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目的探讨在腹腔镜下经腹膜或腹膜后治疗腰椎间盘疾病的可行性及安全有效入路。方法解剖10例成人尸体标本(男女各5例),对腰椎前主要的血管等解剖学参数进行详细记录。同时取20只家猪,分为腹腔镜下经腹膜和腹膜后入路两组,给予不同治疗,比较两种入路的有效性和安全性。结果通过解剖尸体发现腹主动脉的分叉点相对变异较多,而髂总静脉的汇合点则相对稳定;女性腹主动脉分叉角度大于男性,分别为(59.0±1.6)°和(54.9±2.1)°;在髂总静脉汇合角度上,女性和男性为(64.9±1.8)°和(61.4±1.9)°;腹主动脉分叉点与L5椎体下缘的距离分别为男性(3.5±0.8)cm,女性(3.6±0.7)cm;髂总静脉汇合点与L5椎体下缘的距离分别为男性(2.2±0.6)cm,女性(2.4±0.4)cm;L5/S1椎间隙手术窗大小分别为男性(3.7±1.2)cm,女性为(3.4±0.8)cm。动物实验表明,经腹膜入路显露L6/S1较为满意,而显露L2~L5选择腹膜后入路较为满意。结论使用腹腔镜技术对椎间盘疾病进行治疗是可行的,要依据不同的椎间盘节段合理选用经腹膜或腹膜后入路。
Objective To investigate the feasibility and safety of laparoscopic peritoneal or retroperitoneal treatment of lumbar disc disease. Methods Ten adult cadaver specimens (5 males and 5 females) were dissected. The anatomic parameters of major anterior lumbar vertebrae were recorded in detail. At the same time take 20 domestic pigs, divided into laparoscopic peritoneal and retroperitoneal approach two groups, given different treatment, compare the effectiveness and safety of the two approaches. Results The bifurcation points of the abdominal aorta were relatively variable, but the confluence points of the common iliac vein were relatively stable. The bifurcation angles of the abdominal aorta were higher than those of the male (59.0 ± 1.6) ° and (54.9 ± (64.9 ± 1.8) ° and (61.4 ± 1.9) ° respectively. The distance between the bifurcation point of abdominal aorta and the inferior edge of L5 vertebral body was 3.5 ± (3.6 ± 0.7) cm. The distance between the confluence of common iliac vein and the inferior border of L5 vertebral body were respectively (2.2 ± 0.6) cm and 2.4 ± 0.4 cm The sizes were male (3.7 ± 1.2) cm and female (3.4 ± 0.8) cm respectively. Animal experiments show that the peritoneal approach revealed L6 / S1 is more satisfactory, and revealed L2 ~ L5 choice of retroperitoneal more satisfied. Conclusion Laparoscopic surgery for the treatment of disc disease is feasible, according to different segments of the disc reasonable choice of peritoneal or retroperitoneal approach.