Dibenedetto L M, Lei Q, Gilroy A M, Hermey D C, Marks S C, Page D W
Department of Cell Biology, University of Massachusetts Medical School, Worcester 01655, USA.
Clin Anat. 1996;9(4):232-6. doi: 10.1002/(SICI)1098-2353(1996)9:4<232::AID-CA3>3.0.CO;2-G.
Laparoscopic repair of inguinal hernias is gaining acceptance in the repertoire of the general surgeon. However, nerve entrapment sequelae have been reported and appear to be higher with the laparoscopic approach. Contributing factors include pelvic variations in nerve pathways and the use of staples. We examined the pelvic relations of the lateral femoral cutaneous nerve (LFCN) to the anterior superior iliac spine (ASIS) and the iliopubic tract (IPT) because of the high morbidity of entrapment of this nerve, despite its low incidence. The LFCN, ASIS, and IPT were identified and their relationships measured in 48 male and 24 female cadavers ranging in age from 61 to 96 yr. The LFCN was located 1.7 (+/- 1.2) cm medial to the ASIS along the IPT and 1.4 (+/- 0.7) cm posterior (deep) to the IPT at this point, with no significant sex differences. The intrapelvic pathway of the LFCN, including its branches, varied widely so that in 18% of these specimens the LFCN was in either the vertical plane of the ASIS (13%) or in the plane of the IPT (5%). In 11% this nerve was within 1 cm of the ASIS. These data indicate that exclusive use of the ASIS as a guide for staple placement may result in entrapment of this nerve or its branches.
腹腔镜腹股沟疝修补术在普通外科医生的手术范围内越来越被接受。然而，已有神经卡压后遗症的报道，并且腹腔镜手术方式下的发生率似乎更高。促成因素包括神经走行的骨盆变异和吻合器的使用。由于股外侧皮神经（LFCN）卡压的发病率虽低但却很高，我们研究了该神经与髂前上棘（ASIS）和髂耻束（IPT）的骨盆关系。在48具年龄在61至96岁之间的男性尸体和24具女性尸体中识别出LFCN、ASIS和IPT，并测量它们之间的关系。LFCN沿IPT位于ASIS内侧1.7（±1.2）cm处，在该点位于IPT后方（深面）1.4（±0.7）cm处，无明显性别差异。LFCN的盆腔内走行，包括其分支，差异很大，以至于在这些标本中有18%的LFCN位于ASIS的垂直平面（13%）或IPT平面（5%）内。在11%的标本中，该神经距ASIS在1cm以内。这些数据表明，仅以ASIS作为吻合器放置的导向可能会导致该神经或其分支被卡压。
