耻骨肌孔解剖结构对腹腔镜腹股沟疝修补术的意义

Clinical significance of spatial anatomy of myopectineal orifice in laparoscopy inguinal hernia repair

目的探讨耻骨肌孔（myopectineal orifice,MPO）解剖结构对腹腔镜腹股沟疝修补术的意义。方法回顾性分析2013-06至2016-06收治的96例经腹腔镜修补术腹股沟疝患者的病例资料,经腹腔腹膜前疝修补术（TAPP）手术组54例,完全腹膜外疝修补（TEP）手术组42例,对引起术后并发症的相关因素进行分析。结果 96例共进行122侧完全腹膜外疝修补术（totally extraperitoneal prosthetic,TEP）或腹腔镜腹膜前修补术,包括经腹腔腹膜外疝修补术（transabdominal preperitoneal prosthesis,TAPP）,无一例中转开放手术,均获得成功。手术平均时间（45±12）min,术中出血10-50 ml。术后阴囊、精索血清肿3例。术后随访6-36个月,无复发病例。结论掌握耻骨肌孔的解剖结构特点是成功开展腹腔镜疝修补手术的关键,合理的手术操作可有效避免术中损伤,减少术后并发症。

Objective To investigate the clinical significance of spatial anatomy of myopectineal orifice（ MPO） in laparoscopic inguinal hernia repair（ LIHR）. Methods The Ddata of ninety-six TEP or TAPP cases treated between Jun 2013 and Jun2016 were retrospectively analyzed. The patients were divided into TEP group（ n = 42） and TAPP group（ n = 54）. The symptoms and postoperative recovery were analyzed and recorded respectively. The potential risk factors correlated with postoperative complications were also analyzed. Results Operations were successful in all the cases and no open surgery was produced. The duration of operation was（ 45 ± 12） min,and the main post operative complications were scrotal seroma（ hematoma）（ 3 cases,3. 1%）. Followups lasted 6 months to 3 years in all the cases. No recurrence was observed. Conclusions A good knowledge of the anatomical features and techniques of spatial anatomical separation of myopectineal orifice is essential to the prevention of recurrence and post-operative complications.