前腹壁膜解剖在腹腔镜全腹膜外腹股沟疝修补术中临床意义的探讨  

Clinical significance of anterior abdominal wall fascial in totally extraperitoneal herniorraphy

作　　者：李健文[1] 乐飞[1] Li Jianwen;Yue Fei(Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai Minimally Invasive Medical Center,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院普外科上海市微创外科临床医学中心,200025

出　　处：《中华消化外科杂志》2019年第11期1018-1021,共4页Chinese Journal of Digestive Surgery

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.14321)。

摘　　要：前腹壁腹横筋膜和腹膜之间所有筋膜临床上都可称为腹膜前筋膜。根据“联合筋膜平面”学说,腹膜前筋膜为多层次结构,其膜层将腹膜前间隙分为壁、脏2个外科平面。腹腔镜全腹膜外腹股沟疝修补术(TEP)的手术操作平面需按区域划分:中央脐膀胱区域,手术必须在壁平面进行,即腹横筋膜和腹膜前筋膜之间,为疏松的无血管区域,是TEP的“神圣”平面。两侧Doom区域,因精索成分穿越腹壁的特殊性,手术被迫转入脏平面,即腹膜前筋膜和腹膜之间。外侧髂窝区域,腹壁恢复正常结构,手术可在脏平面或壁平面进行。在壁平面向脏平面转换过程中,需要切开转折处的腹膜前筋膜。“平面转换”学说可以诠释“腹膜前环”的形成机制以及耻骨膀胱间隙和Bogros间隙不相通的原因。笔者总结数千例TEP临床经验,结合相关权威文献,探讨前腹壁膜解剖在TEP中的临床意义。All fascia between the transversalis fascia of anterior abdominal wall and the peritoneum can be called the preperitoneal fascia clinically.According to the interfascial plane theory,the preperitoneal fascia is a multi layer structure,and preperitoneal space was divided into two surgical planes inclu ding parietal and visceral by its membrane layers.Surgical planes of totally extraperitoneal herniorraphy(TEP)can be described as follow:for median region,surgery can be per formed in parietal plane,that is avascular region filled with loose areolar tissues between the transversalis fascia and the preperito neal fascia,which is called“holy plane”of TEP.For Doom region,surgery is transferred into viscecal plane,which is between the preperitoneal fascia and the peritoneum,due to the particularity of spermatic cord through the abdominal wall.For lateral region,the abdominal wall restores to normal structure,and surgery can be performed in parietal plane or viscecal plane.The preperitoneal fascia needs to be dissected during the transfer from parietal plane to viscecal plane.The concept of plane trans formation can explain the formation mechanism of preperitoneal loop and no connection between Reztius space and Bogros space.The author has elucidated the significance of preperitoneal fascial anatomy of anterior abdominal wall in TEP based on clinical experience of TEP and authoritative literatures.

关 键 词：疝 腹股沟疝 膜解剖 腹腔镜检查 

分 类 号：R65[医药卫生—外科学]