腹腔镜结合CTA观察腹股沟疝患者死冠血管

目的 腹腔镜手术结合CTA观察腹股沟疝患者死冠血管,研究死冠血管的解剖学特点及在不同类型疝患者中存在的临床意义.方法 选取2015年6月至2016年10月在本科住院的48例患者的临床资料,其中男性33例,女性15例,年龄(61.0±15.5)岁,均临床诊断为腹股沟疝(直疝或斜疝),住院期间进行腹腔镜疝修补术,手术前行CT检查,对死冠血管存在情况及数据进行采集,结合患者临床资料及影像学数据进行分析.结果 48例腹股沟疝患者共56侧腹股沟疝(直疝21侧,斜疝35侧),死冠血管出现率58.9％ (33/56),距离耻骨联合中点水平距离为(54.4±6.9)mm,动脉直径为(2.2 ±0.8)mm,明显小于静脉直径(2.8 ±1.1)mm,P＜0.05].在腹股沟直疝中死冠血管总出现率明显低于斜疝(P＜0.05),其中死冠动脉出现率也明显低于斜疝(P＜0.05).男性患者死冠动静脉出现率均显著高于女性(P＜0.05),同时男性患者发病年龄更高,血管直径更大,直疝患者的发病年龄大于斜疝患者(P＜0.05).结论 死冠血管在腹股沟斜疝患者中出现率较高,男性出现率高于女性;该血管参与构成腹股沟区血供,能减缓该区域腹壁退化.

Observation of corona mortis in inguinal hernia patients by laparoscopy and CT angiography

Objective To observe the corona mortis in inguinal hernia patients under laparoscopic surgery with CT angiography (CTA),and investigate the anatomic features and clinical significances of this variant vascular anastomosis in patients with different types of hernia.Methods A total of 48 patients with inguinal hernia (direct hernia or oblique hernia) admitted in our department between June 2015 and October 2016 were enrolled in this study.They were 33 males and 15 females,at a mean age of 61.0 ± 15.5 years.CTA scanning was performed before the operation.All patients underwent laparoscopic hernia repair.The conditions of corona mortis were collected,and analyzed with clinical data and radiological results.Results Among the 48 cases,there were totally 56 sides involved (21 sides of direct hernia and 35 sides of oblique hernia).The occurrence rate of corona mortis was 58.9％ (33/56).The distance from the blood vessels to pubic symphysis midpoint was 54.4 ± 6.9 mm.The average diameter of arteries in the corona mortis was 2.2 ± 0.8 mm,obviously smaller than that of the veins (2.8 ± 1.1 mm,P ＜ 0.05).The occurrence of corona mortis was significantly lower in the patients with direct hernia than those with oblique hernia (P ＜ 0.05),so were that of corona mortis in arteries (P ＜ 0.05).The males had significantly higher occurrence of corona mortis in veins than the females (P ＜ 0.05),while older onset age,larger blood vessel diameter,older in those with direct than oblique hernia were found in male patients (P ＜ 0.05).Conclusion The occurrence rate of corona mortis is higher in the oblique than direct hernia patients,and in the males than the females.The blood vessels of corona mortis are involved in blood supply of the abdominal wall and can slow its degradation.