Anatomical variations of the inguinal nerves and risks of injury in 110 hernia repairs
Anatomical variations of the inguinal nerves and risks of injury in 110 hernia repairs
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DOI：
10.1007/s00276-002-0006-9
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发表时间：
2002-05-01
影响因子：
1.4
通讯作者：
Al-Dabbagh, AKR
中科院分区：
文献类型：
--
作者：
Al-Dabbagh, AKR
本研究的目的是确定髂腹股沟神经（TIN）和髂腹下神经（IHN）在腹股沟疝手术修复过程中腹股沟行程的解剖变异。采用补片技术对110例原发性腹股沟疝进行了连续修补。特别注意早期识别和记录TIN和IHN的病程，并在整个手术过程中保存它们。在110次探查中，只有46次（41.8%）发现两条神经的行程与解剖学文本中描述的一致。在110例（58.2%）探查中的64例中，发现一条或两条神经的行程是一个变量，并且经常使它们容易受伤。这些变化包括：（1）在64例患者中，有20例患者的TIN在其出口处的腹股沟浅环（SIR）纤维后方呈急性下外侧成角，（2）在64例患者中，有18例患者的TIN方向相似，但位于腹外斜肌腱膜（EOA）的浅表面和SIR的近端;（3）64例中24例为精索上双神经单干型，以后有变异，（4）64例中8例为单支或双支缺如，（5）64例中3例为副TIN或IHN。（6）2例TIN起源于生殖股神经（GFN）。术后3个月时，105例患者中的68例（依从率65%）均未主诉感觉障碍或TIN或IHN皮区分布疼痛。它的结论是，解剖变异的腹股沟过程中的TIN和IHN是非常常见的，但很容易识别。早期识别和保存它们可能会消除或大大减少术后感觉变化和/或神经痛的发生率。
The aim of this study was to identify the anatomical variations in the inguinal course of the ilioinguinal nerve (TIN) and the iliohypogastric nerve (IHN) during operative repair of inguinal hernias. A consecutive series of 110 primary inguinal hernias were repaired by the mesh technique. Particular attention was paid to early identification and recording of the course of both the TIN and IHN and preserving them throughout the operative procedure. The course of both nerves was found to be consistent with that described in anatomical texts in only 46 of 110 explorations (41.8%). The course of one or both nerves was found to be a variant in the other 64 of 110 (58.2%) explorations and often rendered them susceptible to injury. These variations included: (1) acute infero-lateral angulation of the TIN at its exit behind the superficial inguinal ring (SIR) fibers in 20 of 64 cases; (2) similar direction of the TIN but in a plane superficial to the external oblique aponeurosis (EOA) and proximal to the SIR in 18 of 64 cases; (3) a single stem for both nerves over the spermatic cord in 24 of 64 cases, with variation in the subsequent course; (4) absence of one or both nerves in 8 of 64 cases; (5) accessory TIN or IHN in 3 of 64 cases; and (6) aberrant origin of the TIN from the genitofemoral nerve (GFN) in 2 of 64 cases. None of 68 of 105 patients seen at 3 months postoperatively (compliance rate 65%) complained of sensory disturbances or pain in a dermatome distribution of the TIN or IHN. It is concluded that anatomical variations in the inguinal course of the TIN and the IHN are extremely common but readily identifiable. Their early identification and preservation is likely to abolish, or considerably decrease, the incidence of postoperative sensory changes and/or neuralgia pain.