耻骨肌孔在腹膜前间隙无张力疝修补术中的临床意义

Clinical significant of anatomical insight into myopectineal orifice in preperitoneal inguinal herniorrhaphy

目的复习耻骨肌孔的解剖学特点,探讨其在腹膜前间隙无张力疝修补术中的临床意义。方法回顾性分析2009年6月至2013年6月,石家庄市第一医院收治腹股沟疝患者110例,均行腹膜前间隙无张力疝修补术治疗,对其临床资料进行回顾性分析。结果患者手术时间50~120 min,平均（70±17）min,住院时间2~5 d,平均（4.0±0.8）d。全组患者无切口感染,无腹膜前血清肿及切口皮下积液。110例均获随访,随访时间6~24个月,随访期间无复发,无腹股沟区硬化、皮下脓肿及补片周围深部脓肿等发生,慢性疼痛3例,腹股沟区麻木感4例,异物感1例。结论腹膜前间隙无张力疝修补术是一种针对耻骨肌孔修补的手术,易于掌握,安全有效,术后恢复快,不易复发,值得在临床上加以推广。手术时对耻骨肌孔及腹膜前间隙解剖结构要深入了解,将补片完全覆盖耻骨肌孔是手术成功的关键。

Objective To investigate the clinical significant of anatomical insight into myopectineal orifice in preperitoneal inguinal herniorrhaphy. Methods Analyzing the data of 110 cases with preperitoneal inguinal heriorrhaphy operated in Shijiazhuang First Hostpital from June 2009 to June 2013. Results The mean operation time was （70.0 ± 17.4） （range 50 to 120） minutes. And the mean length of hospitalization stay was （4.0 ± 0.8 ） （ range 2 to 5 ） days. No incision infection, preperitoneal seroma or subcutaneous hydrops was observed. No recurrence cases occurred in the period of follow-up （range 6 to 24 months）. There were no cases of inguinal stiffness, subcutaneous abscess or mesh related deep abscess, but 3 cases of chronic pain, 4 cases of numbness in groin and 1 case of foreign body sensation were noted. Conclusion It will be a recommended approach that repairs the myopectineal orifice with artificial mesh in preperitoneal space with its safety, efficiency and convenience. Having a deep insight into the anatomy of myopectineal orifice and preoperitoneal space, and completely overlapping myopectineal orifice with the mesh are keys to the success of this operation.