耻骨肌孔解剖认知在经腹股沟切口腹膜前疝修补术中的应用研究

Clinical application of anatomical insight into myopectineal orifice in preperitoneal inguinal hernioplasty via an inguinal incision

目的探讨经腹股沟切口腹膜前疝修补术的手术体会，分析耻骨肌孔解剖认知在手术中的临床应用要点。方法在开展国人耻骨肌孔腹膜前间隙尸体解剖研究的基础上，回顾性分析2010年12月至2012年12月治疗腹股沟疝210例的临床经验。结果平均手术时间60min，术后平均住院5d。术后切口疼痛20例，切口皮下积液2例，阴囊肿胀4例，无腹膜前血清肿，无切口感染。术后随访11～30个月，平均22个月，复发1例，慢性疼痛6例。结论经腹股沟切口的腹膜前疝修补术安全有效、复发率低，腹膜前间隙的充分游离和补片的准确放置是手术成功的关键，术后慢性疼痛等不适并不少见，减少腹横筋膜前加强片的使用及缝合固定可能有助于减少术后慢性疼痛的发生。

Objective To discuss the experience of preperitoneal inguinal hernioplasty via an inguinal incision and to evaluate the clinical application of anatomical insight into myopectineal orifice. Methods A total of 210 cases with inguinal hernia were enrolled and analyzed from December 2010 to December 2012 based on the chinese myopectioneal orifice preperitoneal anatomic studies. Results The mean operation time was 60 minutes and the mean of hospitalization stay lasted 5 days. Twenty cases suffered from postoperaitve pain. The subcutaneous hydrops occurred in 2 cases and scrotum swelling occurred in 4 cases. No preperitoneal seroma or incision infection was observed. The follow-up ranged from 11 to 30 months （ median 22 months）. One case developed recurrence and 6 cases suffered from chronic pain in the inguinal region. Conchlsions The preperitoneal inguinal hernioplasty via an inguinal incision is safe and effective with low recurrence rate. The extensive dissection of preperitoneal space and accurate placement of the mesh are critical for operation. Chronic pain in the inguinal region is not rare. Reducation of pre- transverse fascia strengthen patch and suture fixation may help lessen the occurrence of chronic pain.