腹腔镜结直肠癌术中避免输尿管损伤的解剖学因素探讨_Toldt筋膜的分离及显露.pdf

中华腔镜外科杂志（电子版）2009 年 12 月第2 卷第 1 期 Chin J Laparoscopic Surgery （Electronic Edition ），December 2009，Vol 2 ，No. 1 · 14 · ·临床研究· 腹腔镜结直肠癌术中避免输尿管损伤的解剖 学因素探讨：Toldt筋膜的分离和显露 卢榜裕 张慧明 蔡小勇 陆文奇 黄玉斌 靳小建 孙志刚 【摘要】 目的 从解剖学层面探讨腹腔镜结直肠癌手术中如何减少发生输 尿管损伤的风险。方法 回顾分析 2006 年 12 月至 2008 年 12 月 80 例腹腔镜结 直肠癌的手术录像资料，观察术中主要的手术进路以及输尿管与 Toldt 筋膜的关 系，探讨避免腹腔镜下结直肠癌手术中输尿管损伤的方法。结果 80 例均完成 腹腔镜手术，术中主要采用结肠系膜进路和侧腹膜进路，有 12 例术中因解剖过 深突破 Toldt 筋膜或过分游离输尿管出现输尿管损伤的风险，两种手术进路均存 在此风险（7 例对 5 例，P=0.75 ）。结论 腹腔镜结直肠癌手术中结肠系膜进路 和侧腹膜进路各有特点，无论采用哪种手术进路，熟知输尿管解剖关系、术中准 确寻找 Toldt 筋膜都是避免输尿管损伤的关键。 【关键词】 腹腔镜；结直肠癌；手术进路；输尿管损伤；Toldt’s 筋膜 The investigation to avoid ureter injured from anatomical factors in the laparoscpic radical resection for colorectal cancer-separate and expose toldt’s fascia LU Bang-yu, ZHANG Hui-ming, CAI Xiao-yong, LU Wen-qi, HUANG Yu-bin, JIN Xiao-jian ，SUN Zhi-gang. Center of Minimally Invasive Surgery, Guangxi Medical University, Nanning 530007,China 【Abstract 】 Objective To investigate how to decrease the risk of ureteral injured in the laparoscopic radical resection for colorectal cancer from the anatomical level. Methods Video information of 80 cases of laparoscopic radical resection for colorectal cancer from December 2006 to December 2008 were analyzed retrospectively ，Observation of the main surgical approachs，and the relationship between ureter and Toldt’s fascia ，Investigate the method avoid ureter injured in the laparoscopic radical resection for colorectal cancer. Results 80 cases of laparoscopic radical resection for colorectal cancer were successfully completed surgery. The main use of Mesocolon approach and Lateral peritoneal approach ，too much separation ureter and breakthrough Toldt’s fascia are easy t