腹腔镜全结肠切除术治疗FAP中避免输尿管损伤的解剖学因素研究

Laparoscopic Colectomy in the Treatment of FAP Avoid Anatomical Factors of Ureteral Injury

目的：探讨腹腔镜治疗FAP术中如何在腹腔、盆腔筋膜解剖层面减少发生输尿管损伤风险。方法：选择自2008年1月-2013年8月在淄博市中心医院高青院区及总院就诊的 FAP 患者，将成功施行腹腔镜结肠全切术（ LTC）的20例患者作为研究对象，均保留手术影像学资料。通过分析手术视频观察手术入路过程中筋膜间隙定位与输尿管、腹部、盆腔筋膜关系，避免腹腔镜下治疗FAP术中输尿管损伤。结果：20例患者均完成腹腔镜下手术，根据探查情况采取了结肠系膜入路与侧腹膜入路，有5例患者因视野不清、出血造成解剖层次过深而破坏Toldt’ s筋膜及因分离输尿管过度出现输尿管损伤的风险。2种手术入路的男女患者均存在此风险。结论：腹腔镜治疗FAP术中的结肠系膜入路和侧腹膜入路各有优劣，但无论采用哪种手术入路，熟练掌握输尿管毗邻关系、镜下准确寻找腹盆腔筋膜及间隙都是避免输尿管损伤的关键。

Objective：To investigate how laparoscopic surgery in the treatment of FAP abdominal, pelvic fascia anatomical level to re-duce the risk of ureteral injury .Methods：select FAP patients from January 2008 to August 2013 in Zibo central hospital Green hospital district and high total hospital that had successfully laparoscopic colon resection whole （ LTC） .20 patients were conserving surgery ima-ging data.By analyzed the operation of video observation during surgical approach fascial space positioning and ureter, abdominal, pelvic fascia, avoiding laparoscopic surgery treatment FAP ureteral injury .Results：20 cases of patients completed laparoscopic surgery, take the road and taking the mesenteric side retroperitoneal approach based on exploratory case, there are five cases of patients due to poor visibili-ty, excessive bleeding caused by anatomical level Toldt＇s deep fascia and excessive damage due to separation of the ureter the risk of ure -teral injuries occur .Both male and female patients of surgical approach are present this risk .Conclusion：Laparoscopic treatment （ FAP） intraoperative mesocolon approach and lateral retroperitoneal approach have advantages and disadvantages, but either surgical approach a-dopted, master ureter adjacent relationship, endoscopic abdominal and pelvic fascia and accurately find the gaps are is the key to avoiding ureteral injury.