李金斯坦无张力疝修补术

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.
在“意识镇静”时，由外科医师或麻醉师给予镇静药物可减轻患者的焦虑。给予起效快、 具有遗忘作用的抗焦虑药物，如异丙酚，可以减少术中局麻药物的用量，特别是在对肥胖病人 施行双侧腹股沟疝修补术时。
Local anesthesia tech 局部麻醉技术
Injection of local anesthesia is performed by the surgeon as part of the surgical technique. It is placed in dermal and subcutaneous layers prior to the skin incision and deeper planes as the dissection progresses.
• 今天，这一技术已成为开放式无张力疝成形手 术的金标准。
Anatomy 解剖
For proper performance of this procedure, an excellent understanding of the anatomy of the inguinal region is mandatory. The inguinal region may be divided into superficial and deep planes by defining the layers of the inguinal canal.
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.
•
1984年起，Lichtenstein及其同伴即开始在手术
中常规使用聚丙烯网片，并将这种手术方式命名为 并将这种手术方式命名为 无张力疝成形术。 无张力疝成形术。
This technique has become the gold standard in open tension-free hernioplasty.
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， 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。 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.
局部麻醉是一种安全、简单、有效、经济的麻醉方式，而且无恶心、呕吐、尿潴留等副作 用。此外，在切开皮肤之前给予局麻药，可以抑制局部炎症介质的合成，从而延长镇痛效果。 Epidural anesthesia 硬脊膜外麻醉
Epidural anesthesia is preferable for repair of non-reducible inguinal hernias.
Lichtenstein Hernia Repair
By Dr. PK Amid
President of American Hernia Society
Dirctor 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
Anatomy 解剖 ------ Deep tissues 深层组织
1. Inguinal ligament
腹股沟韧带
2. Internal oblique muscle
腹内斜肌
3. Transversus muscle
腹横肌
4. Rectus sheath
腹直肌鞘
5. Cremasteric muscle
The mesh reinforcement has both therapeutic and prophylactic benefits. It prevents the entire groin region from herniation due to future mechanical stress factors and/or metabolic derangements.
翻译： 翻译：同济医院普外科
Aesculap. All it takes to operate.
Introduction 简介
In 1996,Liechtenstein attracted the attention of surgeons worldwide by justifying the use of a prosthetic mesh to create a tension-free hernia repair, thereby minimizing postoperative discomfort, one of the supplementary criteria for evaluating the efficacy of hernia repair.
提睾肌
6. Deep epigastric vessels
腹壁深动静脉
Anatomy 解剖 ------ Inguinal canal 腹股沟管
凹间韧带
1. Transversalis fascia 2. Internal ring (IR) 3. Ducts deferens 4. Spermatic vessels
腹横筋膜 内环（IR） 输精管 精索血管
Inguinal triangle 股沟三角 腹
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.
硬脊膜外麻醉适用于难复性腹股沟疝的修补。 脊 Use of sedative drugs 镇静药物的使用
Sedative drugs given by the surgeon or by an anesthesiologist during ”conscious sedation” will reduce the patient’s anxiety. Infusion of fast-acting, amnesic and anxiolytic agents such as protocol also reduces the amount of local anesthetic agents required, especially with cases such as bilateral inguinal hernia repair in obese patients.
• Lichtenstein有效地使用了修补网片进行无张力 疝修补手术，并在1996年引起了全球外科医生的关 注。这种手术方式极大地减轻了患者术后的不适， 而这一点正是评价疝修补术疗效的重要标准之一。
Liechtenstein's team popularized routine use of polypropylene mesh in 1984 and coined the term “tension-free hernioplasty”.
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.
为了正确实施该项手术，充分理 解腹股沟区的解剖结构是非常必 要的。根据腹股沟管的解剖层次 ，可将腹股沟区分为浅层和深层 两个层面。