O'Malley K J, Monkhouse W S, Qureshi M A, Bouchier-Hayes D J
Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland.
Clin Anat. 1997;10(5):313-7. doi: 10.1002/(SICI)1098-2353(1997)10:5<313::AID-CA4>3.0.CO;2-R.
There are a number of important structures to be avoided in suturing or stapling during laparoscopic inguinal herniorrhaphy, not all of which are easily identifiable at laparoscopy. This is particularly so of the ductus deferens. Measurements were taken of the angle made by the ductus deferens with testicular vessels, and of the thickness of tissue in the vicinity of the internal ring into which sutures or staples are likely to be inserted. The angle (mean +/- SD) made by the ductus with testicular vessels was 38.6 degrees +/- 4.4 degrees on the right, and 48.6 degrees +/- 7.2 degrees on the left (P < 0.05) (measurements for right and left sides taken from different cadavers). Thickness of tissue around the ring (peritoneum, transversalis fascia and intervening connective tissue) varies at different sites, being greatest lateral to the testicular vessels (2.2 +/- 0.4 mm) and least over the ductus (0.2 +/- 0.1 mm). The angle measured constitutes the apex of the "triangle of doom" (Spaw et al., 1991. J. Laparoendoscopic Surg. 1:269-277) and with its use the position of the ductus deferens may be predicted and the underlying external iliac vessels avoided when stapling during herniorrhaphy.
在腹腔镜腹股沟疝修补术中进行缝合或吻合器操作时，有许多重要结构需要避开，其中并非所有结构在腹腔镜检查时都易于识别。输精管尤其如此。对输精管与睾丸血管形成的角度以及内环附近可能插入缝线或吻合器的组织厚度进行了测量。输精管与睾丸血管形成的角度（平均值±标准差），右侧为38.6度±4.4度，左侧为48.6度±7.2度（P<0.05）（左右两侧测量取自不同尸体）。内环周围组织（腹膜、腹横筋膜及其间的结缔组织）厚度在不同部位有所不同，在睾丸血管外侧最厚（2.2±0.4毫米），在输精管上方最薄（0.2±0.1毫米）。所测量的角度构成了“危险三角”的顶点（Spaw等人，1991年。《腹腔镜与内镜外科杂志》1:269 - 277），利用该角度可以预测输精管的位置，在疝修补术中使用吻合器时可避开其下方的髂外血管。
