股疝诊断与治疗的分析(1)
【摘要】 目的:探讨股疝的诊断和手术治疗方法及临床疗效。方法:对23例股疝的诊断、鉴别诊断和外科手术治疗的情况进行回顾性分析。结果:23例股疝中嵌顿16例,其中2例发生绞窄,1例肠梗阻,1例肠瘘,均经腹、股部联合切口手术治愈。12例误诊为淋巴结炎、脂肪瘤、圆韧带囊肿。除2例肠梗阻及肠瘘外其余病例均手术治愈,疝无复发 结论:股疝诊断不难,但在基层腹股沟韧带下方切口,行疝修补,手术方法简单,费用低。
【关键词】 疝;股疝;疝修补术
Diagnosis and treatment 0f femoral hernia
HU jingxu
【Abstract】Objective Tb determine the diagnosis,treatment and clinical results 0f femoral hernia.Methods The medical records of 23 patients with femoral hernia treated at we Hospital were analyzed retrospectively. Results Among the 23 patients.16 were diagnosed with irreducible femoral hernia;ofthese patients 2had incarcerated and strangulated hernia,1 had intestinal obstruction, and 1 had intestinal Fistula.Twelve patients were misdiagnosed with lymphadenitis.1iparomphalus and cyst of the round ligament at their first visit.All of the 23 patients were treated surgically.Surgically procedures included incision below e inguinal ligament(19 patients),incision above the inguinal ligament(2 patients),and combined abdominal-tight incision(2 patients).The procedures were accomplished successfully.Conclusions Femoral hernia is easy to diagnose without specific examinations.The selection 0f surgical procedures must be fit to the conditions of the patient.In general,minimally invasive surgical treatment is preferred.If the conditions of the patient are not permitted.the repair of hernia through an incision below the inguinal ligament is an alternative.
, http://www.100md.com
【Key word】Hernia;Femoral hernia;Herniorrhaphy
【中图分类号】R605【文献标识码】B【文章编号】1005-0515(2010)011-0067-02
股疝是一种较少见的疝,约占腹股沟疝总数的3%～5%,但股疝中嵌顿者高达60%,女性多见,女性患股疝较男性多4~6倍。发现股疝在诊断和治疗上还存在一些问题,现就其诊断和治疗谈点意见。
1 资料与方法
1.1 一般资料:本院收治和会诊处理股疝23例,男性2例,女性21例,年龄为28～76岁,平均年龄56.7岁,除1例28岁男性外,均在47岁以上,6l岁以上16例,女性多且年龄较大。右侧股疝1l例,左侧11例,双侧1例,其中嵌顿绞窄2例,难复性14例:其中12例误诊为腹股沟淋巴结炎、脂肪瘤,2例误诊为圆韧带囊肿,可复性7例。
, 百拇医药
1.2 手术方法。
1.2.1 单纯股疝和嵌顿疝(2l例):2l例股疝,患者均在腰麻或硬膜外麻醉下,从股部切口。可沿腹股沟韧带下方斜切口,也可行腹股沟韧带下直切口。切开皮肤、皮下组织,切开筋膜达疝囊,仔细切开疝囊,注意不能损伤疝内容物。本组2例为小肠,余均为大网膜。将内容物还纳(在麻醉后疼痛消失肌肉松弛,疝内容物易还纳)。如大网膜水肿、粘连不能还纳,可切除多余大网膜,牢靠结扎后送回腹腔,将疝囊分离至股环处,贯穿缝合结扎后切除多余疝囊,用钳或镊子将结扎疝囊残端送回腹腔。冲洗伤口,将腹股沟韧带及耻骨梳韧带缝合封闭股环,一般缝合2～3针即可。手术过程中或缝合时,应注意始终不能伤及股静脉,也不能缝合过紧影响股静脉血液回流。其中2例在腹股沟韧带上切口,切开疝囊,还纳内容物。切除疝囊,高位结扎,将腹股沟韧带与耻骨肌筋膜缝合2~3针,冲洗后缝合皮下及皮肤。2.股疝嵌顿肠梗阻(1例):疝内容物不能还纳,全麻下行左下腹直肌切口,因疝环小不能将肠管回纳腹腔,又从股部切口,切断腹股沟韧带,松解疝环,将肠管回纳腹腔。肠管已坏死,切除吻合。彻底冲洗腹腔,将疝囊从股环处切断,行高位结扎,缝合切断的腹股沟韧带,然后再将腹股沟韧带与耻骨梳韧带缝合,封闭股环。再次彻底冲洗腹腔分层缝合腹壁各层。在切断腹股沟韧带时注意不能损伤股静脉,在缝合封闭股环时,也注意不能损伤股静脉,不能缝合过紧影响股静脉回流。
, 百拇医药
1.2.2 股疝嵌顿形成肠瘘(1例):全麻下也经腹部切口,将嵌顿的肠回纳腹腔,将肠管行楔形切除、吻合。再从股部切口,切除肠瘘形成的瘘管,切除疝囊,并高位结扎疝囊后,彻底冲洗腹腔及伤口,封闭股环,缝合腹壁各层,再次冲洗股部伤口,放皮片引流,缝合皮下组织及皮肤。
2 结果
本组23例股疝中嵌顿16例,其中2例发生绞窄,l例肠梗阻,1例肠瘘,均经腹、股部联合切口手术治愈。12例误诊为淋巴结炎、脂肪瘤、圆韧带囊肿。除2例肠梗阻及肠瘘外,其余病例均疝修补术治愈。无手术死亡病例,无并严重并发症发生,随访无复发,临床效果良好。
3 讨论
3.1股疝的发病情况:股疝是一种较少见的疾病,约占腹股沟疝总数的3%～5%,也有报道占腹股沟疝患者的2%~4%[ 1~2],占腹壁疝的4%~5%,女性患股疝较男性多4～5倍,秦胜旗等报告腹股沟疝952例,其中股疝仅9例[ 3]。有报道股疝是在腹股沟疝术后发生[ 4],但本组病例均无腹股沟疝手术史。一般认为股疝女性较多发,常见于多产妇、老年女性,因为女性骨盆宽,相对的股环也较大,而老年妇女由于各种组织松弛,股环自然也松弛,因而女性患病多,尤以多产的老年女性为常见。本组23例中仅有2例为男性,其余均为女性。但本组也有1例28岁健壮男性为双侧股疝,因此在诊断上也要注意个别特殊情况。, 百拇医药(胡敬旭)
【关键词】 疝;股疝;疝修补术
Diagnosis and treatment 0f femoral hernia
HU jingxu
【Abstract】Objective Tb determine the diagnosis,treatment and clinical results 0f femoral hernia.Methods The medical records of 23 patients with femoral hernia treated at we Hospital were analyzed retrospectively. Results Among the 23 patients.16 were diagnosed with irreducible femoral hernia;ofthese patients 2had incarcerated and strangulated hernia,1 had intestinal obstruction, and 1 had intestinal Fistula.Twelve patients were misdiagnosed with lymphadenitis.1iparomphalus and cyst of the round ligament at their first visit.All of the 23 patients were treated surgically.Surgically procedures included incision below e inguinal ligament(19 patients),incision above the inguinal ligament(2 patients),and combined abdominal-tight incision(2 patients).The procedures were accomplished successfully.Conclusions Femoral hernia is easy to diagnose without specific examinations.The selection 0f surgical procedures must be fit to the conditions of the patient.In general,minimally invasive surgical treatment is preferred.If the conditions of the patient are not permitted.the repair of hernia through an incision below the inguinal ligament is an alternative.
, http://www.100md.com
【Key word】Hernia;Femoral hernia;Herniorrhaphy
【中图分类号】R605【文献标识码】B【文章编号】1005-0515(2010)011-0067-02
股疝是一种较少见的疝,约占腹股沟疝总数的3%～5%,但股疝中嵌顿者高达60%,女性多见,女性患股疝较男性多4~6倍。发现股疝在诊断和治疗上还存在一些问题,现就其诊断和治疗谈点意见。
1 资料与方法
1.1 一般资料:本院收治和会诊处理股疝23例,男性2例,女性21例,年龄为28～76岁,平均年龄56.7岁,除1例28岁男性外,均在47岁以上,6l岁以上16例,女性多且年龄较大。右侧股疝1l例,左侧11例,双侧1例,其中嵌顿绞窄2例,难复性14例:其中12例误诊为腹股沟淋巴结炎、脂肪瘤,2例误诊为圆韧带囊肿,可复性7例。
, 百拇医药
1.2 手术方法。
1.2.1 单纯股疝和嵌顿疝(2l例):2l例股疝,患者均在腰麻或硬膜外麻醉下,从股部切口。可沿腹股沟韧带下方斜切口,也可行腹股沟韧带下直切口。切开皮肤、皮下组织,切开筋膜达疝囊,仔细切开疝囊,注意不能损伤疝内容物。本组2例为小肠,余均为大网膜。将内容物还纳(在麻醉后疼痛消失肌肉松弛,疝内容物易还纳)。如大网膜水肿、粘连不能还纳,可切除多余大网膜,牢靠结扎后送回腹腔,将疝囊分离至股环处,贯穿缝合结扎后切除多余疝囊,用钳或镊子将结扎疝囊残端送回腹腔。冲洗伤口,将腹股沟韧带及耻骨梳韧带缝合封闭股环,一般缝合2～3针即可。手术过程中或缝合时,应注意始终不能伤及股静脉,也不能缝合过紧影响股静脉血液回流。其中2例在腹股沟韧带上切口,切开疝囊,还纳内容物。切除疝囊,高位结扎,将腹股沟韧带与耻骨肌筋膜缝合2~3针,冲洗后缝合皮下及皮肤。2.股疝嵌顿肠梗阻(1例):疝内容物不能还纳,全麻下行左下腹直肌切口,因疝环小不能将肠管回纳腹腔,又从股部切口,切断腹股沟韧带,松解疝环,将肠管回纳腹腔。肠管已坏死,切除吻合。彻底冲洗腹腔,将疝囊从股环处切断,行高位结扎,缝合切断的腹股沟韧带,然后再将腹股沟韧带与耻骨梳韧带缝合,封闭股环。再次彻底冲洗腹腔分层缝合腹壁各层。在切断腹股沟韧带时注意不能损伤股静脉,在缝合封闭股环时,也注意不能损伤股静脉,不能缝合过紧影响股静脉回流。
, 百拇医药
1.2.2 股疝嵌顿形成肠瘘(1例):全麻下也经腹部切口,将嵌顿的肠回纳腹腔,将肠管行楔形切除、吻合。再从股部切口,切除肠瘘形成的瘘管,切除疝囊,并高位结扎疝囊后,彻底冲洗腹腔及伤口,封闭股环,缝合腹壁各层,再次冲洗股部伤口,放皮片引流,缝合皮下组织及皮肤。
2 结果
本组23例股疝中嵌顿16例,其中2例发生绞窄,l例肠梗阻,1例肠瘘,均经腹、股部联合切口手术治愈。12例误诊为淋巴结炎、脂肪瘤、圆韧带囊肿。除2例肠梗阻及肠瘘外,其余病例均疝修补术治愈。无手术死亡病例,无并严重并发症发生,随访无复发,临床效果良好。
3 讨论
3.1股疝的发病情况:股疝是一种较少见的疾病,约占腹股沟疝总数的3%～5%,也有报道占腹股沟疝患者的2%~4%[ 1~2],占腹壁疝的4%~5%,女性患股疝较男性多4～5倍,秦胜旗等报告腹股沟疝952例,其中股疝仅9例[ 3]。有报道股疝是在腹股沟疝术后发生[ 4],但本组病例均无腹股沟疝手术史。一般认为股疝女性较多发,常见于多产妇、老年女性,因为女性骨盆宽,相对的股环也较大,而老年妇女由于各种组织松弛,股环自然也松弛,因而女性患病多,尤以多产的老年女性为常见。本组23例中仅有2例为男性,其余均为女性。但本组也有1例28岁健壮男性为双侧股疝,因此在诊断上也要注意个别特殊情况。, 百拇医药(胡敬旭)