Spinosa Jean-Pierre, Dubuis Pierre Yves, Riederer Beat M
Department of Obstetrics and Gynaecology, Morges Hospital, Morges, and Perineology Unit, Lausanne, Switzerland.
BJU Int. 2007 Nov;100(5):1097-102. doi: 10.1111/j.1464-410X.2007.07125.x. Epub 2007 Sep 14.
OBJECTIVE To assess the specific risks of injury to neural and vascular structures inherent in two approaches to transobturator surgery for inserting a suburethral sling, i.e. the outside-in (standard technique) and inside-out approaches. MATERIALS AND METHODS The study comprised seven cadavers, providing 14 obturator regions. Five specimens had a tape inserted outside-in on one side, and inside-out on the other; of the remaining two cadavers, one had an inside-out tape and one an outside-in tape, bilaterally. After tape insertion, the cadavers were dissected. Particular attention was paid to the distances between the tape and the deep external pudendal vessels, and between the tape and the posterior branch of the obturator nerve. RESULTS With the inside-out technique, the safety margins were reduced, and the external pudendal vessels and the posterior branch of the obturator nerve were at greater risk of injury. CONCLUSION The two techniques are not equivalent, with a lower risk of injury to vascular and nerve structures with the outside-in technique.
目的 评估经闭孔置入尿道下吊带手术的两种方法（即由外向内法（标准技术）和由内向外法）对神经和血管结构造成损伤的特定风险。材料与方法 该研究包括7具尸体，提供了14个闭孔区域。5个标本一侧采用由外向内法插入吊带，另一侧采用由内向外法；其余2具尸体中，1具双侧采用由内向外法插入吊带，1具双侧采用由外向内法插入吊带。插入吊带后，对尸体进行解剖。特别关注吊带与阴部外深血管之间的距离以及吊带与闭孔神经后支之间的距离。结果 采用由内向外法时，安全 margins 减小，阴部外血管和闭孔神经后支受损伤的风险更大。结论 这两种技术并不等效，由外向内法对血管和神经结构造成损伤的风险较低。
