腹腔镜腹股沟疝修补术讲诉VIP免费

武警青海总队医院外一科1腹腔镜腹股沟疝修补术（LIHR）及3D补片的应用--TheapplicationofLIHRand3Dmesh武警青海总队医院外一科腹腔镜腹股沟疝修补术（LIHR）Laparoscopicinguinalherniarepair腹股沟疝的发病基础:etiologyofinguinalhernia肌耻骨孔myopectinealorifice武警青海总队医院外一科肌耻骨孔myopectinealorifice武警青海总队医院外一科腹股沟疝修补的目标—完整覆盖肌耻骨孔完整覆盖肌耻骨孔有三层不同的修补层次Reconstructionofthreediffertentlayers（1）腹横筋膜前的肌前修补Extra-transversefasciarepair（2）腹横筋膜后的腹膜前修补Extra-peritonealrepair（3）腹腔内修补Intra-peritonealrepair武警青海总队医院外一科腹腔镜腹股沟疝修补术（LIHR）Laparoscopicinguinalherniarepair（1）完全腹膜外修补术（totallyextraperitonealTEP）（2）经腹腹膜前疝修补术（transabdominalpreperitonealTAPP）（3）腹膜内补片植入术疝修补术（intraperitonealonlaymeshIPOM）武警青海总队医院外一科LIHR手术的合理性1.符合病因学说，腹横筋膜重建。Rebuildthetransversefascia2.符合解剖结构，完全修复了腹股沟部位的薄弱区域。Covertheentireweakpartsofinguinalarea3.符合力学原理，有效缓冲腹腔内压力的冲击BufferthepressureofperitonealcavityWHYLIHR?武警青海总队医院外一科LIHR手术的适应证Indication•优先考虑：双侧疝和复发疝Ideallysuitableforrelapseherniaandbilateralhernia•适用于：I型、II型、III型和IV型的腹股沟直疝、斜疝和股疝Adaptto(type-I/II/III/IV)indirecthernia、directherniaandfemoralhernia------（中华外科学会疝与腹壁外科学组2003年8月修订稿）武警青海总队医院外一科LIHR手术的禁忌证Contra-indication1.不能耐受麻醉和气腹者。intoleranceofanesthesiaandpneumoperitoneum2.严重出血倾向者。serioushemorrhagictendency3.嵌顿疝、绞窄疝。incarceratedherniaandstrangulatedhernia4.腹腔镜手术后严重粘连者。severePost-laparoscopicoperationadhesion5.复杂滑动疝。complicatedslidinghernia6.合并妊娠者。combinedwithpregnancy武警青海总队医院外一科LIHR手术的优点Advantages1.切口小，疼痛轻，美观。Smallincision—Lesspain—BetteroutlookSmallincision—Lesspain—Betteroutlook2.避免了由于切口所致的组织损伤，神经损伤，切口感染。Smallwoundarea—LowriskofinfectionandtissuedamageSmallwoundarea—Lowriskofinfectionandtissuedamage3.局部的紧张感，异物感轻微。Tension-free—MorecomfortableTension-free—Morecomfortable4.空间大，视野清晰，解剖标志明显，补片易于放置到位，展平。AllowedclearvisualizationofallpreperitonealfascialplanesAllowedclearvisualizationofallpreperitonealfascialplanesandanatomiclandmarksandanatomiclandmarksEasytofixthemeshtoplannedplaceEasytofixthemeshtoplannedplace武警青海总队医院外一科LIHR手术的优点Advantages5.术中可探查是否有隐匿疝，并得到及时的治疗。FindandtreatmutipleunexpectedandconcealedherniaFindandtreatmutipleunexpectedandconcealedhernia6.治疗双侧疝、复合疝与复发疝具有一定的优势。IdeallysuitableforrelapseherniaIdeallysuitableforrelapsehernia、、bilateralherniaandbilateralherniaandcomplicatedherniacomplicatedhernia7.允许患者术后更早的回复非限制性活动。QuickerrecoveryQuickerrecovery——ashorterhospitalizationperiodashorterhospitalizationperiod武警青海总队医院外一科全腹膜外腹腔镜腹股沟疝修补术（TEP）TotallyExtraperitonialTEP不进入腹腔，对腹腔无干扰，是LIHR的最佳术式。Noopeningoftheperitoneum,hencenoriskofdamagingNoopeningoftheperitoneum,hencenoriskofdamagingabdominalorgans,TEPisthebestapproachamongabdominalorgans,TEPisthebestapproachamongLIHR.LIHR.由于没有现成的手术空间，需要人造间隙。而且，人造的间隙相对较小，增加了手术难度。Sincenoreadyoperationspace,betterexposureoftheSincen...