Shchukin Dmytro, Lesovoy Vladimir, Garagatiy Igor, Khareba Gennadiy, Hsaine Redouane
Department of Urology, Nephrology and Andrology, Kharkiv National Medical University, 195 Moskovskiy Avenue, Kharkiv 61037, Ukraine.
Department of General, Pediatric and Oncological Urology, Kharkiv Medical Academy of Postgraduate Education, 195 Moskovskiy Avenue, Kharkiv 61037, Ukraine.
Adv Urol. 2014;2014:924269. doi: 10.1155/2014/924269. Epub 2014 Jan 22.
Objective. The purpose of this study was to investigate safety and feasibility of some surgical approaches to the supradiaphragmatic inferior vena cava (IVC) and the right atrium through the diaphragm from the abdominal cavity. Materials and Methods. The material of the anatomical study included 35 fresh cadavers. Several options of surgical access to the supradiaphragmatic IVC were successively performed. Feasibility and risk level of each of the approaches were evaluated with the use of a special scale. Results. The isolation of the supradiaphragmatic IVC and cavoatrial junction was most easily performed via T-shaped or circular diaphragmotomy (grade "easy" was registered in 74.3% and 80% of patients, resp., compared to 31.4% for transverse diaphragmotomy and 40% for isolation of the IVC in the pericardial cavity). The risk analysis has demonstrated the highest safety level for T-shaped diaphragmotomy (grade "safe" was registered in 60% of cases). The intervention via transverse diaphragmotomy, circular diaphragmotomy, and IVC isolation in the pericardial cavity was graded as "risky" in 80%, 62.9%, and 82.9% of cases, respectively. Conclusions. In our opinion, T-shaped diaphragmotomy is the most safe and easy-to-perform access for mobilization of the supradiaphragmatic IVC through the abdominal cavity.
目的。本研究旨在探讨经腹腔通过膈肌对膈上腔静脉（IVC）及右心房进行某些手术入路的安全性和可行性。材料与方法。解剖学研究材料包括35具新鲜尸体。依次对膈上腔静脉的几种手术入路进行操作。使用特殊量表评估每种入路的可行性和风险水平。结果。经T形或圆形膈肌切开术最容易分离膈上腔静脉和腔房连接部（分别有74.3%和80%的患者记录为“容易”等级，相比之下，横断膈肌切开术为31.4%，在心包腔内分离腔静脉为40%）。风险分析表明T形膈肌切开术的安全水平最高（60%的病例记录为“安全”等级）。经横断膈肌切开术、圆形膈肌切开术和在心包腔内分离腔静脉的干预分别在80%、62.9%和82.9%的病例中被评为“有风险”。结论。我们认为，T形膈肌切开术是经腹腔游离膈上腔静脉最安全且易于实施的入路。
