腹腔镜下小儿腹股沟内环口周围的应用解剖学研究

Anatomic study of the region of internal ring in laparoscopy

目的为腹腔镜下小儿腹股沟斜疝修补术提供解剖学依据。方法对16具(32侧)经防腐处理的小儿尸体标本内环口周围血管神经进行观测。结果 (1)髂腹下神经与腹壁下动脉在腹前壁的交点与内环口上缘的距离:男左侧为(16.77±1.36)mm,男右侧为(17.77±2.39)mm;女左侧为(16.41±2.23)mm,女右侧为(15.81±0.57)mm。(2)髂腹下神经与腹壁下动脉的夹角:男左侧为(107.75±11.59)°,男右侧为(106.29±8.87)°,女左侧为(106.42±9.46)°,女右侧为(110.23±9.42)°。各测量数据在性别间差异无统计学意义(P>0.05),各测量数据在双侧无显著性差异(P>0.05)。结论 (1)在腹前壁髂腹下神经与腹壁下动脉之间有一个没有神经和血管的"安全区域",该区可为IPOM手术中腹腔镜下补片固定提供足够的安全范围。(2)以腹壁下动脉为参考标志,可减少髂腹下神经的损伤,减少慢性疼痛的发生率。

Objective To provide anatomic data for laparoscopic repair of inguinal hernia in children.Methods 16 child human cadaveric specimens（32sides）were observed to record the course,distribution and relations of vessels and nerves on the region of internal ring.Results（1）The average distance from internal ring to the intersections of iliohypogastric nerve and inferior epigastric artery： On the right side of the male,the distance was（16.77±1.36）mm,on the left side of the male,the distance was（17.70±2.39）mm;on the right side of the female,the distance was（16.41±2.23） mm,on the left side of the female,the distance was（15.81±0.57）mm.（2）The mean angle of iliohypogastric nerve and inferior epigastric artery： On the right side of the male,the angle was（106.29±8.87）°,on the left side of the male,the angle was（107.75±11.59） °;on the right side of the female,the angle was（110.23±9.42） °,on the left side of the female,the angle was（106.42±9.46）°.It was not significantly different in the measurement data in gender;there was no significant difference between two sides（P0.05）.Conclusion On the region of internal ring,there was a ＂safe region＂without any important vessels and nerves,which were constituted by the inferior epigastric artery and the iliohypogastric nerve.Patch could be fixed in the ＂safe region＂.The inferior epigastric artery can be referred as an anatomical landmark to reduce the incidence of iliohypogastric nerve damage and ensuing chronic pain.