腹腔镜腹股沟疝修补术肌耻骨孔的活体解剖学观察及临床意义

目的　探讨腹膜前间隙的解剖学特点，为腹腔镜腹股沟疝修补术的提供手术解剖依据。 方法　对我院30例腹股沟疝患者行LIHR时进行术中解剖观察及术后回顾分析手术视频，通过解剖学绘图描述LIHR手术入路、解剖层次及技术要点。 结果　腹膜前间隙由Retzius间隙和Bogros间隙组成，其间有间隔分开。腹横筋膜由深浅两层结构组成，腹膜与腹横筋膜的深层之间为无血管区域。 腹横筋膜在腹股沟韧带深面增厚形成髂耻束，参与构成股管的内侧壁及腹股沟管的下壁，生殖股神经股支及股外侧皮神经在髂耻束下方通过。 结论　熟悉腹膜前间隙肌耻骨孔区域解剖标志点，是LIHR手术的前提，具有重要临床意义。

In vivo anatomical observation and clinical significance of myopectineal orifice to laparoscopic inguinal herniorrhaphy

Objective　To explore the anatomical nature of the preperitoneal space during laparoscopic inguinal hernia repair, and provide us with anatomical basis for surgery.　Methods　Anatomic observation and analysis were carried out retrospectively on 30 patients undergoing laparoscopic inguinal hernia repair from January 2012 to December 2012 in our hospital．The surgical approaches, anatomic planes and technical tips were also elucidated by drawings and videos.　Results　Retzius space and Bogros space made up preperitoneal space. Transversalis fascia could be divided into superficial layer and deep layer. Between peritoneum and deep layer of transversalis fascia was avascular area. transversalis fascia thickened to form theiliopubic tract, which lied on the posterior aspect of the inguinal ligament. The iliopubic tract formed medial wall of femoral and inferior walls of the inguinal canal. The femoral branches of the genitofemoral nerve and the lateral femoral cutaneous nerve trvelled through below the iliopubic tract.　Conclusions　The premise of laparoscopic inguinal hernia repair is that we are familiar with the mark point of Myopectineal orifice in preperitoneal space, it has important clinical significance.