3D腹腔镜下正常成年男性腹股沟管内环的活体解剖学观察及临床意义  

In vivo anatomical observation of inner inguinal ring of normal male adults under 3D laparoscope and its clinical significance

作　　者：陈建发 谢奎龙 冯巧智 周勇军 朱文彬 CHEN Jian-fa;XIE Kui-long;FENG Qiao-zhi;ZHOU Yong-jun;ZHU Wen-bin(Department of General Surgery,the First Naval Hospital of Southern Theater Command,Zhanjiang 524009,China)

机构地区：[1]南部战区海军第一医院普通外科,广东湛江524009

出　　处：《广东医科大学学报》2021年第5期612-615,共4页Journal of Guangdong Medical University

摘　　要：目的探讨生理状态下成年男性腹股沟管内环的解剖学特点,为腹股沟疝修补术提供解剖学基础。方法应用高清晰度3D腹腔镜对10例正常成年男性腹股沟内环及其周围解剖结构进行仔细观察和摄像回放研究,分析输精管、精索血管、腹壁下血管、髂耻束、腹横肌、弓状下缘等结构的解剖特点及相互关系。结果腹横肌弓状下缘与输精管和精索血管紧密相邻,未存在一个明确的卵圆形腔隙。传统解剖学中描述成卵圆形腔隙的内环应该是其病理状态,是腹股沟斜疝形成后被动扩大所致;输精管和精索血管在弓状下缘下方离开内环后两者并未立刻分离,而是继续相伴行走直至到达腹壁下血管外上方(2.02±0.17)cm后才相互分离;在内环与输精管和精索血管分叉处之间的腹横筋膜相应增厚,呈帘状将输精管和精索血管紧紧固定于髂耻束和髂腰肌筋膜上;内环上方的弓状下缘、下方的髂耻束以及内侧将两者紧紧相连的凹间韧带共同组成一个强大的具有类似括约肌功能的肌肉筋膜环,起到腹股沟管的开关节制功能。结论正确认识生理状态下腹股沟管内环及其周围解剖结构对准确阐述腹股沟斜疝的形成机制以及制定更加合理的腹股沟斜疝修补方法具有重要的临床意义。Objective To explore the anatomical characteristics of the inner inguinal ring of normal male adults under physiological condition to provide anatomical basis for inguinal hernia repair.Methods The anatomical characteristics of the inner inguinal ring and its surrounding structures in 10 normal male adults were carefully observed by high-definition 3D laparoscopy and studied via video playback.The anatomical characteristics of the vas deferens,spermatic vessels,inferior epigastric vessels,iliopubic tract,transverses abdominis muscle and lower arcuate margin as well as their relationships were analyzed.Results The lower arcuate margin of transverse abdominis muscle was closely adjacent to the vas deferens and spermatic vessels without a definite ovoid fissure.The inner ring,which was described as an oval space in traditional anatomy,was considered the pathological condition of an indirect inguinal hernia resulting from passive enlargement.The vas deferens and spermatic vessels did not separate immediately after they left the inner ring at the lower margin of the lower arcuate margin.Instead,they continued to walk together until they reached the outer upper part of the inferior epigastric vessels(2.02±0.17)cm before separating from each other.The transverse fascia between the inner inguinal ring and the bifurcations of the vas deferens and spermatic vessels was correspondingly thickened,which firmly fixed to the vas deferens and spermatic vessels to the iliopubic tract and the iliopectineal fascia in a drape shape.The lower arcuate margin above the internal inguinal ring,the iliopbubic tract below,and the interfoveolar ligament which connected them together formed a powerful sphincter-like musculofascial ring,which acted as an on/off control of the inguinal canal.Conclusion Correct understanding the anatomical structures of the inner inguinal ring and its surroundings under physiological conditions is of great clinical significance to accurately explain the mechanism of indirect inguinal hernia and to formulate a

关 键 词：腹股沟管 腹腔镜 解剖学 内环 输精管 精索血管 髂耻束 弓状下缘 

分 类 号：R656[医药卫生—外科学]