高频超声在不同类型腹股沟疝患者中的鉴别及与精索腹壁下动脉的关系研究

目的探讨高频超声在不同类型腹股沟疝患者中的鉴别价值及与精索腹壁下动脉的关系。 方法选择2018年5月至2021年6月武汉大学中南医院收治疑似腹股沟疝患者116例为对象，均采用高频超声检查，以手术为腹股沟疝确诊及分类分型的"金标准"，分析高频超声在腹股沟疝中的检出率、鉴别效能及不同类型腹股沟疝超声特点，比较不同类型腹股沟疝疝环直径及与精索腹壁下动脉的关系。 结果116例疑似腹股沟疝患者经手术检查确诊67例，确诊率为57.76%。腹股沟疝患者中排在前两位的分别为：易复性疝或难复性疝与直疝；高频超声检查确诊62例，检查准确度为82.63%（P>0.05）；诊断灵敏度为82.09%、特异度为85.71%；高频超声在直疝、易复性疝或难复性疝、嵌顿性疝及绞窄性疝中的检出率与手术检查结果差异无统计意义（P>0.05）；高频超声下直疝、易复性疝、绞窄性疝疝环直径略高于手术检查，而难复性疝及嵌顿性疝疝环直径略低于手术检查，差异均无统计意义（P>0.05）。 结论高频超声用于腹股沟疝患者中具有较高的检出率，能实现不同类型腹股沟疝鉴别，且与精索腹壁下动脉关系密切。     

腹壁下动脉自发破裂出血1例

1 临床资料患者男,78岁.因右下腹胀痛5天,发热并腹部包块1天,门诊以“阑尾周围脓肿”收住院.患者15年前曾患高血压性心脏病,近年来服“心痛定”10-30mg/d维持治疗,血压22/14～26/16kPa.入院前5天,因用右手提水(约20kg)后,感右下腹疼痛,逐渐加剧,无放射及恶心、呕吐.1天前感畏寒、发热(温度不详),同时于右下腹触到一“土豆”大之包块,在院外服中药,效果不显而入院.     

腹壁下动脉自发破裂出血一例

患者男,78岁。因右下腹胀痛5d,发热并腹部包块1d,门诊以“阑尾周围脓肿”收住院。患者15年前曾患高血压性心脏病,近年来服心痛定10～30mg/d维持治疗,血压165/105mmHg～195/120mmHg(1mmHg=0.133kPa)。入院前5d,因用右手提水(约20kg)后,感右下腹疼痛,逐渐加剧,无放射痛及恶心、呕     

游离腹壁下动脉穿支皮瓣在乳房再造中的应用

目的:探讨游离腹壁下动脉皮肤穿支(deep inferior epigastric perforator,DIEP)皮瓣在早期乳腺癌患者(Ⅰ或Ⅱ期)术后乳房再造中的临床应用。方法:对12例早期乳腺癌患者行根治术或改良根治术同期或二期应用DIEP皮瓣行乳房再造,其中乳腺癌分期I期9例,II期3例。结果:1例皮瓣出现部分坏死,1例皮瓣出现脂肪液化,经换药后愈合,其余皮瓣均成活,再造乳房外形可,弹性好,无皮瓣挛缩变形;无腹壁疝和腹壁膨出。11例获随访平均2.2年,效果均较满意,未出现乳腺癌复发病例,4例获得优,5例获得良,失访1例按良计算,2例效果差,优良率83.3%。结论:乳腺癌术后一期或二期应用DIEP皮瓣游离移植再造乳房,具有皮瓣血运良好、再造乳房外形满意、腹部供区并发症少,可同时行腹壁整形等优点,是乳腺癌术后乳房再造的理想方法之一,放化疗不影响皮瓣的成活。     

应用腹壁下动脉穿支皮瓣再造乳房

目的对应用腹壁下动脉穿支(deepinferiorepigastricperforator,DIEP)皮瓣进行乳房再造进结。方法2000年3月~2005年3月,收治18例患者,其中因乳腺癌导致乳房缺损17例,术前行放射治疗者7例放射治疗者10例;先天性Poland’s综合征1例。胸壁缺损范围12cm×8cm~25cm×20cm。应用DIEP皮瓣游离进行乳房再造,皮瓣切取范围12cm×8cm~35cm×22cm。15例乳房再造患者使用的受区血管是胸廓内血管,其中腹壁下动、静脉分别与切断后的胸廓内动、静脉近、远心端行吻合者13例;仅切取一侧腹壁下血管,与胸廓内动、静心端行吻合者2例。3例行即刻乳房再造者使用的受区血管分别是胸背动、静脉和胸背动、静脉加旋肩胛动、静脉。18例患者中16例术后皮瓣全部成活,2例术后出现皮瓣坏死。其中行放射治疗1例,未行放射治疗1例。Poland合征患者术后皮瓣远端约1/3面积坏死。术后半年行乳头再造和乳房修整者2例。2例术后2周出现腹部供瓣区正口部分裂开,行创面清创后,分别应用直接缝合和植皮的方法进行修复。结论DIEP皮瓣在保留了传统下腹部横直肌皮瓣乳房再造所具有的优点同时,可最大限度保留腹直肌的功能,从而避免术后出现腹壁薄弱、腹壁疝等并发目前较理想的乳房再造方式。     

应用腹壁下动脉穿支皮瓣再造阴道

目的探讨应用腹壁下动脉穿支皮瓣再造阴道的优缺点。方法2004年1月~2005年5月,采用腹壁下动脉穿支(deepinferiorepigastricperforator,DIEP)皮瓣再造阴道5例,年龄19~40岁。先天性无阴道4例,阴道肿瘤1例。术前常规用超声多普勒检测DIEP,设计10cm×9cm~12cm×11cm的菱形皮瓣,将穿支点包括在皮瓣内。皮瓣切取后作内翻缝合成皮筒状,于腹股沟韧带与耻骨之间沿耻骨结节及耻骨上支内侧面,形成皮筒通过的隧道。将阴道皮筒经隧道移位至人工阴道腔隙或阴道肿瘤切除后的创面中再造阴道。结果5例阴道再造均获得成功,1例患者术后2周出现阴道后壁血肿,经清除血肿后愈合。腹壁供区无任何并发症发生。术后随访1~6个月,再造阴道质地柔软,宽敞,3例有性生活,患者感觉满意。结论应用DIEP皮瓣再造阴道是一种较理想的术式,对广泛的阴道肿瘤切除,由于需填充较多组织,仍是较好选择。     

腹壁下动脉穿支皮瓣修复腹部创面

目的探讨应用腹壁下动脉穿支皮瓣修复腹部创面的方法。方法2001年12月至2006年12月,对9例腹部创面,其中3例伴腹壁缺损的患者,用腹壁下动脉穿支皮瓣进行修复,供区直接缝合。结果本组9例腹壁下动脉穿支皮瓣全部Ⅰ期愈合。随访6-12个月,外形良好,均无腹壁疝和腹内疝的发生。结论腹壁下动脉穿支皮瓣是修复腹部创面合理、可靠的新方法,手术简单,易于普及推广。     

腹壁下动脉穿支皮瓣修复腹部创面

目的探讨应用腹壁下动脉穿支皮瓣修复腹部创面的方法。方法2001年12月至2006年12月,对9例腹部创面,其中3例伴腹壁缺损的患者,用腹壁下动脉穿支皮瓣进行修复,供区直接缝合。结果本组9例腹壁下动脉穿支皮瓣全部Ⅰ期愈合。随访6~12个月,外形良好,均无腹壁疝和腹内疝的发生。结论腹壁下动脉穿支皮瓣是修复腹部创面合理、可靠的新方法,手术简单,易于普及推广。     

CT血管成像技术在腹壁下动脉穿支皮瓣术前设计中的应用

目的 探讨CT血管成像(computed tomography angiography,CTA)技术在腹壁下动脉穿支(deep inferior epigastrie artery perforator,DIEAP)皮瓣术前设计中的应用. 方法 2007年1月至2008年3月,对13例拟行DIEAP皮瓣手术的患者术前应用CTA技术对腹壁下动脉进行检查,包括5例阴道先天性缺如、4例阴茎阴囊Paget's病、4例乳腺癌术后乳房缺损的患者,将获得的数据进行处理,包括多平面重组、最大密度投影以及容积显示.观察腹壁下动脉的走行、分支以及穿支位置,并将CTA图像结果与术中情况进行比较. 结果 CTA图像提供腹壁下动脉在肌肉内走行和穿支位置等有效信息,指导DIEAP皮瓣的术前设计,并在手术中得到验证. 结论 术前对腹壁下动脉进行CTA检查,可以有效地指导DIEAP皮瓣的术前设计.     

Inferior epigastric artery false aneurysm following incisional hernia repair

Introduction

We report a case of IEA false aneurysm following a mesh repair of a large incisional hernia. We emphasize the importance to consider the diagnosis to help avoid inappropriate interventions which could increase patient morbidity.

Case report

A 68-year-old male patient, who 4 weeks previously had had a mesh repair of a large incisional hernia, presented with a painful left iliac fossa swelling. This was found to be an IEA false aneurysm. This was treated successfully with percutaneous thrombin injection.

Conclusions

We feel an inferior epigastric artery false aneurysm must be included in the differential diagnosis when investigating the cause of any lateral swelling following incisional hernia repair. This would help reduce the chance of a missed diagnosis and avoid any inappropriate interventions which may cause increased patient morbidity.     

应用腹壁下动脉穿支岛状皮瓣修复会阴部软组织缺损

目的提供一种修复会阴前区软组织缺损的方法。方法采用腹壁下动静脉为血管蒂,保持腹直肌的完整性,形成腹壁下动脉穿支岛状皮瓣,带蒂移位,修复会阴前区皮肤肿瘤切除或放疗所致的大面积创面。结果本组6例患者,皮瓣切取面积6.0cm×12.0cm~10.0cm×28.0cm。皮瓣全部成活,供瓣区无腹壁薄弱、腹壁疝等并发症发生。结论腹壁下动脉穿支岛状皮瓣血运丰富,不损伤腹直肌,是修复会阴部大面积缺损的一种较好的方法。     

The preperitoneal approach to the groin and the inferior epigastric vessels

Preperitoneal, a word coined by Nyhus in the 1960s, has been applied not only to posterior approaches that he, Stoppa, and Wantz popularized but to anterior exposures of the groin, which divide the transversalis fascia. This assumes that all give similar views of the easily cleaved space of Bogros. However, accumulated anatomical observations reveal the transversalis fascia as having not one but two layers. The inferior epigastric vessels run between rather than in the preperitoneal space, which is avascular and has its own fascia lining the peritoneum. Historical evidence shows that both the midline Cheatle-Henry and lateral Ugahary-Kugel approaches, which transect the abdominal wall, provide excellent exposure of the avascular preperitoneal space. However, neither the unilateral posterior McEvedy approach nor the anterior approach does, as only part of the musculature and fasciae are retracted. The inferior epigastric vasculature and posterior lamina transversalis fascia, which remain in situ, block the view. Unless they are disrupted or circumvented, neither of the latter approaches or subsequent repairs should be labeled preperitoneal.     

Rare origin of the inferior epigastric and medial circumflex femoral arteries arising from a common trunk

A case of unilateral anomalous arterial supply of the lower limb and the anterior abdominal wall is presented. In this case, inferior epigastric artery arose from a common trunk with the medial circumflex femoral artery. The common trunk arose from the femoral artery. The inferior epigastric artery reached the anterior abdominal wall by passing deep to the inguinal ligament. The medial circumflex artery ran between the femoral artery and vein within the femoral triangle. A possible ontogenetic explanation is provided for this situation. Awareness of the variations in anatomy of the inferior epigastric and femoral arteries is important for angiographers and the surgeon who operates in this region. Received: 28 October 1999 / Accepted: 10 July 2000     

腹壁下动脉穿支皮瓣游离移植修复四肢软组织缺损

目的：报告腹壁下动脉穿支皮瓣游离移植修复四肢组织缺损临床应用结果。方法：自2006年1月至2012年1月,应用腹壁下动脉穿支皮瓣带蒂移植修复小腿（7例）和前臂（6例）软组织缺损13例,其中男9例,女4例;年龄21-45岁,平均33岁。软组织缺损范围7 cm×17 cm-8 cm×26 cm。外侧支和内侧支穿支皮瓣分别是7例和6例。供区直接缝合。结果：1例皮瓣发生小的皮缘裂开,术后1个月自然愈合,皮瓣全部成活。术后随访1.8-4.0年,平均2.8年,受区外形较好。结论：腹壁下动脉穿支皮瓣游离移植很适宜修复四肢软组织缺损,这种技术安全、可靠,可降低对供区的损伤。     

Diagnosis and classification of inguinal hernias

Background: The aim of this prospective clinical study was to determine whether the presence of a hernia, its size, and its type can be established preoperatively by clinical and ultrasound, examination. Methods: The study population comprised 220 consecutive patients referred to our department for the surgical management of an inguinal hernia. On admission, both inguinal regions were examined clinically and by ultrasound. All patients were operated on laparoscopically. Results: In regard to the intraoperative findings for both inguinal regions, clinical and ultrasound examination for the diagnosis of inguinal hernia yielded a high total rate of accuracy of 93% respective 94%. However, when the same methods were used to differentiate between lateral and medial hernia, the total rate of accuracy fell to only 54% respective 62%. In the determination of inguinal hernia size, it was even lower: 50% respective 53%. Conclusions: Although a diagnosis of inguinal hernia can be established reliably by clinical and ultrasound examination, only an approximate classification is possible by these methods.     

Transumbilical endoscopic surgery for completely enclosing inguinal hernias in children

Background/Purpose

There has been great interest in natural orifice transluminal endoscopic surgery in recent years. We report another new approach for pediatric inguinal hernia repair: transumbilical endoscopic surgery (TUES). Compared with the natural orifice transluminal endoscopic surgery technique, TUES can obtain similar scarless results on the abdomen.

Methods

In our hospital, 2-trocar TUES was the standard procedure used to repair pediatric inguinal hernias. Through 2 intraumbilical incisions, two 5-mm trocars were inserted into the abdomen under laparoscopic guidance. With the use of a needle-holding forceps, a round needle with 2-0 nonabsorbable suture material was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The orifice of the hernial sac was closed extraperitoneally with a purse-string suture around the internal inguinal ring, and intraperitoneal knot-tying was performed.

Results

A total of 76 inguinal repairs were performed in 64 children (age range, 6 months to 9 years; median, 3.8 years; 44 boys, 20 girls). All operations were completed successfully by TUES, with the exception of one case of intraoperative bleeding because the inferior epigastric vein was punctured. The mean operating time was 20 minutes (range, 15-30 minutes). No postoperative bleeding, hydrocele, or scrotal edema in this group of patients was found, and there were no known cases of postoperative testicular atrophy or hypotrophy nor hernia recurrence on the symptomatic side.

Conclusions

Our preliminary experience shows satisfactory outcomes with TUES for completely enclosing inguinal hernias in children. This technique appears to be safe, effective, and reliable. The cosmetic result is excellent.     

General vs regional anaesthesia in outpatient treatment for inguinal hernias using extraperitoneal laparoscopy

Summary The treatment of inguinal hernias using laparoscopy can be performed without violating the peritoneal cavity using the totally extraperitoneal technique (TEP). This procedure is usually done with general anaesthesia. The objective of this article is to evaluate the general and regional anaesthesia techniques in extraperitoneal laparoscopic surgery for treating inguinal hernias in an outpatient surgery unit. A prospective clinical study of 131 patients with uncomplicated inguinal hernia undergoing surgery using extraperitoneal laparoscopy was completed. Two study groups were established according to the anaesthesia technique used: general (n = 90) and regional (n = 41). We analyzed clinical data (age, sex, associated diseases, prior abdominal surgery, site and hernia type), intra-operative complications (bleeding, peritoneal rupture, subcutaneous emphysema, reconversion rate, haemodynamic stability, respiratory problems and degree of satisfaction), postoperative complications (haematomas, urinary retention, post lumbar puncture headaches, nausea, vomiting and postoperative pain) and recurrence rate. General anaesthesia was used significantly more in the cases of prior infra-umbilical surgery and bilateral hernias (p < 0.05). Statistically significant differences were not shown for intra- or post-operative complications. The rate of conversion was higher for general (5.5%) than for regional anaesthesia (2.4%). Recurrence was detected only in the regional anaesthesia group. In conclusion, general anaesthesia is not required for the performance of extraperitoneal laparoscopic inguinal hernia repair; regional anaesthesia is a safe and efficient alternative.     

Prevalence of abdominal aortic aneurysms in over 65-year-old men with inguinal hernias

INTRODUCTION

The aim of this study was to determine the prevalence of abdominal aortic aneurysms (AAAs) in over 65-year-old men who have inguinal hernias and discuss if pre-operative selective screening of this population is appropriate.

PATIENTS AND METHODS

A prospective study on 70 consecutive male patients with an age range of 65–88 years (mean, 74 years) who were referred to a single vascular consultant''s out-patient clinic with an inguinal hernia were screened for the presence of an AAA with an ultrasound scan before hernia repair over a period of 3 years.

RESULTS

Two patients were found to have an AAA measuring 3.8 cm and 6.0 cm giving an AAA prevalence of 3% (exact 95% confidence interval = 0–10%).

CONCLUSIONS

This study does not demonstrate an increased AAA prevalence in over 65-year-old male patients with inguinal hernias, scanned pre-operatively when compared to screening programmes. Selective screening of this cohort cannot be justified on this evidence.