腹膜外间隙空间的建立与细分对耻骨肌孔后腹股沟疝修补术的意义

目的探讨将空间细分的方法运用于耻骨肌孔后方腹膜外间隙手术空间建立的意义。方法自2001年以来开展536例腹腔镜全腹膜外疝修补术(totally extraperitoneal,TEP),利用TEP电视腹腔镜的视觉效果以及CO2气压制造空间的作用在腹膜外间隙建立手术空间并将手术空间分成4部分,分别为第1、2、3、4空间。在"四空间"技术成熟之后将其应用于415例其它耻骨肌孔后方腹股沟疝修补手术中,如TAPP、IPOM、Kugel、开放TEP以及改良TAPP等手术。结果 "四空间"技术可使TEP手术操作连贯、易于掌握,手术时间缩短,手术并发症和疝复发减少。另外的收获是:"四空间"技术完全可以应用于其它耻骨肌孔后方腹股沟疝修补手术,使这些手术更加易于理解和进行。结论腹膜外间隙空间的建立与细分的方法可以:①缩短TEP手术的学习曲线;②加深对复杂的耻骨肌孔及其后方解剖结构的学习和理解;③促进TAPP、IPOM、Kugel、开放TEP以及改良TAPP等手术的开展;④有助于对疝复发部位和原因的研究;⑤帮助疝补片的材料和形态的改进与研究。

The significance of the establishment and subdivision of extraperitoneal spaces for myopectineal orifice rear inguinal herniorrhaph

Objective To investigate the significance of using the technology of spatial subdivision in establishing the myopectineal orifice rear extraperitoneal spaces for operation.Methods There have been 536 cases of laparoscope totally extraperitoneal herniorrhaphy from 2001.Using TEP video-laparoscopic visual effect and the effect of CO2 barometric pressure made spaces,establishing the operation spaces in extraperitoneal spaces and subdividing the operation spaces into four sections.There were the first,the second,the fourth and the fifth space.After the technique of "the four spaces" was mature,it was applied in another 415 myopectineal orifice rear inguinal herniorrhaphy cases,such as transabdominal preperitoneal(TAPP),intraperitoneal onlay mesh(IPOM),Kugel,opened TEP,improved TAPP and other related operations.Results "The four spaces" technology makes the TEP operating more consistently,grasping easily,using less operating time,and decreasing the recurrence of the hernia and surgical complication.The additional acquisition is that "the four spaces" technology can be used in another myopectineal orifice rear inguinal herniorrhaphy,and it makes this kind of operation much easier to understand and operate.Conclusions There are five significant advantages by establishing extraperitoneal spaces for operation and using the technology of spatial subdivision.The first advantage is it shortens the period of TEP 's learning-curve;The second one is it enhances the understanding of the myopectineal orifice's complex anatomical structure;The third one is it advances the development of TAPP,IPOM,Kugel,opened TEP,improved TAPP and other related operations;The fourth one is it helps investigating the postoperative recurrence place and reason of the myopectineal orifice rear inguinal herniorrhaphy;The fifth one is it helps research and improves the form and material of Patch.