腹内疝的诊断和治疗

目的:探讨腹内疝发生的原因，提高腹内疝的早期诊断及治疗水平。 方法:回顾分析68例腹内疝的临床资料。 结果:术后证实为盲肠旁疝1例；毕II式结肠前胃空肠吻合术后输出段空肠疝入输入段空肠与横结肠系膜间隙6例，其中发生肠坏死1例，行疝复位、肠切除吻合后治愈；Miles术后盆底腹膜裂开所致内疝4例；降结肠造口术后降结肠与侧腹壁形成的间隙致内疝6例；大网膜与乙状结肠造口肠壁粘连形成内疝1例；因手术、腹腔炎症引起的粘连与腹膜、卵巢、膀胱、子宫、肠壁或肠与肠之间的孔隙改变形成内疝50例（73.5%），其中肠坏死3例，行疝复位裂孔修补、粘连松解、肠切除吻合后治愈。 结论:腹内疝术前诊断困难。对有手术史，经常腹痛或肠梗阻表现者应考虑腹内疝的可能，并应早期诊断及时手术，以防发生肠绞窄，肠坏死。

Diagnosis and therapy of intra-abdominal hernia

Objective To investigate the causes of intra-abdominal hernia and improve the level of early (diagnosis) and therapy of intra-abdominal hernia. Methods A retrospective analysis of the clinical data of 68 cases of intra-abdominal hernia was made. Results The postoperative confirmed diagnosis was para-occal hernia in 1 patient;herniation of efferent jejunal loop through the space between the afferent jejunal loop and the mesocolon after Billroth II gastrectomy in 6 patients,one of which had bowel necrosis,all of the 6 patients were cured after reduction of the hernia or enterectomy after and enteroanastomsis;internal henia though (ruptured) pelvic (peritoneum) after Miles operation in 4 patients;internal hernia though the space between the (descending) colon and the lateral abdominal wall after colostomy of descending colon in 6 patients;internal (hernia) caused by (adhesion) of omentum to the intestinal wall of sigmoidostomy in 1 patient;internal hernia through hiatuses caused by postoperative or post-peritonitis adhesions to the peritoneum,ovaries,urinary (bladder),uterus,(intestinal) wall or between loops of intestine in 50 patients(73.5%),including 3 cases of bowel (necrosis).All of those patients were cured after reduction of the hernias,repair of the hiatuses,release of (adhesions) or enterectomy and enteroanastomosis. Conclusions Preoperative diagnosis of internal abdominal hernia is difficult.The possibility of internal abdominal hernia should be cansidered in patients with a history of operation,and who complain of frequent abdominal pain or bowel obstruction.Early diagnosis and prompt (operation) is necessary to prevent the occurrence of bowel strangulation and bowel necrosis.