Wong J, Anvari M
Department of Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.
Surg Laparosc Endosc Percutan Tech. 2001 Apr;11(2):148-51.
Laparoscopic inguinal herniorrhaphy has become a popular operation for the treatment of inguinal hernia. However, injury and entrapment of the cutaneous nerves of the lumbar plexus by the staples or tackers used for mesh fixation have been described. Laparoscopic removal of the staples or tackers in the inguinal region has been attempted with variable success. The success of the laparoscopic approach for removal of helical tackers in particular is sometimes limited by the fact that the offending tackers are deeply embedded in the preperitoneal tissues and not readily located with a simple laparoscopic view. The authors report a case in which fluoroscopy was used to help identify tackers that could not be visualized laparoscopically. The neuralgia disappeared after successful removal of the offending tackers with no neurologic deficit. Liberal use of fluoroscopic guidance in the laparoscopic removal of helical tackers in similar cases is recommended.
腹腔镜腹股沟疝修补术已成为治疗腹股沟疝的一种常用手术。然而，已有文献报道用于固定补片的吻合器或钉合器会损伤和卡压腰丛皮神经。人们尝试过在腹腔镜下取出腹股沟区的吻合器或钉合器，但成功率不一。特别是腹腔镜取出螺旋钉合器的成功率有时会受到限制，因为引起问题的钉合器深深嵌入腹膜前组织，仅通过简单的腹腔镜视野难以定位。作者报告了一例使用荧光透视来帮助识别腹腔镜下无法看到的钉合器的病例。成功取出引起问题的钉合器后神经痛消失，且无神经功能缺损。建议在类似病例的腹腔镜下取出螺旋钉合器时广泛使用荧光透视引导。
