疝修补术Lichtenstein procedure课件.ppt

Lichtenstein Hernia RepairBy Dr. PK AmidPresident of American Hernia SocietyDirctor Lichtenstein Hernia Institute李金斯坦无张力疝修补PK Amid 医生美国疝协会主席李金斯坦疝中心主任 翻译：同济医院普外科 Introduction 简介 Anatomy 解剖 Anatomy 解剖  ------ Superficial tissues 浅层组织 Anatomy 解剖  ------ Deep tissues 深层组织 Anatomy 解剖 ------ Inguinal canal 腹股沟管 Anatomy 解剖 ------ Rethophysiology 病理生理 The role of protease and protease-inhibitor imbalance in the pathogenesis of groin hernias has lead to a new understanding of the etiology of groin hernias and the causes of their surgical failure. 蛋白酶-抑制剂失衡在腹股沟疝的发病机制中有重要作用，这一发现使得对腹股沟疝的病因和外科治疗失败的原因有了新的认识。 The biochemical evidence that adult male inguinal hernias are associated with impaired hydroxylation of praline has lead to the theory that these changes lead to weakening of the fibro connective tissue of the groin and subsequent development of inguinal hernias. 已有证据证明成年男性腹股沟疝患者通常伴有脯氨酸羟基化作用减弱，这些改变导致了腹股沟纤维连接组织薄弱，并最终导致了腹股沟疝的发生。 The utilization of this already defective tissue, especially under tension, is a violation of basic principles of surgery. 利用这种已经有缺陷的组织进行手术，特别是在有张力的情况下，违背了外科基本原则。 Indications 适应症 This procedure is suitable for all adult patients regardless of their age, weight, general health or the size of the hernia. 这种手术适用于所有的成年病人，无论患者的年龄、体重、身体情况或者疝的大小。 Major principles 主要原则 In tension-free hernioplasty, the entire inguinal floor is reinforced by inserting a sheet of polypropylene mesh. The prosthesis is placed between the transversalis fascia (TF) and the external oblique aponeurosis (EOA). It should extend well beyond the inguinal triangle in order to provide sufficient mesh/tissue interface. Upon increased intra-abdominal pressure, the EOA applies counter-pressure upon mesh. This allows the increase in intra-abdominal pressure to act as an aide to the repair. 无张力疝成形术是在腹横筋膜(TF)和腹外斜肌腱膜(EOA)之间放置一张聚丙烯网片来加固腹股沟管的后壁。网片应延伸至腹股沟三角之外，以提供足够的网片/组织接触界面。在腹内压增加的情况下，腹外斜肌腱膜（EOA）可在网片上产生相应的对抗力。这种反方向的抗张