Wan Wei Hwang, Tan Ee Lee Daniel
Department of Surgery, Alexandra Hospital, Jurong Health Services, 378 Alexandra Road, Singapore 159964, Singapore.
Surg Radiol Anat. 2011 Jan;33(1):59-63. doi: 10.1007/s00276-010-0732-3. Epub 2010 Oct 22.
We aim to establish the surface marking of the deep inguinal ring by laparoscopy and investigate if the patient's build influences it.
Sixty consecutive patients undergoing laparoscopic hernia repairs were studied. The bony landmarks, anterior-superior iliac spine (ASIS) and pubic tubercle (PT), and the two traditional landmarks, the mid-inguinal point (MIP) and midpoint of inguinal ligament (MPIL), were marked on the anaesthetized patient before the surgery. The deep ring was located by indenting the surface until laparoscopy shows the deep ring being occluded.
The true surface marking of the deep ring was found to lie at a mean distance of 9.6 mm medial to the MPIL landmark and 4.5 mm lateral to the MIP, approximately one-third of the distance from the MIP to the MPIL. Multivariate analysis confirmed that age, gender, race, BMI or pelvic habitus did not vary it.
The deep ring is located under a point just lateral to the MIP, which is the midpoint of a line drawn joining the ASIS and pubic symphysis. This should be taught to future generations of medical students as the point to apply occluding pressure to differentiate clinically between direct and indirect inguinal hernias.
我们旨在通过腹腔镜检查确定腹股沟深环的体表标志，并研究患者体型是否会对其产生影响。
对连续60例行腹腔镜疝修补术的患者进行研究。在手术前，于麻醉状态下的患者身上标记骨性标志（髂前上棘和耻骨结节）以及两个传统标志（腹股沟中点和腹股沟韧带中点）。通过向体表施压直至腹腔镜显示深环被封闭来确定深环位置。
发现深环的真正体表标志位于腹股沟韧带中点内侧平均9.6毫米处、腹股沟中点外侧4.5毫米处，约为从腹股沟中点到腹股沟韧带中点距离的三分之一。多因素分析证实年龄、性别、种族、体重指数或骨盆形态均不会使其改变。
深环位于腹股沟中点（即连接髂前上棘和耻骨联合的线的中点）外侧的一点下方。这一点应传授给未来的医学生，作为临床上施加压迫以鉴别直疝和斜疝的部位。
