The Relationship of Tension‐Free Vaginal Tape Insertion and the Vascular Anatomy
The Relationship of Tension‐Free Vaginal Tape Insertion and the Vascular Anatomy
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无张力阴道胶带插入与血管解剖结构的关系
DOI：
10.1016/s0029-7844(03)00011-5
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发表时间：
2003
影响因子：
7.2
通讯作者：
M. Walters
中科院分区：
文献类型：
--
作者：
T. Muir;P. Tulikangas;M. Paraiso;M. Walters
目的探讨无张力阴道带针与耻骨后间隙和前腹壁主要血管的接近程度。方法采用双侧无张力阴道带针植入术。解剖腹壁浅血管、腹壁下血管、髂外血管和闭孔血管。测量从侧面的针到内侧边缘的血管被记录下来。在另一具尸体中，通过将一根绳子从中阴唇到肩部、肱二头肌中部和尸体伸展的同侧手臂肱二头肌中部外侧6厘米处放置三个平面。一名不了解耻骨后解剖结构的手术人员将针穿过了这两个平面。测量针到髂外血管和闭孔血管的距离。结果所有血管均位于无张力阴道带针的外侧。无张力阴道带针距闭孔血管的平均距离为3.2 cm（范围1.6 ~ 4.3 cm）。无张力阴道带针距腹壁浅血管平均距离3.9 cm（范围0.9 ~ 6.7）；到上腹部下血管，3.9 cm（范围1.9-6.6 cm）；到髂外血管4.9厘米（范围2.9-6.2厘米）。当针头指向肱二头肌中部外侧6 cm时，刺穿髂外静脉。结论耻骨后间隙和前腹壁主要血管位于无张力阴道带针外侧0.9 ~ 6.7 cm。如果无张力阴道带针侧向瞄准或旋转，可发生大血管损伤。
OBJECTIVETo describe the proximity of the major vessels in the retropubic space and anterior abdominal wall to the tension-free vaginal tape needle.METHODSTension-free vaginal tape needles were inserted bilaterally in ten cadavers. Dissection of the superficial epigastric, inferior epigastric, external iliac, and obturator vessels was performed. Measurements from the lateral aspect of the needle to the medial edge of the vessels were recorded. In an additional cadaver, three planes were created by placing a string from the midlabia to the shoulder, mid–biceps brachii muscle, and 6 cm lateral to the mid–biceps brachii muscle of the cadaver's extended, ipsilateral arm. An operator, blinded to the retropubic space anatomy, passed the needle in these planes bilaterally. The distances from the needle to the external iliac and obturator vessels were measured.RESULTSAll vessels measured were lateral to the tension-free vaginal tape needle. The mean distance from the tension-free vaginal tape needle to the obturator vessels was the closest: 3.2 cm (range 1.6–4.3 cm). The mean distance from the tension-free vaginal tape needle to the superficial epigastric vessels was 3.9 cm (range 0.9–6.7); to the inferior epigastric vessels, 3.9 cm (range 1.9–6.6 cm); and to the external iliac vessels, 4.9 cm (range 2.9–6.2 cm). When the needle was directed 6 cm lateral to the mid–biceps brachii muscle, the external iliac vein was punctured.CONCLUSIONThe major vessels in the retropubic space and anterior abdominal wall lie 0.9–6.7 cm lateral to the tension-free vaginal tape needles. If the tension-free vaginal tape needle is laterally aimed or rotated, major vascular injury can occur.