腹股沟管的解剖学观察  

Anatomy observation of the inguinal canal

作　　者：江志鹏[1] 杨斌[1] 李英儒[1] 张育超[1] 赖东明[1] 宗振[1] 温润龙[1] 吕泽坚[1] 刘高杰[1] 陈双[1] 

机构地区：[1]中山大学孙逸仙纪念医院胃肠外科华南疝与腹壁外科培训中心,广东广州510120

出　　处：《中国实用外科杂志》2014年第1期90-92,共3页Chinese Journal of Practical Surgery

摘　　要：目的通过对腹股沟管的细致解剖,分析腹股沟管的解剖结构及其意义。方法从2011年6月至2012年5月,中山大学孙逸仙纪念医院胃肠外科选择开放式无张力腹股沟疝修补术的男性病人115例(双侧疝10例)纳入观察,用高清影像设备对手术过程进行摄录和回放观察,分析腹沟管内的神经分布特点,提睾肌的分布以及精索与腹股沟管内、外环口的关系。结果生殖股神经生殖支、髂腹股沟神经和髂腹下神经的可见率分别为90.4%、98.4%和38.4%。提睾肌在腹股沟管内对精索的包绕并不完整,呈"Ω"形分布。提睾肌精索与腹股沟韧带和腹股沟镰之间均有天然的解剖层面。精索与内、外环口均存在固定附着点。结论髂腹股沟神经在腹股沟管内出现较为恒定,它与髂腹下神经经腹股沟管后发出皮支,从理论上讲可以安全切断。精索在内、外环口均存在固定机制,这是防止精索移位和斜疝发生的一种保护机制。在外环口内侧耻骨结节上方,精索与腹股沟镰之间存在一无血管区域,可作为游离精索的入路。Objective Analysis of the inguinal canal anatomical structures and their significance by intraoperative observation. Methods From June 2011 to May 2012,a total of 115 male patients（10 patients with bilateral hernias） whom were undergone open tension-free heruioplasty were involved in the observation. In open operation field, with high definition video equipment for recording and playback of the procedure, distribution of cremaster and nerves inside the inguinal canal and the relationship between spermatic cord and the inguinal canal rings were analyzed. Results The visible rates of the genital branch of genitofemoral nerve, ilioinguinal and iliohypogastric nerves were 90,4%, 98,4% and 38.4%, respectively. Cremaster muscle was ＂~＂ shape wrapping the spermatic cord. There were natural anatomic planes between spermatic cord and the inguinal ligament and inguinal falx. The spermatic cord was relatively fixed inside the inguinal canal by attachment of the inner and outer rings. Conclusion Ilioinguinal nerve is relatively constant in the inguinal canal, which theoretically could be safely cut off alike with the iliohypogastric nerve, as they are cutaneous branch in this position. The fixation of spermatic cord by the inguinal rings is a protective mechanism to prevent indirect hernia occurs. The anatomical planes between the spermatic cord and the inguinal canal can be used of division.

关 键 词：腹股沟疝 腹股沟管 精索 提睾肌 解剖学 

分 类 号：R6[医药卫生—外科学]