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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 evaluate the effect of establishing posterior abdominal space in two different locations. Methods Sixty-four consecutive inpatients with laparoscopic surgery requiring urological diseases from June 2014 to March 2015 were selected and divided into two groups: the lumbar group and the iliac crest group, with 32 cases in each group. Retroperitoneal laparoscopic surgery by the same group of doctors to implement the establishment of the posterior abdominal space are the same doctor (Zhang Nan) completed. In the lumbar group, the posterior abdominal space was expanded by transverse incision of 1.0-1.5 cm under the twelve ribs of the axillary line. The posterior abdominal cavity was created by the transverse incision of 1.0-1.5 cm on the iliac crest of the iliac crest. The number of anatomical landmarks initially observed was recorded and the differences in the proportions of anatomical landmarks observed between the two groups were analyzed. Results Compared with those of the upper iliac crest group, the intraperitoneal space time in the lumbar group and the iliac crest group was significantly higher than that in the control group [(10.5 ± 1.8) vs (11.2 ± 1.1), P = 0.23], body mass index [(23.8 ± 2.0) VS (24.1 ± 1.8) 0.53]. The anatomical landmarks in the lumbar and iliac crest groups were compared: the psoas muscle (96.87% VS 68.75%, P = 0.003), Kyrgyzstan fascia (100% VS 100%), the anterior peritoneal fold (68.75% VS 37.50 (P = 0.012), retroperitoneal (100% VS 100%), ureter (37.50% VS 6.25%, P = 0.002), gonadal (9.38% VS 6.25%, P = 0.64) Inferior vena cava fluctuated (37.50% VS 15.62%, P = 0.048). Conclusions The establishment of retroperitoneal space and iliac crest after the establishment of lumbar spine enlargement can observe more anatomical landmarks and is more conducive to the implementation of retroperitoneal laparoscopic surgery. Urinary surgeons with initial laparoscopic surgery are recommended to choose the lumbar dilatation to establish the posterior abdominal space.