【摘要】 目的:通过对脐内侧襞解剖学的研究,为腹腔镜完全腹膜化腹腔内置补片修补术(total peritoneum intraperitoneal onlay mesh,TPIPOM)提供准确的临床应用解剖基础。方法:尸体解剖组(A组):解剖脐内侧襞及内环周边,与腹腔镜下解剖作为对照;腹腔镜手术患者分为B组(疝修补组)和C组(非疝修补组),测量脐内侧襞厚度(T)及宽度(W);B组行TPIPOM,术中观测脐内侧襞局部解剖。结果:B、C两组患者双侧脐内侧襞厚度平均为(3.0±1.2)mm,宽度为(10.1±3.2)mm;尸体及腹腔镜活体解剖表明脐内侧襞周边无重要神经、血管毗邻。B组均在腹腔镜下完成手术,手术时间平均(29.5±9.5)min,下床活动时间平均(36±8)h,平均住院(3.5±1.5)d,费用平均(8 500±880)元;术后平均随访(12±6)个月,未见复发。结论:脐内侧襞在TPIOPM术中可完全覆盖补片,此术式具有安全、可靠、微创、经济等优点。更多还原

【Abstract】 Objective:To study anatomy of medial umbilical fold,provide accurate anatomic basis of the clinical application for total peritoneum intraperitoneal onlay mesh(TPIPOM).Methods:Group A(group of autopsy):medial umbilical fold and abdominal ring were dissected to compare with laparoscopic anatomy;patients of laparoscopic operation were divided into group B(group of TPIPOM) and group C(group of no TPIPOM),to measure thickness(T) and width(W) of medial umbilical fold,regional anatomy of medial umbilical fold was observed in group B.Results:The thickness of group B and C was(3.0±1.2)mm,the width was(10.1±3.2)mm;autopsy and laparoscopic anatomy indicated that there were not significant nerve and vessel in surrounding of medial umbilical fold;The laparoscopic operations were successfully performed in group B:the operating time was(29.5±9.5)min,the average time of ambulation was(36±8)h,the mean hospital stay was(3.5±1.5)d,the mean cost was(8 500±880) yuan;The patients were followed up for(12±6) months and recurrence was not found.Conclusions:Patch could be covered by medial umbilical fold in TPIPOM,which is safe,reliable,minimally invasive and economical.更多还原