无张力腹股沟疝修补术中腹股沟解剖范围内髂腹下神经的临床观察

Clinical observation of iliohypogastric nerve in the surgical area of tension-free inguinal hernioplasy

目的探讨腹外斜肌腱膜下髂腹下神经在腹股沟疝修补术野的走行解剖。方法333例次开放式腹股沟疝修补术患者应用宽度3.5cm的小补片95例次,5.5cm的大补片238例次。观察长径从耻骨结节至内环口外长6cm,宽径分别为垂直腹股沟韧带向内上宽3.5cm和5.5cm补片覆盖区域范围的腹外斜肌腱膜下的髂腹下神经。结果 126例次(37.84%)在腹外斜肌腱膜下观察到髂腹下神经。其中,在宽度3.5cm的范围内有24例次(25.26%)观察到髂腹下神经,明显少于5.5cm的102例次(42.86%)(P<0.05)。结论开放式腹股沟疝修补术中,随着腹外斜肌腱膜下的解剖范围扩大,髂腹下神经暴露、误伤机会增加,需要适当处理好网片与神经的关系。

Objective To observe the anatomy of the iliohypogastric nerves under in the surgical area of tension-free inguinal hernioplasy. Methods The open inguinal hernioplasty was performed in 333 male patients,in whom the mesh of 3.5 cm-wide mesh was used in 95 cases and 5.5 cm-wide meshe was used in 238 cases. The iliohypogastric nerves were observed in the area extending from the internal ring to the pubic tubercle in length and from the reflex of the inguinal ligament to the place above 3.5 cm（group A） or 5.5 cm（group B） vertical to the inguinal ligament in width, respectively. Results The iliohypogastirc nerves were observed in 126 cases（37. 84~）, in whom 24 cases（25.26%） were from group A and 102 cases（42.86%） from group B（P〈0. 05）. Conclusion During open inguinal hernioplasty, as the width of separation under the aponeurosis of external oblique extends, the possibility of exposure and injury to the iliohypogastric nerve increases and more attention should be paid to properly manageing the relation of the nerve and mesh.