Clinical Observation Of The Anatomical Relationship Between Round Ligament Of The Uterus And Hiatal Herniasac And Laparoscopic Treatment Method

Objective: Anatomy of inguinal region structure difference between men and women, Through careful observations of anatomical, careful analysis of clinical data, Find the relationship between the processing method and the round ligament of the uterus and hiatal hernia sac, Thus provided some experience for women under laparoscopic hernia operation. Methods:1.The autopsy showed:Through contact with the school of medicine, in the teaching of anatomy of the male and female bodies respectively. With bilateral inguinal region through understanding of women and men in the groin area differences in anatomical structure and the operation area. 2. Study through the analysis of the collected clinical data:Collection of the Affiliated Hospital of Qinghai University abdominal laparoscopic hernia surgery,Since 2012 January to 2014 October, 13 women patients with hernia repair, operation, Through the research of operation, and video data. Results:A.through autopsy to know: Women in the groin area structure is very different from men:1. Female inguinal canal have round ligament of the uterus, have no the spermatic cord; 2. Women have a layer of muscle like Cremaster muscle; 3. Women have the part of the round ligament out of abdominal external oblique aponeurosis. B.the characteristics of female inguinal hernia:1. Hernia are generally not large, and many of them are limited in the inguinal canal, Rarely appears huge hernia like men, Also seldom fall into the labia majora.2. Intraoperative common hernial sac with round ligament are difficult to isolate, Used in the separation process of hernial sac were broken. In order to complete excision of the hernia sac, Often Passive resection the round ligament together.3. In the pathogenesis of female and male with Inguinal hernia are the samed, Right sided lesions mainly and hernia Found in operation:The hernia sac and the round ligament of female adult inguinal hernia has many types of relation(1)Has a good loose connective tissue space between the hernia sac with round ligament, The hernial sac and round ligament of peel off very easily.(2) there is a gap between the hernia sac and the round ligament, But the gap is very small, The separation of the hernia sac with round ligament needs careful.(3) The connected so closely between the round ligament of the hernia sac, Round ligament transverse truncation surface cyst wall wrapped presents the Greek letter “?”shape. To separate the two parts, It is very difficult, Forced separation results for hernial sac rupture, round ligament rupture.C.Processing method:There are 3 kinds of treatment methods by transection, stripping and longitudinal incision to the round ligament of the uterus.1. Loose type 2.Small gap type 3. No clearance type. With the round ligament of the uterus by peeling off, longitudinal incision and transverse 3 ways of treatment. Conclusion:Through anatomical observation of the anatomy of the round ligament of the uterus of the female, consistent with the classic anatomy textbook described. Through clinical practice of patients with gapless type lengthwise, we realize advantages as follows:(1) can ensure the integrity of the round ligament of the uterus, to avoid peritoneal damage, does not affect the subsequent peritoneal suture;(2) without the need of round ligament of uterus to peel off, to avoid bleeding and side injury;(3)make the operation easy, shortening the operation time. Needs to be stressed is the round ligament of uterus suture of peritoneum, and combined with the lowest point should be closely, folding suture, reconstruction of peritoneal integrity, avoid patch exposed, at the same time be careful the stitches do not damage the fallopian tubes and ovaries. Methods to contrast the above treatment of the round ligament of the uterus, We think along the round ligament of the uterus and longitudinal incision peritoneum, The complete separation of the round ligament of the uterus from the peritoneum,The realization of abdominal wall,A lot of advantages compared with stripping and transverse technology with,The technology of clinical practical, simple, short learning curve, Has great clinical application prospect and popularization value.