图解股疝修补术.pptVIP

* 股疝修补术 F1/7 1.The space between the inguinal ligament and the superior ramus of the pubis is filled laterally by the iliopsoas muscle. The pectineal (Coopers) ligament is thickened periosteum over the pectineal ridge of the superior pubic ramus. The lowest fibers of the external oblique aponeurosis (inguinal ligament) reflect back onto the pectineal ligament forming the lacunar (Gimbernats) ligament. The pectineus muscle originates from the superior ramus of the pubis below the pectineal ligament.. 2/7 2. The femoral artery and vein occupy the space between the iliopsoas muscle and lacunar ligament. The femoral nerve emerges through the fibers of the iliopsoas muscle lateral to the vessels. Note the small space between the vein and the lacunar ligament.. 3/7 3.A continuation of the transversalis fascia of the abdomen surrounds the femoral vessels forming the femoral sheath. The small space medial to the vein within the femoral sheath is the femoral canal through which lymphatics pass from the leg into the abdomen. The femoral nerve is outside the femoral sheath.. 4/7 4A femoral hernia passes through the femoral canal and reflects up toward the inguinal ligament. It is often difficult to differentiate a femoral from an inguinal hernia. If the majority of the bulge is below the inguinal ligament (a straight line between anterior superior spine and pubic tubercle) it is likely to be femoral.. 5/7 5The hernia is freed from surrounding tissue and reduced if no compromised bowel is present. Reduction is sometimes difficult. The femoral ring can be widened by incising the lacunar ligament medially or the inguinal ligament anteriorly. It is important to isolate only the fascial layer before cutting because of the presence of an aberrant obturator artery immediately above in up to 25% of individuals.. *