腹腔镜入路骶神经电刺激器植入的解剖学特点及其临床意义

Anatomical study of laparoscopic sacral nerve stimulator implantation and its clinical significance

目的讨论腹腔镜下骶前方植入骶神经电刺激电极手术入路解剖及手术可行性。方法在20具成人尸体标本上模拟腹腔镜下显露骶骨前第2~4骶神经前支手术,观察骶骨前方第2~4骶神经前支的形态特征和骶孔周围可能损伤重要血管的区域。结果第2~4骶神经前支出骶前孔至汇成骶丛的长度:S2左(32.62±3.15)mm,右(31.46±3.28)mm;S3左(21.96±2.59)mm,右(20.61±3.14)mm;S4左(15.04±1.64)mm,右(16.09±1.38)mm。骶外侧动脉的脊支动脉进入骶前孔的方位主要为内上象限。臀下动脉穿过神经时比较偏外侧靠近神经汇合处。骶椎旁静脉在第2~4骶前孔处与骶外侧动脉伴行,脊支静脉出骶前孔的位置与动脉一致。结论骶骨前方第2~4骶神经前支游离的长度能够达到硬膜外型骶神经电刺激器电极植入的要求。手术中骶前孔内侧为血管易损伤的危险区域。

Objective To discuss the surgical approach of anterior sacral nerve electrical stimulation electrode under laparoscope and its feasibility.Methods Mock laparoscopic operations on 2~4 sacral anterior nerves were conducted on twenty adult cadavers.The morphology of 2~4 sacral nerve anterior branch in front of the sacrum and the area around the sacral foramina where the important blood vessels may be damaged were observed and measured.Results The lengths of 2~4 sacral nerve anterior branch from the anterior sacral foramina to the sacral plexus were measured as followings respectively:left side of the S2(32.62±3.15)mm,right side of the S2(31.46±3.28)mm;S3 left(21.96±2.59)mm,right(20.61±3.14)mm;S4 left(15.04±1.64)mm,right(16.09±1.38)mm.The location of vertebral artery of lateral sacral artery on the 2~4 anterior sacral foramina was in the upper inner quadrant.The inferior gluteal artery passed through the nerves and laterally near the junction of the nerves.Sacral paravertebral veins were accompanied by the lateral sacral artery at the 2~4 anterior sacral foramina.The position of the spine vein out of the sacral foramina was consistent with the artery.Conclusions The length of the dissociative presacral S2~4 anterior branches could meet the requirements of the installation of epidural sacral nerve electronic stimulator.The medial side of the anterior sacral foramina was the dangerous area of vascular injury during surgery.