闭孔疝的诊断和治疗体会

目的对闭孔疝的病因、诊断、治疗和预后进行总结和讨论。 方法回顾性分析2013年1月至2018年1月，复旦大学附属华东医院普外科疝和腹壁外科治疗与培训中心收治的9例闭孔疝患者的相关临床资料。 结果8例患者术前行腹盆腔CT，7例提示闭孔疝形成伴小肠嵌顿，1例未提示闭孔疝。所有患者均行手术治疗，8例行急诊手术治疗，1例非手术治疗3 d后予手术治疗。其中5例行传统剖腹探查手术，余4例行经腹股沟切口腹膜外入路手术，并行腹腔探查。所有患者均在术中明确闭孔疝，病变位于左侧4例，右侧4例，双侧1例。回纳疝内容物后，行小肠修补3例，1例因嵌顿小肠缺血坏死予以切除。修补方式中，1例行直接缝合，8例行补片修补，其中4例植入生物补片，4例植入合成补片。手术时间40～120 min，平均77.8 min。术后8例患者治愈出院，1例因感染性休克死亡。住院时间4～19 d，平均10.7 d。出院患者术后均随访，随访时间3个月至3年，中位数1.5年，随访期间患者均无闭孔疝复发。 结论对有体型消瘦、多次生育史的老年女性患者，如出现不明原因的小肠梗阻症状，应考虑闭孔疝可能，进行积极的诊治，行腹盆腔多层螺旋CT检查可作为诊断的标准方法。一旦明确诊断，应尽早行积极的手术治疗，术中应注意有无合并疝和对侧隐匿疝的探查。为防止复发，若无禁忌证，使用补片修补较为恰当。

Experience in diagnosis and treatment of obturator hernia: a report of 9 cases

BackgroundObturator hernia is a rare abdominal external hernia. It is not well understood in clinic and may lead to delayed treatment due to misdiagnosis. ObjectiveTo summarize and discuss the etiology, diagnosis, treatment and prognosis of obturator hernia. MethodsMSCT was performed in 8 cases, 7 cases showed obturator hernia with intestinal incarceration. 8 patients received emergency surgical treatment, and 1 patient received surgical treatment after 3 days of conservative treatment. Among them, 5 cases through conventional laparotomy and 4 cases through extraperitoneal approach via inguinal incision. 1 case underwent direct suture repair while 8 cases underwent mesh repair. 4 cases were implanted with biological mesh and 4 cases were implanted with synthetic mesh. After operation, 8 patients were cured and 1 died of septic shock. No recurrence occurred during the follow-up period. ConclusionThose elderly female patients with thin body and have multiple pregnancies history, when they appear unknown intestinal obstruction, should be considered the possibility diagnosis of obturator hernia and given proper treatments. MSCT can be taken as the golden criterion to diagnose obturator hernia. Once the diagnosis is confirmed, the surgeons should perform operations as soon as possible and pay attention to exploring the occult hernia. If there is no contraindication, using mesh repair is the most appropriate way to prevent recurrence.