弓状线在腹腔镜完全腹膜外疝修补术中的临床解剖学观察及其临床意义

Anatomical observation and clinical significance of the arcuate line in totally extraperitoneal preperitoneal(TEP)herniorrhaphy

目的观察弓状线的位置、形态和毗邻关系,为腹腔镜完全腹膜外疝修补术(TEP)提供应用解剖学资料和手术指导。方法对60例成人原发性腹股沟疝患者TEP时解剖显露弓状线,用穿刺针从皮肤垂直刺入测量弓状线的位置和长度、观察其形态和数量。结果60例分为经典组(脐下4~5 cm)15例(25.0%),高位组(3 cm)1例(1.7%),低位组(6~12 cm)43例(71.6%)和无弓状线组1例(1.7%)。单个弓状线22例(36.7%),而多条弓状线38例(63.3%)。直线形弓状线2例(3.3)%,弧形和逐渐变薄消失形各为28例和29例(各占46.7%和48.3%)。结论弓状线是腹直肌鞘后层缺如所形成的弓状游离缘,其位置、形态和数量存在很大差异,弓状线变异不仅加大了TEP手术难度,而且也增加了手术并发症。弓状线在TEP手术中具有重要的临床意义。

Objective To study the position and morphological features of the arcuate line and get better understanding of its clinical significance,so as to provide the applied anatomical data and operation guide for the totally extraperitoneal(TEP)herniorrhaphy.Methods The arcuate line was dissected and observed during TEP in 60 cases of adult patients with primary inguinal hernia.The location and length of the arcuate line were determined by puncturing needle vertically through the skin,and its morphology and quantity data were recorded.Results The arcuate line was recorded and divided into four groups,namely,a classical group(4~5 cm)in 15 cases(accounting for 25.0%),a high level group(less than 3 cm)in one case(accounting for 1.7%),a low level group(6~12 cm)in 43 cases(accounting for 71.6%),an absent arcuate line group in one case(accounting for 1.7%).Twenty-two cases were single arcuate line(accounting for 36.7%),while 38 cases were multiple arcuate line(accounting for 63.3%).Two cases were the straight shaped arcuate line(accounting for 3.3%),28 cases and 29 cases were the arc-shaped and the transition shaped arcuate line(accounting for 46.7%and 48.3%respectively).Conclusions The arcuate line is the free margin formed by the absence of the posterior layer of the rectus sheath.There are great differences in its position,morphology and number.The variation of arcuate line not only increases the difficulty of the TEP surgery,but also increases the complications.The arcuate line has important clinical significance in the TEP operation.