中国实用外科杂志

中国实用外科杂志

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膜解剖平面在腹腔镜全腹膜外修补术中临床意义

李健文，乐    飞   

  1. 上海交通大学医学院附属瑞金医院普外科 上海市微创外科临床医学中心，上海200025
  • 出版日期:2021-04-01 发布日期:2021-04-20

  • Online:2021-04-01 Published:2021-04-20

摘要： 全腹膜外腹股沟疝修补术（TEP）是腹膜前间隙手术，可将腹横筋膜（TF）和腹膜组成的间隙理解为单层TF和多层次腹膜前筋膜（PPF）所构成的筋膜间平面。PPF将腹膜前间隙分为壁平面和脏平面。中央区域分离应在壁平面操作，过浅或过深有损伤腹壁下血管或膀胱的风险。壁平面是TEP的“神圣”平面，但在斜疝区域时，为了分离疝囊和保护精索，必须转入脏平面进行。“平面转换”对于疝囊回纳、腹膜前环分离以及补片展平等操作具有重要的临床意义。现代疝外科对腹膜前间隙的认知逐渐从“膜”转向“面”，核心是强调TEP应在不同区域进入相对应的平面，而非寻找所谓的“膜”。

关键词: 全腹膜外腹股沟疝修补术, 腹横筋膜, 腹膜前筋膜, 疝囊, 精索

Abstract: The clinical significance of surgical plane in laparoscopic totally extraperitoneal inguinal hernia repair        LI Jian-wen，YUE Fei. General Surgery，Ruijin Hospital，Shanghai Jiao Tong University School of Medicine，Shanghai 200025，China
Corresponding author：LI Jian-wen，E-mail：ljw5@yeah.net
Abstract    Totally extraperitoneal（TEP） is a preperitoneal procedure. It is more appropriate to understand the space of transversalis fascia（TF） and peritoneum as the interfascial plane formed by a single-layer TF and multi-layer preperitoneal fascia（PPF）. PPF membranes divides the preperitoneal space into the parietal plane and the visceral plane. Dissections of the median area should be performed in the parietal plane，otherwise the inferior epigastric vessels or the bladder could be damaged. The parietal plane is the “holy plane” of TEP. However，we must transit into the visceral plane，in order to reduce hernia sac and protect the elements of spermatic cord while dissecting the indirect hernia zone. The “plane transition” plays an important clinical role in the procedures such as hernia sac reduction，preperitoneal loop separation and mesh flattening. Modern hernia surgery has transferred the cognition of the preperitoneal space from “membrane” to “plane”，which emphasize the key role of performing TEP within corresponding planes in different zones，instead of identifying those membranes.

Key words: totally extraperitoneal, transversalis fascia, preperitoneal fascia, hernia sac, spermatic cord