Wang Wei, Lang Jing-He, Zhu Lan
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Fu Chan Ke Za Zhi. 2008 Sep;43(9):657-61.
To investigate the route of minimal invasive sling procedures and evaluate their safety.
Tension-free vaginal tape (TVT), TVT-obturator (TVT-O) and posterior intravaginal sling (P-IVS) procedure were performed on five fresh pelvis. 4% formaldehyde was used to preserve the cadavers and colored latex was injected into the vessels. An anatomic study and measurements between the trocars and related vessels or organs were carried out.
There was no complication during all injections. The distance between TVT trocar and pubic vessels, the bladder, external iliac vessels and obturator vessels were 0.6, 0.6, 4.2 and 4.3 cm, respectively. Out of control of TVT trocar, the axial rotation or lateral diversion of TVT handle could injure these structures. We found during TVT-O operation, the retropubic space was not violated. The right placement of introducer was very important. When the beginning point was too deep into the anterior vaginal wall, 2.2 cm proximal to urethral meatus or on a horizontal plane with a 35 degrees angle relative to the urethral sagittal plane, the introducer would enter the retropubic space or perforate the upper posterior zone of the obturator membrane, where the obturator vessels and nerves exit the obturator canal. Based on our study, the diversion of P-IVS trocar would damage the rectum, and the pudendal vessels and nerves were relatively safe.
The TVT trocar passes the retropubic space and may injure the important vessels or organs. The route of TVT-O inside-out operation is stable and the retropubic space is not violated. The blunt design in the P-IVS trocar tips is helpful to reduce injury.
探讨微创吊带手术路径并评估其安全性。
在5具新鲜骨盆上进行无张力阴道吊带术（TVT）、经闭孔无张力阴道吊带术（TVT-O）和阴道后吊带术（P-IVS）。用4%甲醛保存尸体，并向血管内注入彩色乳胶。对套管针与相关血管或器官进行解剖学研究和测量。
所有注射过程均无并发症。TVT套管针与耻骨血管、膀胱、髂外血管和闭孔血管之间的距离分别为0.6、0.6、4.2和4.3厘米。TVT套管针失控时，TVT手柄的轴向旋转或侧向偏移可能会损伤这些结构。我们发现在TVT-O手术中，耻骨后间隙未被侵犯。导引器的正确放置非常重要。当起始点过深进入阴道前壁、尿道口近端2.2厘米处或相对于尿道矢状面呈35度角的水平面上时，导引器会进入耻骨后间隙或穿透闭孔膜的上后区，闭孔血管和神经从此处穿出闭孔管。根据我们的研究，P-IVS套管针的偏移会损伤直肠，而阴部血管和神经相对安全。
TVT套管针穿过耻骨后间隙，可能会损伤重要血管或器官。TVT-O由内向外手术路径稳定，未侵犯耻骨后间隙。P-IVS套管针尖端的钝性设计有助于减少损伤。
