个体化经肛提肌外腹会阴联合切除术对女性盆底生物力学影响的有限元分析
Effect of Extralevator Abdominoperineal Excision on Biomechanics of Female Pelvic Floor:A Finite Element Analysis
王捷夫 1路心然 2王文鹏1
作者信息
- 1. 300060 天津,天津医科大学肿瘤医院结直肠肿瘤科,国家恶性肿瘤临床医学研究中心,天津市恶性肿瘤临床医学研究中心,天津市消化系统肿瘤重点实验室
- 2. 100191 北京,北京大学医学部基础医学院
- 折叠
摘要
目的 应用有限元分析研究4种个体化ELAPE手术对于女性盆底生物力学的影响.方法 建立6种女性盆底有限元模型:正常模型、ELA-PE模型和4种个体化ELAPE模型,测量6种模型在相同载荷作用下的各组织最大应力,并观察应力分布.结果 正常模型和ELAPE模型的非肛提肌组织内最大应力为(1.953±0.060)MPa和(5.111±0.081)MPa.模型1的肛提肌部分保留侧和完整切除侧非肛提肌组织内最大应力分别为(3.101±0.133)MPa和(4.868±0.123)MPa,均低于ELAPE模型(均P<0.01).模型2的双侧非肛提肌组织内的最大应力均为(5.138±0.091)MPa,与ELAPE模型比较差异无统计学意义(P>0.05).模型3和模型4的非肛提肌组织内的最大应力为(4.700±0.105)MPa和(3.653±0.156)MPa,均低于ELAPE模型(均P<0.01).结论 单侧肛提肌切除平面靠近直肠的、双侧耻骨尾骨肌外侧切断肛提肌的、保留直肠前方肛提肌的ELAPE手术对于盆底非肛提肌组织内的应力均有降低作用,其中单侧肛提肌切除平面靠近直肠的ELAPE手术在肛提肌部分保留侧更为明显;单侧肛提肌切除平面靠近盆壁的ELAPE手术对于盆底非肛提肌组织内的应力无明显降低作用.
Abstract
Objective To explore the effects of four extralevator abdominoperineal excision(ELAPE)procedures on the biomechanics of female pelvic floor through finite element analysis.Methods Six finite element models of the female pelvic floor were established,including a normal model,an ELAPE model,and four individual models.The maximum stress in each model was measured under the same pressure,and the stress distribution was observed.Results The maximum stress of non-levator ani muscle tissues on the partially reserved side and totally removed side of the levator ani muscle were 3.101±0.133 and 4.868±0.123 MPa in individual model 1,respectively,which were lower than the maximum stress in the ELAPE model(5.111±0.081 MPa;both P<0.01).The maximum stress in the non-levator ani muscle tissue were 5.138±0.091 MPa on both sides in individual model 2,which were not significantly different from that in the ELAPE model(P>0.05).The maximum stress of non-levator ani muscle tissues were 4.700±0.105 and 3.653±0.156 MPa in individual models 3 and 4,respectively,which were lower than the maximum stress in the ELAPE model(both P<0.01).Conclusion Three ELAPE procedures,including ELAPE with unilateral levator ani muscle resection plane close to the rectum,and the bilateral pubococcygeal muscle lateral resection of levator ani muscle and levator ani muscle in front of the rectum preserved could decrease stress in the non-levator ani muscle tissue on both sides.The effect is evident on the levator ani muscle partially reserved side of ELAPE with unilateral levator ani muscle resection plane close to the rectum.ELAPE with unilateral levator ani muscle resection plane close to the pelvic wall has no significant reduction effect on the non-levator ani muscle tissue on either side.ELAPE模型(均P<0.01).
关键词
直肠肿瘤/ELAPE手术/盆底/生物力学/有限元分析Key words
Rectal neoplasm/ELAPE/Pelvic floor/Biomechanics/Finite element analysis引用本文复制引用
基金项目
天津市医学重点学科(专科)建设项目(TJYXZDXK-009A)
国家自然科学基金面上项目(82373134)
天津市教委科研计划项目一般项目(2022KJ228)
天津医科大学肿瘤医院国家自然基金培育计划(220108)
出版年
2024
国家科技期刊平台
NSTL
万方数据