腹腔镜腹股沟疝修补术中出血控制及解剖分析

Bleeding control and anatomical analysis in laparoscopic inguinal hernia repair

目的探讨腹腔镜腹股沟疝完全腹膜外疝修补术中出血原因及控制方法。方法回顾性分析2009年4月至2010年6月,深圳市第三人民医院80例腹腔镜腹股沟疝完全腹膜外疝修补术患者的临床资料,记录所有患者术中出血较多的解剖部位,统计所有出血部位数量,计算各出血部位所占比例。结果本组患者均顺利完成手术,其中75例患者术中有较多出血;共记录到出血部位189个,其中睾丸血管58个,斜疝被盖41个,耻骨膀胱间隙34个,腹壁下血管29个,输精管血管14个,外侧髂窝间隙9个,耻骨梳韧带上3个,疝囊残端1个;其中85%的患者术中有2处以上出血。结论在腹腔镜腹股沟疝完全腹膜外疝修补术中需熟练掌握腹膜外空间血管解剖,对于睾丸血管、斜疝被盖、耻骨膀胱间隙等出血风险较大的解剖部位,手术时需慎重操作。

Objective To investigate the causes and management of bleeding during laparoscopic totally extraperitoneal（ TEP） inguinal hernia repair. Methods A retrospective analysis was conducted on80 cases of inguinal hernia who underwent TEP repair in Shenzhen Third People＇s Hospital from April 2009 to June 2010. The anatomical sites with the most common bleeding in all patients were recorded,and the number of bleeding sites was calculated and analyzed. Results All operations were successfully completed in this group of patients. 75 cases showed various degree of bleeding. A total of 189 bleeding sites were recorded,including 58 in testicular vessels,41 in hernia covering,34 in Retzius space,29 in inferior epigastric vessels,14 in vas deferens vessels,9 in external iliac fossa space,3 in Cooper＇s ligament and 1 in stump of hernia sac. 85% patients had more than 2 bleeding sites in above places. Conclusion The vascular anatomy of extraperitoneal space should be well known by the surgeon who is going to perform the TEP hernia repair. More careful attention to the testicular vessels,the hernia covering and the Retzius space were required during the surgery.