脐内侧襞解剖与腹腔镜腹股沟疝修补术的应用研究  

The applied research of anatomy of medial umbilical fold and laparoscopic inguinal hernia repair

作　　者：贺轲[1] 向国安[2] 王汉宁[2] 陈开运[2] 萧金丰[2] 李鹏胜[2] 

机构地区：[1]南方医科大学附属南粤医院,广东广州510317 [2]广东省第二人民医院

出　　处：《腹腔镜外科杂志》2011年第2期125-128,共4页Journal of Laparoscopic Surgery

基　　金：吴阶平医学基金会临床科研基金资助项目(编号:32027100502;320675009106);广东省医学科学基金资助项目(编号:A2007144;A2009132)

摘　　要：目的:通过对脐内侧襞解剖学的研究,为腹腔镜完全腹膜化腹腔内置补片修补术(total peritoneum intraperitoneal onlay mesh,TPIPOM)提供准确的临床应用解剖基础。方法:尸体解剖组(A组):解剖脐内侧襞及内环周边,与腹腔镜下解剖作为对照;腹腔镜手术患者分为B组(疝修补组)和C组(非疝修补组),测量脐内侧襞厚度(T)及宽度(W);B组行TPIPOM,术中观测脐内侧襞局部解剖。结果:B、C两组患者双侧脐内侧襞厚度平均为(3.0±1.2)mm,宽度为(10.1±3.2)mm;尸体及腹腔镜活体解剖表明脐内侧襞周边无重要神经、血管毗邻。B组均在腹腔镜下完成手术,手术时间平均(29.5±9.5)min,下床活动时间平均(36±8)h,平均住院(3.5±1.5)d,费用平均(8 500±880)元;术后平均随访(12±6)个月,未见复发。结论:脐内侧襞在TPIOPM术中可完全覆盖补片,此术式具有安全、可靠、微创、经济等优点。Objective： To study anatomy of medial umbilical fold, provide accurate anatomic basis of the cllmcal application for total peritoneum intraperitoneal onlay mesh （TPIPOM）. Methods：Group A （group of autopsy） ：medial umbilical fold and abdominal ring were dissected to compare with laparoscopic anatomy;patients of laparoscopic operation were divided into group B （ group of TPI- POM） and group C （group of no TPIPOM） ,to measure thickness（T） and width（W） of medial umbilical fold, regional anatomy of me- dial umbilical fold was observed in group B. Results ： The thickness of group B and C was （3.0 ± 1.2 ） mm, the width was （ 10.1 ± 3.2 ） mm;autopsy and laparoscopic anatomy indicated that there were not significant nerve and vessel in surrounding of medial umbilical fold ;The laparoseopie operations were successfully performed in group B：the operating time was （29.5 ± 9, 5 ）rain, the average time of ambulation was （36 ± 8） h,the mean hospital stay was （3.5 ± 1.5 ） d, the mean cost was （8 500 ± 880） yuan ; The patients were fol- lowed up for （12 ± 6） months and recurrence was not found. Conclusions：Patch could be covered by medial umbilical fold in TPI- POM, which is safe, reliable, minimally invasive and economical.

关 键 词：脐内侧襞 疝 腹股沟 解剖学 疝修补术 腹腔镜检查 

分 类 号：R656.21[医药卫生—外科学]