腹股沟斜疝的修及术式解剖层次.doc

图1　腹股沟斜疝的解剖改变 图2　修复腹膜及腹横筋膜的手术途径 3-1　切口 3-2　切开浅筋膜浅层和深层 3-3　分离浅筋膜深层下结缔组织 3-4　切开腹外斜肌腱膜 3-5　向两侧分离 3-6　拉开腹内斜肌、腹横肌，切开提睾肌 3-7　寻找并切开疝囊 3-8　分离疝囊至内环处，辨清周围重要组织 3-9　疝囊小的，可高位缝扎切断 3-10　疝囊大的，可高位荷包缝合，切除多余的上半段囊壁 3-11　修复内环、腹横筋膜 3-12　将联合肌腱缝于腹股沟韧带上 3-13　将腹外斜肌腱膜重叠缝合 图3　精索原位腹股沟斜疝修复术（ferguson） 4-1　缝合内环处腹横筋膜缺损后，将联合肌腱缝于腹股沟韧带上 4-2　精索移位至腹内斜肌外面，重叠缝合腹外斜肌腱膜 图4　精索腱膜下移位腹股沟斜疝修复术（bassini） 5-1　耻骨韧带和腹股沟韧带的关系 5-2　修复内环处的腹横筋膜缺损后，切开腹直肌前鞘，减少缝合张力 5-3　将联合肌腱缝于耻骨韧带上 图5　改良精索腱膜下移位腹股沟斜疝修复术（mcvay） 6-1　拉开精索间断缝合腹横筋膜缺损后，将联合肌腱缝于腹股沟韧带上 6-2　重叠缝合腹外斜肌腱膜，精索置于皮下层 图6　精索皮下移位腹股沟斜疝修复术（halsted） 7-1　向耻骨结节方向剪开腹横筋膜（注意腹壁下动脉及腹膜外脂肪组织） 7-2　从下向上逆行交叉连续缝合腹横筋膜 7-3　再由上向下将上瓣游离缘与下瓣同腹股沟韧带深面融合处连续缝合 7-4　将联合肌腱与腹横肌腱缝合到腹股沟韧带上 7-5　精索置于腹外斜肌腱膜下，缝合该腱膜 图7　腹横筋膜修复术 图8　睾丸的供应血管 coupling Centre shall be checked, the second poured concrete strength of more than 70%. In the process of reaming or boring, apart from the special provisions in factory, does not allow any work that may affect the coupling Centre, such as irrigation, to cylinder connections to flood the condenser pipes and so on. Well boring, hinge bolt hole flange with coupling of vertical, not oblique. Mounting bolts should be added lubricants, typing gently with a small hammer, not too loose or too tight, packed the bolts with the corresponding seal screw hole should be marked. 6.4.5.4.2 coupling reamed and pairings is close to the diameter of bolt bearing good hinge holes, dressed with a good two coupling bolts before you can move the rotor, boring-reaming hole in turn. Coupling bolts must be tight coupling is symmetrical diameter, in boring, reaming, two bolts out. Well boring, hinge bolt hole flange with coupling of vertical, not oblique. Due to the coupling bolts in accordance with hinge holes corresponding to the diameter of the screw holes one by one after processing, processing back bolt installation location cannot be changed, so according to bolt after the actual weight difference of nut and