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中华疝和腹壁外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 472 -475. doi: 10.3877/cma.j.issn.1674-392X.2020.05.002

所属专题: 文献

临床论著

膜解剖理念在腹腔镜完全腹膜外疝修补术中的应用
董泾青1,()   
  1. 1. 510220 广州市红十字会医院胃肠肛肠外科
  • 收稿日期:2020-05-11 出版日期:2020-10-20
  • 通信作者: 董泾青
  • 基金资助:
    2019年度广东省医学科研基金指令性课题(C2019080)

Application of membrane anatomy TEP in treatment of inguinal hernia

Jingqing Dong1,()   

  1. 1. Department of General Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou 510220, China
  • Received:2020-05-11 Published:2020-10-20
  • Corresponding author: Jingqing Dong
引用本文:

董泾青. 膜解剖理念在腹腔镜完全腹膜外疝修补术中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2020, 14(05): 472-475.

Jingqing Dong. Application of membrane anatomy TEP in treatment of inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2020, 14(05): 472-475.

目的

探讨膜解剖理念在腹腔镜完全腹膜外疝修补术(TEP)中的应用。

方法

回顾性分析2016年1月至2019年12月,南方医院和广州市红十字会医院腹股沟疝患者311例,按手术方式分标准TEP组(169例)和膜解剖TEP组(142例),比较2组患者术中腹壁下血管损伤、膀胱表面血管损伤、生殖血管损伤、输精管损伤、腹膜破损和术后疝复发情况。

结果

与标准TEP组比较,膜解剖TEP组的腹壁下血管损伤少,膀胱表面血管损伤少,腹膜破损率低,差异均有统计学意义(P<0.05);2组生殖血管损伤、输精管损伤和术后疝复发情况比较,差异无统计学意义(P>0.05)。

结论

膜解剖理念在TEP中的应用,对减少术中血管损伤和腹膜破损有优势,值得临床推广。

Objective

To explore the application of membrane anatomy TEP in the treatment of inguinal hernia.

Methods

Between January 2016 and December 2019, a retrospective study in Nanfang Hospital and Red Cross Hospital was conducted on 311 cases of primary inguinal hernia patients who were assigned into two groups, standard TEP group (n=169) and membrane anatomy TEP (n=142). Intraoperative data (inferior epigastric vessels injury, bladder surface vessels injury, reproductive blood vessels injury, vas deferens injury, peritoneum breakage), and long term postoperative data such as recurrence rate were compared.

Results

Compared with the standard TEP group, the membrane anatomy TEP group had less inferior epigastric vessels injury, less bladder surface vessels injury and less peritoneum breakage rate (P<0.05). There were no statistically significant differences between two groups about reproductive blood vessels injury, vas deferens injury and recurrence rate (P<0.05).

Conclusion

As compared with standard TEP, membrane anatomy TEP has fewer vessels injury and peritoneum breakage. It is a better method for inguinal hernia patients.

表1 2组患者术中及术后情况的比较[例(%)]
图1 内环至弓状线之间:腹壁下血管位于腹直肌与腹横筋膜之间
图2 多层腹膜前筋膜
图3 脐膀胱筋膜和脐膀胱前筋膜
图4 Bogros间隙的脏层面和壁平面
图5 直疝假疝囊和腹膜前筋膜之间壁平面的分离
图6 完整剥离疝囊时,疝囊与腹膜前筋膜的比邻关系
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