腹腔镜骶骨固定术与排便障碍综合征：一项解剖临床研究
Laparoscopic sacropexy and obstructed defecation syndrome: an anatomoclinical study.
作者信息
Cosma Stefano, Menato Guido, Ceccaroni Marcello, Marchino Gian Luigi, Petruzzelli Paolo, Volpi Eugenio, Benedetto Chiara
机构信息
Department of Gynecology and Obstetrics, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy,
出版信息
Int Urogynecol J. 2013 Oct;24(10):1623-30. doi: 10.1007/s00192-013-2077-z. Epub 2013 Mar 29.
INTRODUCTION AND HYPOTHESIS
Laparoscopic sacropexy (LSP) is associated with obstructed defecation syndrome (ODS) in 10-50% of cases. An anatomoclinical study was carried out to investigate whether there is any correlation between iatrogenic denervation during LSP and ODS.
METHODS
Five female cadavers were dissected to identify possible sites of nerve injury during LSP. Subsequently, the videos of 18 LSP were blindly reviewed to assess the location of sacral dissection and tacks, the position and depth of the peritoneal tunnel, and another 4 variables. An anatomical triangle was defined on the right lumbosacral spine so as to clearly describe the sites of the surgical variables, which were then statistically correlated with the patients' postoperative outcome.
RESULTS
The only variable associated with postsurgical ODS was dissection in the 90° angle of the anatomical triangle, where the superior hypogastric plexus was observed in all cadavers.
CONCLUSIONS
Medial and midline dissection over the sacral promontory might be associated with postoperative ODS.
引言与假设
在10%至50%的病例中，腹腔镜骶骨固定术（LSP）与排便梗阻综合征（ODS）相关。开展了一项解剖临床研究，以调查LSP术中医源性去神经支配与ODS之间是否存在任何关联。
方法
解剖5具女性尸体，以确定LSP术中可能的神经损伤部位。随后，对18例LSP手术视频进行盲法回顾，以评估骶骨剥离和钉合的位置、腹膜隧道的位置和深度，以及另外4个变量。在右腰骶椎上定义一个解剖三角，以便清晰描述手术变量的部位，然后将这些变量与患者术后结果进行统计学关联分析。
结果
与术后ODS相关的唯一变量是在解剖三角90°角处的剥离，在所有尸体中均观察到上腹下丛。
结论
骶岬上方的内侧和中线剥离可能与术后ODS有关。
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