成年男性腹股沟区腹膜的3D腹腔镜活体观察及临床意义

3D laparoscopic viviperception of inguinal peritoneum and its clinical significance in adult males

目的活体观察成年男性腹股沟区腹膜解剖学结构,探讨腹股沟斜疝的形成机制。方法选取76例成年男性右侧腹股沟斜疝患者和76例配对正常对照者,用高清晰度3D腹腔镜活体观察右侧腹股沟区腹膜结构及其在斜疝形成前后的变化。结果腹股沟区腹膜以输精管盆腔段为界分为前、后腹壁腹膜。腹股沟斜疝形成过程中,后腹壁腹膜自前腹壁腹膜后外侧嵌入形成憩室样改变,再经内环和腹股沟管向腹壁凸出;前腹壁腹膜并不进入疝囊,只是向前抬起和向腹壁下血管方向皱缩。结论成年男性右侧腹股沟区腹膜包括前、后腹壁腹膜,二者的错层、凹陷和憩室化可能是腹股沟斜疝形成的基础。

Objective To investigate the pathomechanism ofindirect inguinal hernia(IIH)by viviperception of inguinal peritoneum in adult males.Methods The right inguinal peritoneum structure and its change before and after IIH were observed in vivo by 3D laparoscopy in 76 adult males with or without IIH.Results The inguinal peritoneum was divided into anterior and posterior abdominal peritoneum,with the boundary of the pelvic vas deferens.During the development of IIH,the posterior abdominal peritoneum was inserted posterolaterally to the anterior abdominal peritoneum to form a diverticular structure that protruded to the abdominal wall via the inner ring and the inguinal canal,while the anterior abdominal peritoneum was lifted forward and retracted toward the inferior abdominal vessels rather than entering the hernial sac.Conclusion The right inguinal peritoneum of adult males includes anterior and posterior abdominal peritoneum.Their dislocation,indentation and diverticulization may contribute to the formation of IIH.