[1]付召军,魏健,杨玉辉,等.腹腔镜结合CTA观察腹股沟疝患者死冠血管[J].第三军医大学学报,2017,39(16):1679-1683.
 FU Zhaojun,WEI Jian,YANG Yuhui,et al.Observation of corona mortis in inguinal hernia patients by laparoscopy and CT angiography[J].J Third Mil Med Univ,2017,39(16):1679-1683.
点击复制

腹腔镜结合CTA观察腹股沟疝患者死冠血管(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
39卷
期数:
2017年第16期
页码:
1679-1683
栏目:
临床医学
出版日期:
2017-08-30

文章信息/Info

Title:
Observation of corona mortis in inguinal hernia patients by laparoscopy and CT angiography
作者:
付召军魏健杨玉辉李敏龙田晓军胡楠
四川省自贡市第四人民医院普外一科
Author(s):
FU Zhaojun WEI Jian YANG Yuhui LI Minlong TIAN Xiaojun HU Nan

First Department of General Surgery, the Fourth People’s Hospital of Zigong City, Zigong, Sichuan Province, 643000, China

关键词:
死冠血管腹腔镜CTA腹股沟疝出现率
Keywords:
corona mortis laparoscope computed tomography angiography inguinal hernia occurrence rate
分类号:
R322.12; R656.21; R814.42
文献标志码:
A
摘要:

目的     腹腔镜手术结合CTA观察腹股沟疝患者死冠血管,研究死冠血管的解剖学特点及在不同类型疝患者中存在的临床意义。 方法     选取2015年6月至2016年10月在本科住院的48例患者的临床资料,其中男性33例,女性15例,年龄(61.0±15.5)岁,均临床诊断为腹股沟疝(直疝或斜疝),住院期间进行腹腔镜疝修补术,手术前行CT检查,对死冠血管存在情况及数据进行采集,结合患者临床资料及影像学数据进行分析。 结果       48例腹股沟疝患者共56侧腹股沟疝(直疝21侧,斜疝35侧),死冠血管出现率58.9%(33/56),距离耻骨联合中点水平距离为(54.4±6.9)mm,动脉直径为(2.2±0.8)mm,明显小于静脉直径[(2.8±1.1)mm,P<0.05]。在腹股沟直疝中死冠血管总出现率明显低于斜疝(P<0.05),其中死冠动脉出现率也明显低于斜疝(P<0.05)。男性患者死冠动静脉出现率均显著高于女性(P<0.05),同时男性患者发病年龄更高,血管直径更大,直疝患者的发病年龄大于斜疝患者(P<0.05)。 结论     死冠血管在腹股沟斜疝患者中出现率较高,男性出现率高于女性;该血管参与构成腹股沟区血供,能减缓该区域腹壁退化。
 

Abstract:

Objective     To observe the corona mortis in inguinal hernia patients under laparoscopic surgery with CT angiography (CTA), and investigate the anatomic features and clinical significances of this variant vascular anastomosis in patients with different types of hernia. Methods      A total of 48 patients with inguinal hernia (direct hernia or oblique hernia) admitted in our department between June 2015 and October 2016 were enrolled in this study. They were 33 males and 15 females, at a mean age of  61.0±15.5 years. CTA scanning was performed before the operation. All patients underwent laparoscopic hernia repair. The conditions of corona mortis were collected, and analyzed with clinical data and radiological results. Results     Among the 48 cases, there were totally 56 sides involved (21 sides of direct hernia and 35 sides of oblique hernia). The occurrence rate of corona mortis was 58.9% (33/56). The distance from the blood vessels to pubic symphysis midpoint was 54.4±6.9 mm. The average diameter of arteries in the corona mortis was 2.2±0.8 mm, obviously smaller than that of the veins (2.8±1.1 mm, P<0.05). The occurrence of corona mortis was significantly lower in the patients with direct hernia than those with oblique hernia (P<0.05), so were that of corona mortis in arteries (P<0.05). The males had significantly higher occurrence of corona mortis in veins than the females (P<0.05), while older onset age, larger blood vessel diameter, older in those with direct than oblique hernia were found in male patients (P<0.05). Conclusion     The occurrence rate of corona mortis is higher in the oblique than direct hernia patients, and in the males than the females. The blood vessels of corona mortis are involved in blood supply of the abdominal wall and can slow its degradation.

参考文献/References:

[1]PUA U, TEO L T. Prospective diagnosis of corona mortis hemorrhage in pelvic trauma[J]. J Vasc Interv Radiol, 2012, 23(4): 571-573. DOI: 10.1016/j.jvir.2011.12.018.
[2]赵渝,王学虎. 腹股沟疝修补术血管并发症的预防与治疗[J]. 中华消化外科杂志, 2016, 15(10): 978-981. DOI: 10.3760/cma.j.issn.1673-9752.2016.10.008.
ZHAO Y, WANG X H. Prevention and treatment of vascular complications of inguinal hernia repair[J]. Chin J Dig Surg, 2016, 15(10): 978-981. DOI: 10.3760/cma.j.issn.16739752.2016.10.008.
[3]JAMES G, BITTNER I V. Incarcerated/Strangulated Hernia: Open or Laparoscopic?[J]. Adv Surg, 2016, 50(1): 67-78. DOI: 10.1016/j.yasu.2016.03.006.
[4]杨峻峰, 肖民辉, 何正宇, 等. 经脐单孔腹腔镜输尿管及肾盂切开取石术18例临床分析[J]. 第三军医大学学报, 2017, 39(1): 95-100. DOI: 10.16016/j.10005404.201607083.
YANG J F, XIAO M H, HE Z Y,et al. Transumbilical laparoendoscopic singlesite ureterolithotomy and nephrolithotomy: report of 18 cases[J]. J Third Mil Med Univ, 2017, 39(1): 95-100. DOI: 10.16016/j.1000-5404.201607083.
[5]魏健,付召军,杨玉辉,等. 腹腔镜全腹膜外疝修补术中死冠血管的解剖及临床意义[J]. 中国普外基础与临床杂志, 2017, 24(2): 185-189. DOI: 10.7507/1007-9424.201606013.
WEI J,FU Z J,YANG Y Y,et al. Anatomy of mortis corona vascular and its clinical significances in laparoscopic total extraperitoneal hernia repair [J]. Chin J Bases Clin General Surg, 2017, 24(2): 185-189. DOI:10.7507/10079424.201606013.
[6]DIXON S, ANTHONY S, UBEROI R. Corona mortis artery as a cause of a type Ⅱ endoleak in an internal arteryaneurysm[J]. J Vasc Interv Radiol, 2011, 22(11): 1634-1635. DOI: 10.1016/j.jvir.2011.07.006.
[7]杨柳青,张磊,文利. CT头面部三维重建在颅缝早闭中的诊断价值[J]. 第三军医大学学报, 2016, 38(8): 881-884. DOI:10.16016/j.1000-5404.201509075.
YANG L Q,ZHANG L,WEN L.Value of CT head facial 3D reconstruction in diagnosis of craniosynostosis[J]. J Third Mil Med Univ, 2016, 38(8): 881-884. DOI: 10.16016/j.10005404.201509075.
[8]OMAR C S, SALVADOR P S, MARIA  A M, et al. Urgent treatment of incarcerated obturator hernias by laparoscopic hernioplasty. Case report and review of the literature[J]. Rev Hispanoam  Hernia, 2014, 2(1): 17-21. DOI: 10.1016/j.rehah.2013.10.002.
[9]ABET E, DUCHALAIS E, DENIMAL F, et al. Laparoscopic incisional hernia repair: long term results[J]. J Visc Surg, 2014, 151(2): 103-106.  DOI: 10.1016/j.jviscsurg.2014.01.012.
[10]TAUSSIG J S, REQUARTH J A, BETTMANN M. Abstract No. 283: Corona Mortis: An important vascular variant in pelvic trauma[J]. J Vasc Interv Radiol, 2008,19(2): S105-S106. DOI: 10.1016/j.jvir.2007.12.321.
[11]孙善平, 崔兆清, 章阳. CoronaMortis血管的解剖学特征及在腹股沟疝修补术中的研究[J]. 中华疝和腹壁外科杂志(电子版), 2013, 7(6): 8-9. DOI: 10.3877/cma.j.issn.1674-392X.2013.06.004.
SUN S P,CUI Z Q,YHANG Y,et al.Corona Mortis vascular anatomy and research in inguinal hernia repair[J]. Chin J Hernia Abdom Wall Surg(Electr Ed), 2013, 7(6): 8-9. DOI: 10.3877/cma.j.issn.1674392X.2013.06.004.
[12]NAYAK S B, DEEPTHINATH R, PRASAD A M, et al. A South Indian cadaveric study on obturator neurovascular bundle with a special emphasis on high prevalence of venous corona mortis[J].Injury, 2016, 47(7): 1452-1455. DOI: 10.1016/j.injury.2016.04.032.
[13]SMITH J C,GREGORIUS J C,BREAZEALE B H, et al.The corona mortis, frequent vascular variant susceptible to bluntpelvic trauma: identification at routine multidetector CT[J]. J Vasc Interv Radiol, 2009, 20(4): 455-460. DOI: 10.1016/j.jvir.2009.01.007.
[14]P-LISSIER E,NGO P,ARMSTRONG O.Tratamiento quirúrgico de las hernias obturatrices[J]. EMCTécnicas QuirúrgicasAparato Digestivo, 2010, 26(3): 1-5. DOI: 10.1016/s12829129(10)70115x.
[15]谢炜,肖林康,张雷,等. 单孔腹腔镜与传统腹腔镜胆囊切除对胆囊良性疾病的疗效对比分析[J]. 第三军医大学学报, 2015, 37(19): 1989-1992. DOI: 10.16016/j.1000-5404.201501208.
XIE W, XIAO L K, ZHANG L, et al. Clinical outcomes of singleincision laparoscopic cholecystectomy versus 3port laparoscopic cholecystectomy[J]. J Third Mil Med Univ, 2015, 37(19): 1989-1992. DOI: 10.16016/j.1000-5404.201501208.
[16]ESPOSITO C, ESCOLINO M, TURR-F, et al. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era[J]. Semin Pediatr Surg, 2016, 25(4): 232-240. DOI:10.1053/j.sempedsurg.2016.05.006.
[17]VIKTORIN-BAIER P, RANDAZZO M, MEDUGNO C, et al. Internal Hernia Underneath an Elongated External lliac Artery: A Complication After Extended Pelvic Lymphadenectomy and Robotic-assisted Laparoscopic Prostatectomy[J]. Urology Case Reports, 2016, 8: 9-11. DOI: 10.1016/j.eucr.2016.05.003.
[18]BECK M. Tratamiento laparoscópico de las hernias inguinales del adulto por vía totalmente extraperitoneal[J]. EMCTécnicas QuirúrgicasAparato Digestivo, 2014, 30(2): 1-13. DOI: 10.1016/s1282-9129(14)67353-0.
[19]HOLIHAN J L, BONDIE I, ASKENASY E P, et al. Sublay versus underlay in open ventral hernia repair[J]. J Surg Res, 2016, 202(1): 26-32.  DOI: 10.1016/j.jss.2015.12.014.
[20]YETIIR F, SALMAN AE, -ZL-O, et al. An alternative anterior tension free preperitoneal patch technique by help of the endoscope for femoral hernia repair[J]. Int J Surg, 2013, 11(9): 962-966. DOI: 10.1016/j.ijsu.2013.06.008.

相似文献/References:

[1]慕庆玲,薛敏,肖松舒,等.腹茧症合并不孕症14例临床分析[J].第三军医大学学报,2015,37(18):1905.
[2]朱新生,章跃民,李柏红,等.部分肝血流阻断器在腹腔镜肝切除术中的应用[J].第三军医大学学报,2007,29(14):1447.
[3]卢小刚,代远斌.腹腔镜腰交感神经节切除术的解剖学基础及临床应用[J].第三军医大学学报,2007,29(11):1116.
 LU Xiao-gang,DAI Yuan-bin.Anatomic study for retroperitoneoscopic lumbar sympathectomy[J].J Third Mil Med Univ,2007,29(16):1116.
[4]王立明,杨华,张朝军,等.急腹症腹腔镜探查100例诊治体会[J].第三军医大学学报,2007,29(22):2151.
[5]吴庆蓉.腹部手术史的患者行妇科腹腔镜手术32例分析[J].第三军医大学学报,2006,28(03):265.
[6]甘露,张超,曾冬竹,等.结直肠癌患者腹腔镜手术与开腹手术后并发症的风险因素分析[J].第三军医大学学报,2008,30(17):1668.
 GAN Lu,ZHANG Chao,ZENG Dong-zhu,et al.Laparoscopic-assisted versus open colorectal surgery: risk factor analysis for postoperative complications[J].J Third Mil Med Univ,2008,30(16):1668.
[7]余佩武.腹腔镜胃癌根治术的应用现状与展望[J].第三军医大学学报,2008,30(19):1775.
[8]刘小艳,吴凤英,邱涛,等.妇科腹腔镜手术并发症的护理[J].第三军医大学学报,2008,30(24):2337.
[9]饶芸,程琳,徐春霞,等.腹腔镜辅助下胃癌根治术患者的围手术期护理[J].第三军医大学学报,2006,28(18):1905.
[10]郑小东,马海,杨红春.腹腔镜胆囊切除术中Calot三角解剖的技巧[J].第三军医大学学报,2006,28(15):1594.

更新日期/Last Update: 2017-08-23