腹股沟区腹横筋膜弓应用解剖学研究

APPLIED ANATOMICAL STUDY ON FASCIA TRANSVERSALIS ARCH OF INGUINAL REGION

在１８具福尔马林固定的男尸上，观察了３６侧腹股沟区腹横筋膜，发现３２侧（８８．９％）腹横筋膜在腹内斜肌和腹横肌弓状下缘水平或稍上方有一明显增厚也呈弓状的腹横筋膜弓（腹横弓），出现率８８．９％；用游标卡尺测得此结构本身最宽处宽度为＜３ｍｍ７侧（２１．９％）；３～５ｍｍ２１侧（６５．６％）；＞５ｍｍ４侧（１２．５％）。腹横筋膜弓最高点距腹股沟韧带上缘垂直距离为２８．０±６．７ｍｍ，根据以上应用解剖学研究基础，试行改良了腹股沟疝后壁修补方法，即在腹股沟韧带上方２．５～３．０ｃｍ处，从皮下环内侧脚最高处切开的腹外斜肌腱膜至内环处，高位结扎疝囊、紧缩内环后，在精索后方将切开的腹外斜肌腱膜下叶置于腹内斜肌和腹横肌弓状下缘深面与腹横筋膜弓缝合，内侧与联合腱缝合，精索复位，将腹外斜肌腱膜上叶下椎与股沟韧带缝合。这样可能会避免常规修复后壁方法所带来的缝合张力过大以及解剖结构扭曲等因素导致的疝复发。

Fasciae transversalis of 36 sides of inguinal regions have been observed on 18 of formalin-flxcd male corpses. Fascia transversalis arches have been discovered on 32 cases.This arch which becomes obviously thick was just situated in or above the lower arch edge of musculi obliquus internus abdominis and musculi transversus abdominis. The appearing rate of the arch was 88.9%. The widest distance of the structure of the arch has been measured.Seven cases were 3mm, 21 cases 3～5mm, 4 cases > 5mm, making up 21.9%, 65.6% and 12.5% of total cases respectively. The vertical distance of the highest point of the arch is 28.0±6.7mm away from the inguinal ligament. According to above-mentioned data of applied anatomical study, we have modificd the repairing method of inguinal hernia. At the place where is 2.5-3.0cm over the inguinal ligament, aponeurosis of musculi obliquus externus abdominis is cutted from the highest point of medial crus of anulus inguinalis subcutaneus to the anulus inguinalis abdominalis. Then the ligation of bernia sac is made at high location and the anulus inguinalis abdominalis is tightened up. Behind the spermaticus funiculus, the cut lower leaf of aponeurosis of musculi obliquus externus abdominis is put in the depth of lower arch edge of musculi obliquus internus abbdominalis and musculi transversus abdominalis,and is stitched with fascia tranversalis arch. The medial part of the lower leaf is stitched with tendo conjnuctivus. The spermaticus funiculus is returned to the original place. At last, the upper leaf of aponeurosis of musculi obliquus externus abdominalis is pushed downward,and stitched with inguinal ligament. This method may avoid the relapse of hernia which is due to the stitching tention and the twisting of anatomical structure.