腹腔镜腹股沟疝修补术的应用解剖学研究

Anatomic study of groin hernia in laparoscopic herniorrhaphy

目的:应用腹腔镜技术量化研究腹股沟疝患者腹股沟应用解剖学特点,确定疝修补片大小的方法。方法:自2003年11月～2005年1月,完成50例腹股沟疝患者共57个腹股沟疝的腹腔镜疝补片修补术,分为斜疝组43个,直疝组14个,健侧作为对照组共43个。术中测量耻骨联合到腹壁下动脉发出处的长度(L)以及疝环直径(D),统计分析3组结果差异。结果:直疝组和斜疝组L值分别与对照组相比,t值为3.41和9.29,P值分别为0.001和0.000,说明腹股沟直疝和斜疝组的L值均小于对照组,差异具有显著性;直疝组L值和斜疝组相比,t=3.66,P=0.001,即直疝组L值较斜疝组大,差异具有显著性。直疝组疝环D值和斜疝组相比,t=2.58,P=0.013,直疝组D值较斜疝组大,差异也具有显著性意义。结论:腹股沟斜疝与直疝的腹股沟解剖结构具有显著差异,腹腔镜疝修补术中所用的补片大小应参照个体解剖学数据。

Objective： To explore the anatomic nature of groin and the method to decide the size of mesh in inguinal hernia patients undergone laparoscopic repair.Methods： 57 groin hernias in 50 cases consisting of 43 indirect hernias and 14 direct hernias underwent total extmperitoneal repair or transabdominal preperitoneal repair from November 2003 to January 2005. The patients were divided into three groups： the indirect hernias group, the direct hernias group and the control group （the uninjured side）.The length from the pubic symphysis to the root of inferior epigastric artery and the diameter of hernia defect were measured during operation, then analyzed. Results： The average diameter of hernia defect in the indirect hernias and direct hernias groups was 2.41±0.59 cm and 2.87±0.55 cm respectively, which demonstrated significant difference. The length from the pubic symphysis to the root of inferior epigastric artery was 7.13±.49 cm, 6.64±0.36 cm and 5.97±0.66 cm in the control group , the indirect hernias group and the direct hernias group respectively, which showed significant difference among them. Conclusions： The inguinal anatomy in groin hernia patients is of great difference between the indirect hernias and direct hernias. The mesh size used in TEP or TAPP should be better individualization in accordance with the anatomy for every patient.