腹膜前间隙解剖在腹腔镜全腹膜外疝修补术中的应用

目的探讨腹膜前间隙解剖在腹腔镜完全腹膜外疝修补术（laparoscopic total extraperitoneal hernia repair，TEP）中的应用价值。 方法收集2015年4月至2017年1月，三明市第二医院行TEP手术158例患者，进行术中观察、手术录像分析及术后随访。 结果所有病例均成功完成TEP手术，研究发现腹横筋膜存在前后2层，后层将腹膜前间隙分成2个空间：第1个在腹横筋膜前后层之间，第2个在腹膜和腹横筋膜后层之间。本组手术用镜推法经第1间隙分离68例（43%），经第2间隙分离90例（57%），存在腹膜前环75例（47%），腹膜破损35例（22%），手术时间为（40±10）min，术后住院时间2～48 h，出现血清肿10例（6%），术后随访6～24个月，无慢性疼痛、复发病例。 结论掌握腹膜前间隙解剖有助于提高腹腔镜全腹膜外疝修补术的操作安全性，缩短手术时间，减少手术并发症的发生，从而提高手术效率及手术质量。

Application of preperitoneal space anatomy in laparoscopic total extraperitoneal hernia repair

ObjectiveTo explore the value of preperitoneal space anatomy in laparoscopic total extraperitoneal hernia repair (TEP). MethodsFrom April 2015 to January 2017, a total of 158 patients undergoing TEP surgery were performed at the Sanming Second Hospital. The intraoperative observation, surgical video analysis, and postoperative follow-up were performed. ResultTEP were successfully completed in all cases. The study found that there were two layers of the transversalis fascia, and the posterior fascia divided the preperitoneal space into two space. The first space between the anterior and posterior layers of the transversalis fascia, the second between the peritoneum and the posterior layer of the transversalis fascia. In this group, 68 cases (43%) were separated via the first space, 90 cases (57%) were separated via the second space. Peritoneal anterior ring were present in 75 cases (47%). Peritoneum broken in 35 cases (22%). The operation time was (40±10) minutes, the hospitalization time was 24 to 48 hours. There were 10 cases (6%) of seromas. The patients were followed up for 6 to 24 months. No cases of chronic pain were found. ConclusionUnderstanding the anatomy of the preperitoneal space is helpful to improve the safety of laparoscopic total extraperitoneal hernia repair, shorten the operation time, reduce the incidence of surgical complications, thereby improving the efficiency of surgery and surgical quality.