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中华普通外科学文献(电子版) ›› 2017, Vol. 11 ›› Issue (02) : 141 -144. doi: 10.3877/cma.j.issn.1674-0793.2017.02.021

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基于腹横肌松解的后组织分离技术(PCS/TAR)
周太成1, 于洪燕1, 江志鹏1, 李英儒1, 陈双1,()   
  1. 1. 510655 广州,中山大学附属第六医院胃肠、疝和腹壁外科;广东省结直肠盆底疾病研究重点实验室
  • 收稿日期:2017-02-17 出版日期:2017-04-01
  • 通信作者: 陈双
  • Received:2017-02-17 Published:2017-04-01
引用本文:

周太成, 于洪燕, 江志鹏, 李英儒, 陈双. 基于腹横肌松解的后组织分离技术(PCS/TAR)[J]. 中华普通外科学文献(电子版), 2017, 11(02): 141-144.

图1 首先是从后腹直肌鞘正中旁0.5~1 cm切开后鞘(A)。分离腹直肌后鞘至半月线,注意勿损伤腹直肌鞘内的神经血管束(B)
图2 分离至腹直肌前后鞘的连接部位,距离其0.5~1 cm切开后鞘,暴露内层的腹横肌腱膜、肌纤维(A)。切断、游离腹横肌纤维从而进入肌肉后/腹膜前间隙,并沿着此层向左右腰大肌方向分离(B)
图3 根据手术需要,间隙游离的范围:上方可至剑突下、胸骨后、膈肌的中心腱,以修补剑突下疝;或者分离至肋缘下方,以便修补肋缘下疝;下方可游离出Retzius间隙,显露耻骨联合、双侧Cooper's韧带。根据具体情况游离充分后,关闭腹直肌后鞘
图4 在分离出来的肌肉后间隙以Sublay的方式放置补片,用可吸收缝线将固定在腹壁肌肉层
图5 关闭腹直肌前鞘,再造腹白线
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