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中华腔镜泌尿外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (01) : 1 -6. doi: 10.3877/cma.j.issn.1674-3253.2025.01.001

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单支网片全尿道悬吊联合后盆生物力学重建术的临床应用
王星棋1, 申吉泓1,()   
  1. 1.650032 云南,昆明医科大学第一附属医院泌尿外科
  • 收稿日期:2024-05-14 出版日期:2025-02-01
  • 通信作者: 申吉泓
  • 基金资助:
    国家自然科学基金项目(82260297,81960133)

Clinical application of single branch mesh total urethral suspension combined with biomechanical reconstruction of the posterior pelvic floor

Xingqi Wang1, Jihong Shen,1()   

  1. 1.Department of Urology, First Affiliated Hospital of Kunming Medical University, Yunnan 650032, China
  • Received:2024-05-14 Published:2025-02-01
  • Corresponding author: Jihong Shen
引用本文:

王星棋, 申吉泓. 单支网片全尿道悬吊联合后盆生物力学重建术的临床应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 1-6.

Xingqi Wang, Jihong Shen. Clinical application of single branch mesh total urethral suspension combined with biomechanical reconstruction of the posterior pelvic floor[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(01): 1-6.

尿道中段悬吊术是女性压力性尿失禁手术治疗的标准术式,本团队以生理性生物力学重建为理念设计出单支网片全尿道悬吊联合后盆生物力学重建术。根据女性控尿机理,从膀胱颈闭合能力、功能尿道长度、肛提肌、会阴体对膀胱颈及中后段尿道的支撑力度等方面,以产前盆底生理性形态为核心理念进行修复重建,同时兼顾脱垂的阴道前壁进行生理性复位,在治愈压力性尿失禁和阴道前壁脱垂的同时,完成阴道松弛的修复。本文详细介绍该手术的技术要点及疗效。

The midurethral sling is the standard procedure for the surgical treatment of stress urinary incontinence.Our team designed the single branch mesh total urethral suspension combined with posterior pelvic biomechanical reconstruction based on the concept of physiological biomechanical reconstruction. According to the mechanism of female urinary control, the repair and reconstruction is based on the core concept of prenatal pelvic floor physiological morphology in terms of bladder neck closure ability, functional urethra length, and the support strength of the anorectalis muscle and perineal body to the bladder neck and mid and posterior urethra. Besides, the prolapsed anterior vaginal wall is physiologically repositioned, so that while curing stress urinary incontinence and prolapse of the anterior vaginal wall, the vaginal laxity can be repaired at the same time. This article details the technical points and efficacy of the procedure.

图1 正常女性盆腔应力轴向图 注:UB为膀胱;UT为子宫;V为阴道;U为尿道;R为直肠;S为骶骨;C为尾骨;PS为耻骨联合;P为耻骨;PB为会阴体;LP为提肌板;LAM为肛提肌;AL为肛尾韧带;CX为宫颈;箭头①示腹盆腔应力轴向;箭头②示耻骨降支的力矩转移;箭头③示骶尾骨的力矩转移;④示尿道中后段通过阴道前后壁依托于会阴体;⑤示膀胱颈及膀胱后壁通过阴道上段依托于肛提肌;⑥示子宫颈应力轴向
图2 前盆单支网片示意图
图3 单支网片尿道悬吊术提高膀胱颈闭合能力 注:a示压力性尿失禁合并盆腔脏器脱垂Ⅱ度状态;b示示尿道中段悬吊术后状态;c示示单支网片悬吊术后状态
图4 单支网片全尿道悬吊联合后盆生物力学重建术手术 注:a为裁剪单支网片;b为阴道前壁行水分离;c为切开阴道前壁全层;d为穿刺点定位;e为螺旋钩穿刺置入网片;f为网片固定;g示网片包埋+阴道前壁双层折叠;h示关闭阴道前壁切口;i示阴道后壁及会阴体行水分离;j示设计“钻石”型皮瓣;k为游离皮瓣;l示暴露提肌板;m为再造后穹窿,缩小肛提肌裂孔;n示重建会阴体;o示关闭阴道后壁切口
图5 再造后穹隆 图6 前盆单支网片穿刺点解剖定位 注:6a示皮纹粗略定位,穿刺点位于大腿褶皱内侧,阴蒂根都水平以下,大阳唇处;6b示骨性精准定位,穿制点位于耻骨降支与坐骨支交界外0.5 cm
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