腹股沟疝修补术的解剖基础

目的探讨腹股沟管的有关解剖结构,为腹股沟疝修补术提供解剖学基础。方法解剖33具(66侧)成人尸体标本,观察腹股沟韧带、腹股沟镰、腹股沟管等结构,并测量了相关数据。结果腹股沟韧带长度,男性约11.9cm,女性约11.4cm;宽度男性约0.7cm,女性约0.6cm;腹股沟管长度,男性约4.9cm,女性约4.5m;腹股沟管后壁可分为两层紧贴的筋膜层,并形成一个卵圆形的区域,其纵径长度男性约2.9cm,女性约2.6cm,横径约1.4cm;腹股沟镰长度,男性约2.4cm,女性约2.0cm。腹股沟镰可分为4种类型;腹内斜肌起始有3种类型,肌腱移行处呈现3种类型;腹横肌起始有两种类型。结论测量值为腹股沟疝修补术提供了解剖学依据     

老年腹股沟疝的无张力修补术

目的 观察60岁以上老年腹股沟疝患者无张力修补术的临床疗效。方法 126例老年腹股沟疝患者均采用无张力修补术，术后随访1～3年，观察恢复情况。结果 术后患者平均36h下床活动，平均住院8d，没有发生尿潴留，阴囊水肿及切口感染，复发率为0．7％。结论 无张力修补术对老年患者治疗效果良好。     

Anatomical characteristics of the iliopubic tract: Implications for repair of inguinal hernias

The high recurrence rate of inguinal hernias following primary repair has prompted us to re-examine the anatomy of the inguinal region with particular emphasis on the iliopubic tract (IPT). The IPT is described as an aponeurotic band forming the inferior margin of the transversus abdominis lamina. We documented the presence and degree of development of the IPT in dissections of 151 embalmed inguinal regions and in serial sagittal sections of four body halves. The iliopubic tract was identified in all specimens. It stretched between the anterior superior iliac spine laterally and the pubic tubercle and the pubic tubercle and pectineal line medially. The intervening arch formed a discrete structure of variable thickness and was substantial in 63 specimens. Histological sections demonstrated that the IPT is connected to the inguinal ligament, fascia lata, and anterior femoral sheath and is composed primarily of collagenous fibers with a minor elastic component. These data indicate that the iliopubic tract is a consistent and easily identified structure in the inguinal regions. These results suggest that dissection of the iliopubic tract, like the inguinal ligament, should become an integral part of the assessment of groin anatomy during hernia repair. © 1992 Wiley-Liss, Inc.     

Re-recognizing the pathogenesis of inguinal hernias

Over the past century, there has been a significant increase in the understanding of groin anatomy as it is related to inguinal hernia. But no one really knows the function of iliopsoas in sealing the inguinal canal and promoting defecation in squatting position. This paper presents the hypothesis that iliopsoas plays an important role in iliopsoas-abdominal reflex by strengthening the groin region, and thus offers a new insight into the study of the pathogenesis of groin hernia and defecation in the aged. This discovery may explain why squatting instead of sitting is better for defecation and urination and why the elderly males are more susceptible to groin hernia. Moreover, the colorectal disease might also benefit from this discovery.     

Experience with direct Kugel patch method for repair of adult inguinal hernia.

The direct Kugel Patch method is a minimally invasive but nonlaparoscopic preperitoneal method of hernia repair which has various ideal characteristics including all the benefits of laparoscopic hernia repair without the risks of complications. In this retrospective study, we report our experience with this method for adult inguinal hernia repair. Forty-four hernias, including 35 indirect, 7 direct inguinal hernias, and 1 recurrent indirect inguinal hernia, in 41 patients were surgically repaired using the direct Kugel patch method. The average operation time was 45.6 +/- 11.3 min, and the average hospitalization time was 6.2 +/- 5.0 days. There were 5 complications of seroma and only 1 recurrence of hernia which were successfully managed. We concluded that the direct Kugel patch method provides an ideal approach to adult inguinal hernia repair with short operation time and hospital stay and a very low risk of complications or recurrence.     

双层复合补片在腹壁大切口疝及巨大切口疝中的应用

背景：传统缝合修补与自体组织移植修补较大腹壁缺损时具有一定的局限性。 目的：分析人工合成材料双层复合补片修补腹壁大切口疝及巨大切口疝的效果。 方法：回顾性分析郑州大学第一附属医院2008-12/2010-12收治的71例腹壁大切口疝及巨大切口疝患者的临床资料,所有患者均采用双层复合补片行切口疝无张力修补。 结果与结论：全部病例术后恢复顺利,无严重并发症。发生皮下积液5例,经换药治疗后痊愈。术后随访6个月~2.5年,无复发病例,无切口感染病例。提示双层复合补片是目前治疗腹壁大切口疝和巨大切口疝安全可靠的修补材料。     

老年人嵌顿性和绞窄性腹股沟疝的围手术期处理

老年人嵌顿性或绞窄性腹股沟疝是老年外科急腹症的常见病因。老年患者因其自身并存慢性疾病多,机体重要脏器代偿功能差,对疾病反应能力减弱,因此,老年人嵌顿性和绞窄性腹股沟疝患者易发生术后并发症,致使病情危重,甚至死亡。所以,对老年人嵌顿性或绞窄性腹股沟疝强调及时诊断,早期手术,同时应重视术前准备,术中监测及术后支持治疗等围手术期处理,以保证患者顺利康复。     

生物补片植入腹股沟疝无张力疝修补后预防性应用抗生素的荟萃分析

背景：预防性应用抗生素在腹股沟疝无张力修补后非常普遍,但是,不加选择的应用抗生素会增加患者的费用及抗生素耐药。 目的：系统评价预防性应用抗生素对腹股沟疝无张力疝修补术后手术部位感染发生率的影响。 方法：计算机检索PubMed、EMBASE、Cochrane Library、CBM、CNKI、VIP数据库,用RevMan5.0软件进行统计分析。 结果与结论：纳入8篇随机对照试验进行分析,Meta分析结果显示：预防性应用抗生素和安慰剂在预防腹股沟疝无张力疝修补术后手术部位感染发生率方面两组间差异有显著性意义[RR=0.68,95%CI(0.49,0.94)];而敏感性分析结果提示：两组差异无显著性意义[RR=0.78,95%CI(0.56,1.10)]。亚组分析提示β-内酰胺类抗生素和安慰剂相比在预防腹股沟疝无张力疝修补后手术部位感染发生率方面差异无显著性意义[RR=0.63,95%CI(0.16,2.57)],头孢类抗生素和安慰剂相比差异也无显著性意义[RR=0.66,95%CI(0.41,1.06)]。结果提示,没有足够的证据支持腹股沟疝无张力疝修补后常规预防性应用抗生素。     

Defining the position of deep inguinal ring in patients with indirect inguinal hernias

A preliminary survey of surgeons of all grades in our hospital revealed confusion about the position of the deep inguinal ring. Standard teaching is that the deep inguinal ring is lateral to the femoral artery. The aim of this study was to define the position of the deep ring in patients undergoing elective inguinal hernia repair. Thirty consecutive male patients undergoing indirect inguinal hernia repair under local anaesthesia were studied. The following landmarks were marked on the patient with a felt pen: anterior superior iliac spine (ASIS), femoral artery (FA), deep inguinal ring (DR), pubic tubercle (PT) and pubic symphysis (PS). The distance of each point from the ASIS was measured in centimetres. The relation of the femoral artery to the deep inguinal ring was confirmed by palpation through the deep ring during surgery. The femoral artery was consistently identified midway between the anterior superior iliac spine and pubic symphysis (mid-inguinal point). The deep inguinal ring was located medial (22/30) or above (8/30) the femoral artery, but never lateral. The mean distances from the anterior superior iliac spine to the deep ring and femoral artery were 8.8 and 7.7 cm, respectively. Contrary to standard teaching, this study demonstrates that the deep inguinal ring lies medial, not lateral, to the femoral artery. This may clarify some of the variations in textbook anatomy, and explain the difficulty in distinguishing direct and indirect inguinal hernias pre-operatively.Presented at the Association of Surgeons of Great Britain and Ireland (ASGBI, April 2004 Harrogate)     

Shouldice法修补腹股沟疝手术体会（附105例报告）

目的 探讨Ｓｈｏｕｌｄｉｃｅ疝修补术的疗效及手术治疗经验。方法 自１９９１年１月～１９９８年１月应用Ｓｈｏｕｌｄｉｃｅ法修补成人腹股沟疝１０５例并进行回顾性的总结和分析。结果 术后随访１～７年,无一例复发。结论 Ｓｈｏｕｌｄｉｃｅ法是目前修补成人腹股沟疝的最佳方法之一,值得推广。     

腹股沟区腹膜前解剖和疝修补术

目的：重新认识腹股沟区腹膜前解剖的特点，探讨腹膜前腹股沟疝无张力修补术的技术要点。方法：（1）对5具新鲜尸体进行腹股沟区解剖研究；（2）2005年6月-2006年5月行开放式腹膜前腹股沟疝无张力修补术共330例次（292例病人），2002年11月至2006年5月行腹腔镜下无钉合全腹膜外疝修补术（TEP）共240例次（211例病人），进行术中的观察及术后随访。结果：腹股沟区存在两层腹横筋膜，腹膜前间隙在两层腹横筋膜之间，补片即置于腹膜前间隙并覆盖肌耻骨孔。开放式腹膜前腹股沟疝无张力修补术平均手术时间43min，并发症率7．3％（24／330），复发率0．91％（3／330），平均住院时间1．7d。TEP平均手术时间57min，并发症发生率6．7％（16／240），无复发病例，术后平均住院时间2．8d。结论：从腹股沟区腹膜前解剖学特点来看在肌耻骨孔后方用足够大的补片覆盖修补符合压力学原理，腹膜前腹股沟疝无张力修补术具有合理性和可行性。     

Treatment of large ventral and scrotal hernias using preoperative pneumoperitoneum

The repair of abdominal wall hernias is a common procedure; however, large ventral or scrotal hernias with loss of domain indicate alternative methods of repair. Two successfully treated large abdominal wall hernias using preoperative pneumoperitoneum are presented and the benefits and potential complications are discussed. Preoperative pneumoperitoneum should be considered when planning the surgical repair of large abdominal wall hernias.     

Several ultrastructural peculiarities of the fascia transversalis in direct inguinal hernias of senile men

Fascia transversalis of the dorsal wall of the inguinal canal in direct hernias in senile men was studied by transmission electron microscopy. Collagen microfibrils (CMF) were unevenly arranged and rarely formed compact fibres. Dysplastic CMF with variable diameters and nonuniform profiles were also encountered. There was a marked collagenophagy: in some fibroblasts we observed collagen-containing vacuoles in different stages of microfibrillar degradation. Among CMF matrix vesicles were also detected. These ultrastructural findings are discussed as a morphological substrate leading to supportive and mechanical insufficiency of the fascia transversalis causing herniation. It is concluded also that because of the structural defects of the fascial sheath there is a need of alloplastic reconstruction where Bulgarian-made AMPOXEN tissue can successfully be applied.     

Defining the position of the deep inguinal ring using findings at laparoscopic inguinal hernia repair

Purpose  

We aim to establish the surface marking of the deep inguinal ring by laparoscopy and investigate if the patient’s build influences it.