手术组)选取30例拟行腹腔镜TME的直肠癌患者,随机分为研究组和对照组。研究组术中以骶生殖襞为解剖标志预防盆段输尿管损伤,对照组以Toldt's间隙为解剖标志,统计两组术中损伤和术后并发症,并对比手术时间、住院时间和医疗费用等。结果:实验组和手术组均在术中清晰见到骶生殖襞。实验组测量骶生殖襞与直肠系膜的平均距离为(2. 23±0. 23) cm,与盆段输尿管的平均距离为(0. 85±0. 28) cm。研究组手术时间为(127. 37±61. 53) min,短于对照组(t=1. 264,P <0. 05);住院时间、住院费用分别为(12. 54±2. 46) d、(46 257. 29±682. 23)元,与对照组差异无统计学意义(P> 0. 05)。研究组术中无盆段输尿管损伤,对照组盆段输尿管损伤2例,两组术中并发症发生率(6. 67%vs 33. 33%)差异具有统计学意义(χ2=16. 352,P <0. 001),术后并发症发生率(6. 67%vs 26. 67%)差异也具有统计学意义(χ2=9. 624,P <0. 05)。结论:TME以骶生殖襞为解剖标志可有效避免损伤盆段输尿管,降低手术风险,且不增加手术费用,值得临床推广。

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%,χ^2 = 16.352,P<0.001).The difference in postoperative complications between the two groups was statistically significant(6.67% vs 26.67%,χ^2 = 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.