中国伤残医学
中國傷殘醫學
중국상잔의학
CHINESE JOURNAL OF TRAUMA AND DISABILITY MEDICINE
2015年
3期
14-15
,共2页
腹腔镜%家族性腺瘤性息肉病%手术入路%输尿管损伤%腹盆腔筋膜
腹腔鏡%傢族性腺瘤性息肉病%手術入路%輸尿管損傷%腹盆腔觔膜
복강경%가족성선류성식육병%수술입로%수뇨관손상%복분강근막
Laparoscopy%Operation approach%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。
目的：探討腹腔鏡治療FAP術中如何在腹腔、盆腔觔膜解剖層麵減少髮生輸尿管損傷風險。方法：選擇自2008年1月～2013年8月在淄博市中心醫院高青院區及總院就診的 FAP 患者，將成功施行腹腔鏡結腸全切術（ LTC）的20例患者作為研究對象，均保留手術影像學資料。通過分析手術視頻觀察手術入路過程中觔膜間隙定位與輸尿管、腹部、盆腔觔膜關繫，避免腹腔鏡下治療FAP術中輸尿管損傷。結果：20例患者均完成腹腔鏡下手術，根據探查情況採取瞭結腸繫膜入路與側腹膜入路，有5例患者因視野不清、齣血造成解剖層次過深而破壞Toldt’ s觔膜及因分離輸尿管過度齣現輸尿管損傷的風險。2種手術入路的男女患者均存在此風險。結論：腹腔鏡治療FAP術中的結腸繫膜入路和側腹膜入路各有優劣，但無論採用哪種手術入路，熟練掌握輸尿管毗鄰關繫、鏡下準確尋找腹盆腔觔膜及間隙都是避免輸尿管損傷的關鍵。
목적：탐토복강경치료FAP술중여하재복강、분강근막해부층면감소발생수뇨관손상풍험。방법：선택자2008년1월～2013년8월재치박시중심의원고청원구급총원취진적 FAP 환자，장성공시행복강경결장전절술（ LTC）적20례환자작위연구대상，균보류수술영상학자료。통과분석수술시빈관찰수술입로과정중근막간극정위여수뇨관、복부、분강근막관계，피면복강경하치료FAP술중수뇨관손상。결과：20례환자균완성복강경하수술，근거탐사정황채취료결장계막입로여측복막입로，유5례환자인시야불청、출혈조성해부층차과심이파배Toldt’ s근막급인분리수뇨관과도출현수뇨관손상적풍험。2충수술입로적남녀환자균존재차풍험。결론：복강경치료FAP술중적결장계막입로화측복막입로각유우렬，단무론채용나충수술입로，숙련장악수뇨관비린관계、경하준학심조복분강근막급간극도시피면수뇨관손상적관건。
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.
