通过对腹股沟管内、外环和腹膜前间隙膜的精确解剖，辨认开放前入路腹膜前腹股沟疝修补术的正确入路层面，减少术后复发率和并发症。

对600例（628侧）原发性腹股沟疝患者进行术中解剖观察和术后长期随访。切开腹股沟管第一外环显露腹股沟管，切开第二内环进入Bogros间隙，在此分离还纳疝囊并精索壁化，然后切开腹壁下血管内下侧的腹横筋膜进入Retzius间隙。最后切断间隙韧带，将两个不同解剖层面的间隙贯通为一体的腹膜前间隙，放置补片修补耻骨肌孔。

本组600例平均手术时间（50±10）min，平均住院时间（7±2.1）d。术中腹膜损伤23例（3.8%），均立即缝合。术后血肿16例（2.6%），血清肿11例（1.8%），5例慢性疼痛患者中有1例行腹股沟神经封闭理疗。随访12~100个月，平均53个月（随访率83.3%），复发4例。

腹股沟管内、外环及其膜结构和腹膜前间隙膜的精确辨认和解剖，有助于提高开放前入路腹膜前疝修补术的安全性和可靠性，减少手术并发症和复发率。

To reduce the recurrence and complications through studying the precise anatomy of the membranes of the external and internal rings and of preperitoneal space in open preperitoneal hernia repair.

A total of 600 patients (628 hernias) with primary inguinal hernia were retrospectively studied. The intraoperative observation and postoperative follow-up were recorded and analyzed. The Bogros space could be entered by opening the secondary internal ring in the preperitoneal fascia, which lied between the peritoneum and the deeper layer of the preperitoneal fascia. While the Retzius space lay between the transversalis fascia and the superficial layer of the preperitoneal fascia could be entered by dissecting the transversalis fascia. The discontinuity of two layers was connected by resecting the interfoveolar ligament near the epigastria vessels, creating a big enough preperitoneal space to accommodate the patch.

The average operation time was (50±10) min, mean hospitalization was (7±2.1) d. There was minor intraoperative peritoneal tear in 23 cases (3.8%) which was repaired promptly, 16 cases (2.6%) of postoperative hematoma and 11 cases (1.8%) of seroma. There were 5 cases of chronic pain, one of whom needed physical therapy. The incidence of chronic pain and recurrence was 0.8% (4/500) after 53 (12-100) months’ follow-up.

Precise surgical anatomy of external and internal rings and its associated membranes and of preperitoneal space in inguinal region is helpful to improve the safety and reliability of the procedure, reducing the complications and recurrence.