【摘要】 目的对腹腔镜视野下对腹股沟区后壁的解剖结构进行观察,探讨腹腔镜下后入路腹膜前间隙腹股沟疝修补术的要点与难点。方法回顾性分析2013年1月至2018年12月武汉市第一医院所完成的1500例腹腔镜下腹股沟疝修补手术(LIHR)的视频资料,来对腹腔镜完全腹膜外疝修补术(TEP)和腹腔镜经腹腹膜前疝修补术(TAPP)的手术路径、解剖标志、操作要点进行归纳总结。结果在1500例LIHR手术中,TEP方式为660例,TAPP方式为840例。TEP手术和TAPP手术具有不同的手术入路;两种方式的手术区域都在腹膜前间隙(包括Retzius和Bogros间隙);两种手术方式需要辨认相同的解剖标志:如耻骨梳韧带、腹壁下血管、精索结构或子宫圆韧带、Doom三角、死亡冠、髂外血管以及股外侧皮神经和生殖股神经等结构;两种手术方式均需要分离出足够大的腹膜前间隙范围,并正确分离处理疝囊,完成精索去腹膜化,使用10 cm×15 cm的聚丙烯网片完全覆盖整个肌耻骨孔(包括内环、直疝三角及股环)。结论 TEP及TAPP手术都是LIHR的有效的修补方式,熟悉腹腔镜视野下腹股沟后壁的解剖特点,有利于缩短LIHR的学习曲线并更好的掌握该手术方式。更多还原

【Abstract】 Objective To observe the anatomical structures of the posterior wall of inguinal region in the view of laparoscopy, and to explore the main points and difficulties of the laparoscopic posterior approach to the preperitoneal inguinal hernia repair. Methods To collect and collate the video data of 1500 cases of laparoscopic inguinal hernia repair(LIHR) from January 2013 to December 2018 in Wuhan No.1 hospital, and summarize the surgical approaches, anatomical signs, operating key points of laparoscopic totally extra-peritoneal(TEP) and laparoscopic trans-abdominal preperitoneal hernia repair(TAPP). Results In 1500 cases of LIHR, there were 660 cases of TEP and 840 cases of TAPP. TEP and TAPP methods had different surgical approaches, two modes of operation were in the preperitoneal space(including the Retzius and Bogros space); the two surgical methods need to identify the same anatomical signs: such as the pectineal ligament, the inferior epigastric vessels, the spermatic cord structure or the round ligament of the uterus, the Doom triangle, the corona mortis, the external iliac vessels, lateral femoral cutaneous nerve and genitofemoral nerve; the two kinds of surgical methods need to separate enough range of the preperitoneal space, correctly separate the hernia sac, complete the deperitonealization to spermatic cord, and fully cover the whole myopectineal orifice(including the inner ring, Hesselbach’s triangle and femoral ring) with the polypropylene mesh of 10 cm×15 cm. Conclusion The operation of TEP and TAPP are effective methods of LIHR. Familiarity with anatomical features of the posterior wall of the inguinal wall in the view of laparoscopy is beneficial to shorten the learning curve of LIHR and better grasp the operation.更多还原