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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 李建達 | 經閉孔手術治療女性尿失禁: 比較outside-in與inside-out兩種技巧 | 2009/8/24 下午 12:16:00 | 0 |
| 原 文 | 題 目 | Transobturator surgery for female stress incontinence: a comparative anatomical study of outside-in vs inside-out techniques. |
| 作 者 | Spinosa JP, Dubuis PY, Riederer BM. | |
| 出 處 | BJU International | |
| 出版日期 | 2007 | |
| 評 論 |
本文描述治療女性尿失禁經閉孔實施手術的兩種方法（outside-in vs. inside-out; 即TOT vs. TVT-O）其解剖位置與吊帶關係的比較。評估兩種路徑造成神經和血管傷害的風險性。 研究方式是利用七具大體分別使用inside-out與outside-in兩種不同的技術置入吊帶，再去解剖大體；算出兩種不同方式置入的吊帶與深部外陰血管及閉孔神經的距離。 結果發現以inside-out方式置入的方法，其吊帶與神經、血管的安全距離都降低了，顯示這種路徑比outside-in的方法較具傷害的危險性。事實上，也有類似的文章發表inside-out的方法比較會術後疼痛。可能是造成神經受傷引起，而outside-in的方式則比較不會受到lithotomy姿勢的影響；但無論如何，盡可能的貼近ischiopubic ramus內側下針是比較安全的。 |
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| abstract |
OBJECTIVE: To assess the specific risks of injury to neural and vascular structures inherent in two approaches to transobturator surgery for ing a suburethral sling, i.e. the outside-in (standard technique) and inside-out approaches. MATERIALS AND METHODS: The study comprised seven cadavers, providing 14 obturator regions. Five specimens had a tape ed outside-in on one side, and inside-out on the other; of the remaining two cadavers, one had an inside-out tape and one an outside-in tape, bilaterally. After tape ion, the cadavers were dissected. Particular attention was paid to the distances between the tape and the deep external pudendal vessels, and between the tape and the posterior branch of the obturator nerve. RESULTS: With the inside-out technique, the safety margins were reduced, and the external pudendal vessels and the posterior branch of the obturator nerve were at greater risk of injury. CONCLUSION: The two techniques are not equivalent, with a lower risk of injury to vascular and nerve structures with the outside-in technique. |
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