腹腔镜全腹膜外疝修补术中死冠血管的解剖及临床意义  

Anatomy of mortis corona vascular and its clinical significances in laparoscopic total extraperitoneal hernia repair

作　　者：魏健[1] 付召军[1] 杨玉辉[1] 张陈[1] 冯会和[1] 

机构地区：[1]自贡市第四人民医院普外科,四川自贡643000

出　　处：《中国普外基础与临床杂志》2017年第2期185-189,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省医学会科研课题计划项目(编号:S15087);四川省自贡市卫生局立项课题

摘　　要：目的对腹腔镜全腹膜外疝修补手术中死冠血管进行解剖,分析其解剖学特点及临床意义。方法回顾性搜集2013年7月至2015年10月期间在自贡市第四人民医院收治的45例腹股沟疝患者的临床资料并进行分析。结果 1 45例腹股沟疝患者总共52侧腹股沟疝(直疝15侧,斜疝37侧)中,死冠血管出现率为61.5%(32/52),其中死冠动脉出现率明显高于静脉出现率〔46.2%(24/52)比34.6%(18/52),P<0.05〕。耻骨吻合支上缘部位水平距离耻骨联合中点的距离在死冠动脉和死冠静脉间比较差异无统计学意义〔(53±5.2)mm比(54±5.7)mm,t=0.076,P>0.05〕。死冠动脉直径明显小于死冠静脉直径〔(3.2±0.3)mm比(3.4±0.4)mm,t=2.231,P<0.05〕。2男性患者的死冠动脉、静脉出现率均明显高于女性患者(P<0.05),与女性患者比较,男性患者的发病年龄更大(P<0.05),腹壁厚度更小(P<0.05),死冠血管直径更大(P<0.05)。3腹股沟直疝中死冠血管总出现率明显低于斜疝(P<0.05),其中动脉出现率也明显低于其在斜疝中的出现率(P<0.05)。直疝患者的发病年龄大于斜疝患者(P<0.05)。结论死冠血管在腹股沟斜疝患者中出现率较高,其在男性腹股沟疝患者中的出现率高于女性,男性患者的腹股沟疝发病年龄大于女性患者,推断该血管可能对于影响腹壁退化有一定关系,对于腹腔镜全腹膜外疝修补手术中对死冠血管的定位及规避有一定的作用。Objective To study anatomy of mortis corona vascular and analyze its characteristics and clinical significances in laparoscopic total extraperitoneal hernia repair （TEP）. Method The clinical data of 45 patients with inguinal hernia underwent laparoscopic TEP from luly 2013 to October 2015 in the Fourth People＇s Hospital of Zigong City were collected. Results ①There were 45 patients with inguinal hernia a total of 52 bilateral inguinal hernias （15 direct hernias, 37 oblique hernias）. The total appear rate of corona mortis vascular was 61.5% （32/52）. The appear rate of corona mortis artery was significantly higher than that of the corona morris vein [ 46.2% （24/52） versus 34.6% （18/52）, P〈0.05] , the diameter of the corona morris artery was significantly smaller than that of the corona mortis vein [ （3.2±0.3） mm versus （3.4±0.4） mm, t=2.231, P〈0.05]. ②The appear rates of corona mortis artery and vein in the male patients were significantly higher than those of the female patients （P〈0.05）. Compared with the female patients, the age of onset was older （P〈0.05）, thickness of abdominal wall was thinner （P〈0.05）, diameter of corona mortis vascular was bigger （P〈0.05） in the male patients. ③ The total appear rate of corona morris vascular in the patients with direct hernia was significantly lower than that of the patients with oblique hernia （P〈0.05）. The age of onset of the patients with direct hernia was significantly older than that of the patients with oblique hernia （P〈0.05）. Conclusions There is a higher appear rate of corona mortis vascular in patients with oblique hernia, which in male patients is higher as compared with female patients. Age of onset of male patient with inguinal hernia is older than that of female patient with inguinal hernia.It suggests that appear of corona mortis vascular might be associated with degeneration of abdominal wall. It has a certain role for localization and avoidance of corona morris vascular in TEP.

关 键 词：死冠血管 腹腔镜 全腹膜外疝修补手术 出现率 

分 类 号：R656.2[医药卫生—外科学] R322[医药卫生—临床医学]