摘要
目的:重新认识腹股沟区腹膜前解剖的特点,探讨腹膜前腹股沟疝无张力修补术的技术要点。方法:(1)对5具新鲜尸体进行腹股沟区解剖研究;(2)2005年6月～2006年5月行开放式腹膜前腹股沟疝无张力修补术共330例次(292例病人),2002年11月至2006年5月行腹腔镜下无钉合全腹膜外疝修补术(TEP)共240例次(211例病人),进行术中的观察及术后随访。结果:腹股沟区存在两层腹横筋膜,腹膜前间隙在两层腹横筋膜之间,补片即置于腹膜前间隙并覆盖肌耻骨孔。开放式腹膜前腹股沟疝无张力修补术平均手术时间43 min,并发症率7.3%(24/330),复发率0.91%(3/330),平均住院时间1.7d。TEP平均手术时间57min,并发症发生率6.7%(16/240),无复发病例,术后平均住院时间2.8d。结论:从腹股沟区腹膜前解剖学特点来看在肌耻骨孔后方用足够大的补片覆盖修补符合压力学原理,腹膜前腹股沟疝无张力修补术具有合理性和可行性。
Objective： To take a new look at the preperitoneal groin anatomy and investigate the surgical approach of preperitoneal inguinal hernia repair with polyethylene mesh, Methods： （ 1 ）Five fresh male cadavers were dissected to make preperitoneal groin anatomy research （2）From May 2005 to May 2006,330 groin hernias （292 patients ） were treated with an open preperitoneal approach with polyethylene mesh. From November 2002 to May 2006,240 groin hernias （211 patients） were treated with TEP approach with unstapled polyethylene mesh（10cm×15cm）,Patients with recurrent hernias were excluded. During operative and hospital time, symptoms were analyzed and recorded, the recovery after operation were also observed and recorded. Results： The preperitoneal space and inferior epigastric vessels are between the anterior and posterior laminae of the transversus fascia. The mesh was placed in the preperitoneal space and covered myopectineal office. Average operating time of open preperitoneal approach with polyethylene mesh was 43 min （range： 20/65）. Recurrent rate was 0.91%（ 3 cases of 330 patients）.Complication rate was 7.3 %（ 24 patients）. Average hospital time was 1.7 days （range： 1/4）. No recurrent case occurred in TEP group during the follow-up time of 21 months （range： 1/42）. The average operating time was 57 min （range： 30/70）. Complication rate was 6.7%（16 cases of 240 patients） Average postoperative hospital time was 2.8 days （range： 1/6）, Conclusions： From the point of view of properties of preperitoneal groin anatomy, Using enough large mesh to mend and cover the hernia cater the principle of mechanics. So the putpreperitoneal hernia repair approach with polyethylene mesh is rational and feasible.
出处
《中国临床解剖学杂志》
CSCD
北大核心
2008年第2期209-212,共4页
Chinese Journal of Clinical Anatomy
