腹腔镜全腹膜外腹股沟疝修补术精索壁化的解剖学观察及临床意义  

The anatomic observation and clinical significance of perietalization of spermatic cord in laparoscopic totally extraperitoneal prosthesis

作　　者：钟飞庄[1] 翁山耕[2] 林其声[1] 杨双莲[1] 林隆 ZHONG Fei-zhuang;WENG Shan-geng;LIN Qi-sheng(Department of General Surgery,the Second Hospital of Sanming City,Sanming 366000,China;The First Affiliated Hospital of Fujian Medical University)

机构地区：[1]三明市第二医院,福建三明366000 [2]福建医科大学附属第一医院

出　　处：《腹腔镜外科杂志》2019年第10期742-745,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探索腹腔镜全腹膜外疝修补术(TEP)精索壁化正确的外科操作平面。方法:回顾分析为63例成人男性患者行TEP的临床资料,复习、再认识精索壁化的解剖学特点及意义。结果:手术均获成功,并发症少;腹横筋膜表面有网状或树枝状的微小血管分布;腹直肌后鞘连续性覆盖在腹膜下筋膜浅层表面;输精管及生殖血管位于腹膜下筋膜深浅层之间,腹膜与输精管、生殖血管表面的筋膜之间有天然的间隙,腹膜及腹膜下筋膜深层表面均有呈网状或树枝状的微小血管。结论:精索壁化的外科平面在腹膜与腹膜下筋膜深层之间;辨认这些重要的解剖标志——腹膜及筋膜结构表面的微小血管,以其为导向,可进行精准的外科操作,是TEP成功、降低术后并发症发生率的关键。Objective:To discover the correct plane of surgical operation of perietalization of spermatic cord in laparoscopic totally extraperitoneal(TEP)prosthesis.Methods:The clinical data of 63 inguinal hernia male adult patients treated by laparoscopic TEP surgery were retrospectively analyzed.And the anatomic characteristics and clinical significance of perietalization of spermatic cord were reviewed and re-understanded.Results:All the laparoscopic TEP operations were accomplished successfully with few complication.There are many micro vessels whose blood trees show on transveralis fascia.The posterior rectus sheath covers shallow subperitoneal fascia,the deferens and reproductive blood vessels locate in subperitoneal fascia.There is natural gap between the peritoneum and the deferens-reproductive blood vessels.Also there are many micro vessels who show the blood tree on the peritoneum and the deep subperitoneal fascia.Conclusions:The plane of surgical operation of perietalization of spermatic cord is between peritoneum and deep subperitoneal fascia.Identifying those important anatomic landmarks such as the micro vessel on the peritoneum and fascia is the key to certify the success of laparoscopic TEP and reduction of the postoperative complications.

关 键 词：疝 腹股沟 全腹膜外疝修补术 腹腔镜检查 精索壁化 

分 类 号：R656.2[医药卫生—外科学]