目的:评价两个不同扩张位置建立后腹腔间隙的效果。方法选取2014年6月~2015年3月因泌尿外科疾病需实施后腹腔镜手术的连续性住院患者64例,将其分为腰部组和髂嵴上组,各32例。后腹腔镜手术均由同一组医生实施,后腹腔间隙建立均有同一位医生(张楠)完成。腰部组在腋后线十二肋下1.0~1.5 cm横行切口扩张建立后腹腔空间;髂嵴上组在腋中线髂嵴上1.0~1.5 cm横行切口扩张建立后腹腔空间。记录初始观察到的解剖标志的数量,分析两组观察到的解剖标志比例的差异。结果腰部组与髂嵴上组建立后腹腔空间时间比较[(10.5±1.8)VS(11.2±1.1),P=0.23];体重指数比较[(23.8±2.0)VS(24.1±1.8), P=0.53]。腰部组与髂嵴上组观察到的解剖标志比较:腰大肌(96.87% VS 68.75%,P=0.003),吉氏筋膜(100% VS 100%),前腹膜反折(68.75% VS 37.50%,P=0.012),后腹膜反折(100% VS 100%),输尿管(37.50% VS 6.25%,P=0.002),性腺血管(9.38% VS 6.25%,P=0.64),腹主动脉或下腔静脉波动(37.50%VS 15.62%,P=0.048)。结论腰部扩张建立后腹腔间隙与髂嵴上比较,可以观察到更多的解剖标志,更利于后腹腔镜手术的实施;推荐初始开展后腹腔镜手术的泌尿外科医师选择腰部扩张建立后腹腔间隙。
Objective To assess the effect of establishing retroperitoneal space interval in two different expansion places Methods From June 2014 to March 2015, 64 consecutive patients who were admitted to the hospital after laparoscopic operation were divided into 32 cases of lumbar group and 32 cases of iliac crest group. After laparoscopic surgery was performed by the same group of doctors, after the establishment of the peritoneal space have the same doctor (ZHANG Nan) completed. In the lumbar group, twelve ~ 1.5 cm transverse incision was established after the axillary line 1 and transverse incision was established. The iliac crest group was set up in the middle of the axillary line of the iliac crest with 1~1.5 cm transverse incision. The number of initial observed anatomical landmarks was recorded, and the differences in the proportion of anatomical landmarks observed in the two groups were analyzed. Results The space time comparison of retroperitoneal space after the establishment of waist group and group on crista iliaca [(10.5±1.8)VS(11.2±1.1),P=0.23];BMI comparison [(23.8±2.0)VS(24.1±1.8),P=0.53]. The observed anatomic landmark comparison of waist group and crista iliaca group: psoas major (96.87% VS 68.75%,P=0.003), Jishi fascia (100% VS 100%), front peritoneal reflection (68.75%VS 37.50%,P=0.012), back peritoneal reflection (100% VS 100%), ureter (37.50% VS 6.25%,P=0.002), gonad blood vessel (9.38% VS 6.25%,P=0.64), aorta abdominalis or postcava fluctuation (37.50% VS 15.62%,P=0.048). Conclusion After the establishment of waist expansion, compared with that on crista iliaca, more anatomic landmarks are observed on retroperitoneal space interval, which is helpful for implementing retroperitoneal laparoscopic surgery; after the initial launching of the recommendation, urological surgeon of retroperitoneal laparoscopic surgery selects waist expansion to build retroperitoneal space interval.