脐内侧襞解剖与腹腔镜腹股沟疝修补术的应用研究

摘要

Objective:To study anatomy of medial umbilical fold,provide accurate anatomic basis of the clinical application for total peritoneum intraperitoneal onlay mesh (TPIPOM). Methods:Group A (group of autopsy) :medial umbilical fold and abdominal ring were dissected to compare with laparescopic anatomy; patients of laparoscopic operation were divided into group B ( group of TPIPOM) and group C ( group of no TPIPOM), to measure thickness (T) and width (W) of medial umbilical fold, regional anatomy of medial umbilical fold was observed in group B. Results: The thickness of group B and C was (3.0 ± 1.2) mm, the width was ( 10. 1 ± 3.2) mm;autopsy and laparoscopic anatomy indicated that there were not significant nerve and vessel in surrounding of medial umbilical fold; The laparoscopic operations were successfully performed in group B: the operating time was (29.5 ± 9.5 ) min, the average time of ambulation was ( 36 ± 8) h, the mean hospital stay was (3.5 ± 1.5 ) d, the mean cost was ( 8 500 ± 880) yuan; The patients were followed up for (12 ± 6) months and recurrence was not found. Conclusions:Patch could be covered by medial umbilical fold in TPIPOM ,which is safe, reliable,minimally invasive and economical.%目的:通过对脐内侧襞解剖学的研究,为腹腔镜完全腹膜化腹腔内置补片修补术(total peritoneum intraperitoneal onlay mesh,TPIPOM)提供准确的临床应用解剖基础.方法:尸体解剖组(A组):解剖脐内侧襞及内环周边,与腹腔镜下解剖作为对照;腹腔镜手术患者分为 B组(疝修补组)和C组(非疝修补组),测量脐内侧襞厚度(T)及宽度(W);B组行TPIPOM,术中观测脐内侧襞局部解剖.结果:B、C两组患者双侧脐内侧襞厚度平均为(3.0±1.2)mm,宽度为(10.1±3.2)mm;尸体及腹腔镜活体解剖表明脐内侧襞周边无重要神经、血管毗邻.B组均在腹腔镜下完成手术,手术时间平均(29.5±9.5)min,下床活动时间平均(36±8)h,平均住院(3.5±1.5)d,费用平均(8 500±880)元;术后平均随访(12±6)个月,未见复发.结论:脐内侧襞在TPIOPM术中可完全覆盖补片,此术式具有安全、可靠、微创、经济等优点.