本文關(guān)鍵詞：TVT-O治療女性壓力性尿失禁的解剖研究　出處：《鄭州大學(xué)》2007年碩士論文　論文類型：學(xué)位論文

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【摘要】： 目的：通過尸體解剖研究由內(nèi)向外經(jīng)閉孔陰道無張力吊帶術(shù)(TVT-O)治療女性壓力性尿失禁的精確性、安全性和可操作性，并報道吊帶的路徑以及它與周圍器官、組織、結(jié)構(gòu)關(guān)系的解剖學(xué)結(jié)果。 材料和方法： 1．材料 1．1吊帶材料：TVT-O裝置為美國強生醫(yī)療有限公司產(chǎn)品。TVT-O裝置包括螺旋穿刺針，蝶形導(dǎo)引器，和一條帶有倒鉤的聚丙烯網(wǎng)狀吊帶。 1．2尸體：解剖教研室提供的15具新鮮冰凍尸體，未做特殊防腐處理。所有的尸體為年齡在40～75歲之間，沒有骨盆和會陰損傷的女性。 2．方法 2．1 TVT-O手術(shù)：14具尸體分成兩組，分別由不同的外科醫(yī)生在女尸上依照標(biāo)準(zhǔn)進(jìn)行：取過度截石位，于陰道前壁中線處距尿道外口約1cm起做一矢狀切口，長約1.5cm，尿道外口上2cm水平線、大腿內(nèi)側(cè)皺褶外2cm處行0.5cm皮膚切口。組織鉗夾持陰道前壁切口邊緣，游離兩側(cè)陰道粘膜，用彎組織剪采用“邊推邊分”的鈍性方法分離兩側(cè)陰道黏膜，分離的角度應(yīng)與正中線呈45°夾角，，剪刀保持在水平面或者尖端略抬高，繼續(xù)向著恥骨體和恥骨下支連接處分離。當(dāng)?shù)竭_(dá)恥骨體和恥骨下支連接處時，刺穿閉孔膜。插入蝶形導(dǎo)引器且越過恥骨下支，沿著蝶形導(dǎo)引器的軌跡插入螺旋穿刺針，并向前輕輕推進(jìn)，使其穿過閉孔膜。拔除蝶形導(dǎo)引器，使螺旋穿刺針從大腿內(nèi)側(cè)皺褶皮膚切口處穿出。拔除螺旋穿刺針，拉出吊帶。同法穿刺對側(cè)。 2．2解剖方法：15具尸體中的一具不行TVT-O吊帶置入而直接進(jìn)行解剖，來明確閉孔動脈前支以及其它組織結(jié)構(gòu)在置入吊帶后是否有所改變。其它尸體的解剖從股三角開始，將大腿、閉孔和骨盆區(qū)域進(jìn)行解剖，對重要的血管、神經(jīng)進(jìn)行標(biāo)注，并將吊帶經(jīng)過的路徑進(jìn)行記錄。 結(jié)果：吊帶位于從尿道下方到會陰區(qū)的有限的空間內(nèi)，其走行是依據(jù)嚴(yán)格的路徑的，吊帶所處的區(qū)域是坐骨直腸窩最前端的隱窩處，內(nèi)側(cè)界和上界為肛提肌，下界為會陰膜，閉孔內(nèi)肌組成其外側(cè)界。吊帶然后穿過閉孔膜和閉孔肌，穿透內(nèi)收肌群和皮下組織，最后從皮膚穿出。吊帶遠(yuǎn)離了：1)陰蒂背神經(jīng)。陰蒂背神經(jīng)處于會陰膜下更表淺的位置。2)閉孔神經(jīng)和閉孔血管。3)大隱靜脈和股動、靜脈。 結(jié)論：這些發(fā)現(xiàn)充分證明TVT-O吊帶技術(shù)治療女性壓力性尿失禁是高度精確的、可操控的，而且是安全的，術(shù)中不需要進(jìn)行膀胱鏡檢查。
[Abstract]:Objective: to study the accuracy, safety and maneuverability of TVT-O in the treatment of female stress urinary incontinence. The anatomical results of the path of the sling and its relationship with the surrounding organs, tissues and structures are also reported. Materials and methods: 1. Materials 1.1 suspension material: TVT-O device is a product of Johnson Medical Co., Ltd., USA. TVT-O device includes a spiral needle, a butterfly guide, and a polypropylene mesh strap with barbs. 1.2 cadavers: 15 fresh frozen cadavers provided by the Department of Anatomy without special embalming. All corpses are women aged 40 to 75 years without pelvic and perineal injuries. 2. Methodology 2.1 TVT-O: 14 cadavers were divided into two groups and were performed by different surgeons on female cadavers in accordance with the standard: excessive lithotomy. A sagittal incision was made at the midline of the anterior wall of the vagina about 1 cm from the external urethral orifice. The length of the incision was about 1.5 cm, and the horizontal line was 2 cm above the external orifice of the urethra. A 0.5 cm skin incision was made 2 cm outside the medial fold of the thigh. The margin of the incision was clamped by tissue pliers and the vagina mucosa was free on both sides. The blunt method of "pushing and dividing" was used to separate the vaginal mucous membrane of both sides. The angle of separation should be 45 擄with the median line, and the scissors should be kept in the horizontal plane or slightly raised at the tip. Continue to separate toward the junction of the pubic body and the inferior pubic branch. When reaching the junction between the pubic body and the subpubic branch, puncture the obturator membrane. Insert the butterfly guide and cross the inferior pubic branch. Insert the spiral needle along the trajectory of the butterfly guide and gently push it forward through the closed hole film. Remove the butterfly guide. Let the screw puncture needle through the skin incision of the inner thigh fold. Pull out the screw needle, pull out the sling. Puncture the opposite side of the same method. 2.2 Anatomy: one of the 15 cadavers was dissected directly by placing a TVT-O sling. To determine whether the anterior branches of the obturator artery and other tissue structures have changed after placing the sling. Other cadavers are dissected from the femoral triangle, dissecting the thigh, obturator and pelvic regions, and dissecting important blood vessels. The nerve is labeled and the path through which the sling passes is recorded. Results: the sling was located in a limited space from the lower urethra to the perineal area. The traversing of the sling was based on a strict path. The region in which the sling was located was the anterior rectum of the sciatic rectum and the medial and upper margin of the levator ani muscle. The lower boundary is the perineal membrane and the internal obturator muscle forms its lateral boundary. The sling band then passes through the obturator membrane and the obturator muscle and penetrates the adductor muscle group and the subcutaneous tissue. The saphenous vein, femoral vein and femoral vein were located in the superficial position of the clitoris nerve and obturator nerve and obturator vessel. 3) the superior saphenous vein and femoral artery and vein were removed from the saphenous vein of the clitoris and the superficial position of the dorsal clitoral nerve in the perineum. Conclusion: these findings fully demonstrate that the treatment of female stress urinary incontinence with TVT-O sling technique is highly accurate, controllable, and safe, and no cystoscopy is required during the operation.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2007
【分類號】：R694.54;R322

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