闭孔疝临床诊疗分析：附5例报告

背景与目的 闭孔疝是临床罕见的腹外疝，具有术前诊断率低，病死率高的临床特点。本文通过回顾收治的闭孔疝病例，分析总结闭孔疝的病因、临床特点及诊治方法，以期为该病的诊治提供参考。方法 回顾性分析2011年1月—2021年1月期间收治广东医科大学附属医院5例闭孔疝患者临床资料。结果 5例闭孔疝病例中（4例患者，1例女性患者半年内先后被诊断为左、右侧闭孔疝），男1例，女4例；年龄61~87岁；除1例术前诊断右侧腹股沟斜疝术中发现同侧隐匿闭孔疝外，其余均以急性机械性肠梗阻首诊；左侧闭孔疝例3例、右侧闭孔疝2例；3例术前行盆腔CT检查并诊断闭孔疝，2例术中明确。1例择期手术外，其余4例均行急诊手术探查。合并小肠嵌顿4例，1例因嵌顿缺血坏死予以小肠切除，其余3例肠管麻醉状态下自行回纳或腹腔镜下协助回纳。修补方式方面，2例用3-0 Prolene行闭孔管口直接缝合关闭，1例行开放式无张力修补，其余2例腹腔镜下腹膜外间隙补片无张力修补。1例患者因并发感染性休克术后第2天ICU死亡，其余4例病例（3例患者）治愈出院。治愈出院患者均获随访，随访时间为1~5年，中位数（3.0±2.2）年，随访无复发。结论 老年女性患者出现病因不明的急性机械性肠梗阻时应考虑闭孔疝可能，盆腹腔CT检查有助于明确诊断。明确诊断后尽早手术，患者条件允许建议腹腔镜探查并修补。

Analysis of clinical diagnosis and treatment of obturator hernia: a report of 5 cases

Background and Aims Obturator hernia is a clinically rare external abdominal hernia, characterized by low preoperative diagnosis rate and high mortality rate. This article was conducted to analyze and summarize the etiology, clinical characteristics and diagnosis and treatment methods of obturator hernia by reviewing the treated cases with obturator hernia, so as to provide reference for diagnosis and treatment of this condition.Methods The clinical data of 5 cases of obturator hernia admitted to the Affiliated Hospital of Guangdong Medical University between January 2011 and January 2021 were retrospectively analyzed.Results Of the 5 cases of obturator hernia (involving 4 patients, in whom one female patient was diagnosed as left and right obturator hernia successively within half a year), one case was male and four cases were females; except for one case with a preoperative diagnosis of right inguinal hernia and an ipsilateral occult obturator hernia was found during operation, the other four cases were first diagnosed with acute mechanical intestinal obstruction. There were 3 cases of left obturator hernia and 2 cases of right obturator hernia; 3 cases underwent pelvic CT examination and obturator hernia was diagnosed before the operation, and 2 cases were identified during operation. Except one case underwent selective operation, the other cases underwent emergency laparotomy. There were 4 cases with small bowel incarceration, in whom one case underwent small bowel resection due to ischemic necrosis after incarceration, and the remaining 3 cases were reintroduced spontaneously or assisted by laparoscopy under intestinal anesthesia. In the repair method, 2 cases were closed by direct suture of obturator orifice with 3-0 Prolene, one case underwent open tension-free repair, and the other 2 cases underwent transabdominal preperitoneal approach (TAPP). After operation, one patient died in the ICU on the second day after surgery due to infectious shock, and the other 4 cases (3 patients) were cured and discharged. All cured patients were followed up after surgery. The follow-up time was 1 to 5 years, with a median time of (3.0±2.2) years. There was no recurrence of obturator hernia during the follow-up period.Conclusion The possibility of obturator hernia should be considered when elderly women have acute mechanical intestinal obstruction of unknown cause. The abdominopelvic CT examination is helpful for preoperative diagnosis. Surgery should be performed as soon as possible after definite diagnosis, and laparoscopic exploration and repair is recommended if the patients'' condition allowed.