耻骨肌孔的空间分离解剖在腹腔镜全腹膜外疝修补术中的应用及意义

The clinical use and significance of the spatial anatomical separation of myopectineal orifice in totally extraperitoneal prosthesis for repair of inguinal hernia

目的：探讨应用腹腔镜技术对耻骨肌孔的空间分离解剖在腹腔镜全腹膜外疝修补术（totally extraperitoneal TEP）中的意义。方法我院自2005年至2013年开展TEP手术272例，术中将腹膜外耻骨肌孔区域分为初始空间、耻骨空间、髂窝空间和髂血管空间4个空间，依次解剖分离4个空间，在空间内安全操作。结果术中寻求相应解剖标志分别界定4个空间，最终融合为一个大范围空间。所有病例均应用耻骨肌孔的空间分离解剖技术指导完成手术，手术时间48 min（28-60 min），术后住院时间5 d（3-8 d）。术后随访2-60个月，其中2例出现阴囊血肿经抽吸后治愈，无疝复发病例，无切口及补片感染，无慢性疼痛、睾丸萎缩、射精痛等并发症发生，无疝复发。结论耻骨肌孔的空间分离解剖技术可以缩短TEP手术的学习曲线，加深对其复杂的耻骨肌孔及其后方解剖结构的学习和理解，提高手术效率和手术质量，减少手术并发症。

Objective To investigate the significance of using laparoscope technology to identify the spatial anatomy of myopectineal orifice in totally extraperitoneal prosthesis for inguinal hernia. Methods Data of 272 TEP cases from 2005 to 2013 was analyzed retrospectively. The myopectineal orifice was divided into 4 spaces during the operation, and the 4 spaces were anatomically separated one by one. Results Proper anatomical landmarks were used to divide the myopectineal orifice into four spaces, and the four spaces finally formed a larger space. All the cases were operated using the technique of spatial anatomical separation of myopectineal orifice. The mean surgical length was 48 minutes （28-60）, and the mean postoperative hospitalization length was 5 days（3-8）. 2 cases had scrotal seroma after the operation, which were both cured with suction. No recurrence, infection, chronic pain, testicular atrophy and ejaculation pain appeared. Conclusions The technique of spatial anatomical separation of myopectineal orifice shortened the learning time of mastering TEP, deepened the understanding ofthe complicated anatomy of myopectineal orifice and the structure behind it, which can lead to more efficient operation and fewer surgical complications.