腹膜前间隙解剖结构在腹腔镜完全腹膜外疝修补术中的应用-《中国微创外科杂志》

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Title:: Application of Anatomical Structure of Preperitoneal Space in Laparoscopic Total Extraperitoneal Hernia Repair

作者:: 茹东跃陈德兴*; (吉林省前卫医院普外科，长春130012)

Author(s):: Ru Dongyue; Chen Dexing.; Department of General Surgery, Jilin Vanguard Hospital, Changchun 130012, China

关键词:: 腹腔镜; 完全腹膜外疝修补术; 腹股沟斜疝; 直疝

Keywords:: Laparoscopy; Totally extraperitoneal; Indirect inguinal hernia; Direct hernia

文献标志码:: A

摘要:: 目的探讨腹腔镜视野下腹膜前间隙解剖结构在腹腔镜腹股沟疝修补术中的价值。方法对2015年1月~2019年1月529例腹股沟疝行腹腔镜完全腹膜外疝修补术 (totally extraperitoneal, TEP)，脐部置入10 mm trocar，气腹压力12~15 mm Hg。直视下在脐与耻骨连线中上、中下1/3置入2个5 mm trocar。电剪刀切断疏松纤维组织，电凝钩分离并扩大腹横筋膜与腹膜间的Retzius间隙，显露耻骨联合和亮白的Cooper韧带及死亡冠，进一步显露腹壁下动脉，分离钳紧贴腹壁下动脉轻柔分离，逐渐进入Bogros间隙，显露危险三角、疼痛三角等解剖结构，将疝囊与精索输精管游离后离断, 置入15 cm×10 cm补片，修补满意后关闭气腹。结果529例术中显露半环线、Cooper韧带、死亡冠、腹壁下动脉、危险三角、疼痛三角等解剖标志, 将它们作为TEP术中重要的解剖结构。术后15例出现阴囊血清肿，超声引导下穿刺抽液后治愈。3例术后出现腹股沟区疼痛，1个月后症状消失。529例术后随访0.5~5年, 平均3.5年，无复发和慢性疼痛等并发症。结论了解并熟练掌握腹膜前间隙解剖结构,对腹腔镜TEP的操作具有重要的临床意义。

Abstract:: ObjectiveTo explore the value of the anatomical structure of preperitoneal space in laparoscopic inguinal hernia repair. MethodsFrom January 2015 to January 2019, 529 patients with inguinal hernia underwent totally extraperitoneal hernia repair (TEP). A 10 mm trocar was placed in the umbilical region, and the pneumoperitoneum pressure was 12-15 mm Hg. Under direct vision, two 5 mm trocars were placed in the upper middle and lower middle 1/3 of the line between umbilicus and pubis. The loose fibrous tissue was cut off by electric scissors, and the Retzius space between transverse abdominal fascia and peritoneum was separated and expanded by electric coagulation hook. All the pubic symphysis, bright white Cooper ligament and the death crown were exposed. The inferior epigastric artery was further exposed. The dissecting forceps were close to the inferior epigastric artery, and were used to gently separate and gradually enter the Bogros space. The anatomical structures such as dangerous triangle and pain triangle were exposed, and the hernia sac and spermatic vas deferens were dissociated. The pneumoperitoneum was closed after satisfactory repair.ResultsIn the 529 cases, the hemiloop line, Cooper ligament, death crown, inferior epigastric artery, dangerous triangle and pain triangle were exposed during the operation. They were regarded as important anatomical structures in TEP. After surgery, 15 cases of scrotal seroma were found, which were cured after ultrasoundguided puncture and drainage. Three patients developed inguinal pain after operation, and the symptoms disappeared one month later. All the patients were followed up for 05-5 years (mean, 3.5 years). There was no recurrence or chronic pain or other complications.ConclusionUnderstanding and mastering the anatomical structure of preperitoneal space is of great clinical significance for laparoscopic TEP.

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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

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