腹腔镜腰椎手术入路动物模型的解剖学可行性研究

目的：通过动物实验研究探讨腹腔镜腰椎手术技术，确定不同腰椎节段安全有效的镜手术入路。方法：取家猪40只，均分两组采用腹腔镜经腹膜后入路和经腹膜入路显露腰2－骶1椎体、椎间盘，比较两种入路的简便性、安全性。结果：经腹腔L6／S1显露组，未发生1例与器械及操作有关的并发症，经腹腔L2－5以上椎体显露时分离、腰大肌和大血管牵开困难、出血多、椎体难以清楚暴露。腹膜后入路L2－5椎体显露，在结扎并分离一侧腰血管后将腹主动脉及腰大肌向两侧牵开，均可获得较满意的术野显露。而经腹膜后显露L6／S1困难，且2例出现左侧髂静脉裂。结论：腹腔镜技术进行腰椎手术重复性好，对组织损伤小，术野内解剖结构清晰，手术的安全性有效性较高。经腹腔入路是显露下位腰骶椎的安全、合理、有效的手术途径，而上位腰椎的手术显露宜选择经腹膜后间隙入路。

EXPERIMENT STUDY OF OPERATIVE APPROACH OF LAPAROSCOPIC SPINE SURGERY IN ANIMAL MODEL

Objective:To definite the operative approach of different lumbar vertebrae in the laparoscopic surgery, this study described and compared retroperitoneal and transperitoneal laparoscopic approaches to the lumbar vertebrae in pigs. Technical and perioperative complications were evaluated for each approach.Methods:Retroperitoneal and transperitoneal laparoscopic approaches to the lumbar vertebrae were performed in 40 pigs which were divided into 2 groups in which one for retroperitoneal and the other for transperitoneal laparoscopic approaches to exposure L2-S1.Placement of the insufflation needles and trocar ports were determined for each approach. Dissection of the lumbar vertebrae were performed, and the technical and perioperative complications were recorded.Results:There was not any case with perioperative complication in the group of transperitoneal approach to L6/S1. But it was difficulty for exposure of the L2-L5, complications included significant bleeding and difficulty encountered in mobilization of the psoas major muscle from the lumbar vertebrae. On the contrast,retroperitoneal laparoscopic approach to L6/S1 was difficult to exposure lumbar vertebrae, and significant bleeding occurred in 2 cases in which left iliac blood vessel was injuried. While its exposure of L2-L5 was convenient and reliable. Conclusion:The technique of laparoscopic in lumbosacral surgery is reliable, convenient,mininvasive and good replication. The retroperitoneal approach was safe, reasonable and effective for exposure of the L2-L5, while transperitoneal laparoscopic approach is easy and reliable for exposure of subaxil lumbosacral vertebral.