闭孔疝9例临床诊治分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 王祥峰 ^1,2 ,  刘宝华 ¹ , 叶景旺 ¹ , 王李 ¹ , 赵松 ¹

1. ;
2. ;

Corresponding author：

刘宝华, Email: LBH57268@163.com

Keywords：

闭孔疝; 肠梗阻; Howship-Romberg征; 诊治

DOI：

10.7507/1007-9424.20150095

Video：

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目的总结闭孔疝的发病原因、临床特点及诊治策略。方法回顾性分析2000年10月至2011年10月期间第三军医大学大坪医院野战外科研究所和解放军第三二四医院收治的9例闭孔疝患者的临床资料。结果 9例患者的临床表现均为急性机械性肠梗阻。术前均行腹盆腔CT检查，诊断为闭孔疝4例，嵌顿性腹股沟疝3例，嵌顿性股疝1例，原因不明的小肠机械性梗阻1例。急诊行剖腹探查术4例，行择期手术5例。所有患者均于术中确诊，闭孔疝位于左侧4例，右侧5例，嵌顿疝内容物均为回肠。均行闭孔疝修补术，其中8例行闭孔管口直接缝合，1例经腹行腹膜外间隙补片无张力修补。手术时间75～150 min，平均116 min。术后所有患者均治愈出院，住院时间7～26 d，平均13.8 d。术后均获访，随访时间为0.5～2.0年，中位数为1.6年。随访期间所有患者均无闭孔疝复发。结论消瘦老年女性出现病因不明的急性机械性肠梗阻时应考虑闭孔疝可能，腹盆腔CT检查有助于闭孔疝的术前诊断。早期手术是有效的治疗措施，术中应注意探查有无合并疝或对侧隐匿性闭孔疝，同时应避免损伤闭孔血管神经。

Citation： 王祥峰, 刘宝华, 叶景旺, 王李, 赵松. 闭孔疝9例临床诊治分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(3): 354-356. doi: 10.7507/1007-9424.20150095 Copy

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2.	Nasir BS, Zendejas B, Ali SM, et al. Obturator hernia:the Mayo Clinic experience. Hernia, 2012, 16(3):315-319.
3.	Galketiya K, Sakrepatna S, Gananadha S. Obturator hernia-an uncommon cause of small bowel obstruction. J Gastrointest Surg, 2013, 17(4):840-841.
4.	Takada T, Ikusaka M, Ohira Y, et al. Paroxysmal hip pain. Lancet, 2011, 377(9775):1464.
5.	Petrie A, Tubbs RS, Matusz P, et al. Obturator hernia: anatomy, embryology, diagnosis, and treatment. Clin Anat, 2011, 24(5):562-569.
6.	Burt BM, Cevasco M, Smink DS. Clinical images. Classic presenta-tion of a type Ⅱ obturator hernia. Am J Surg, 2010, 199(6):e75-e76.
7.	Igari K, Ochiai T, Aihara A, et al. Clinical presentation of obturator hernia and review of the literature. Hernia, 2010, 14(4):409-413.
8.	Losanoff JE, Richman BW, Jones JW. Obturator hernia. J Am Coll Surg, 2002, 194(5):657-663.
9.	Tokushima M, Aihara H, Tago M, et al. Obturator hernia:a diagnostic challenge. Am J Case Rep, 2014, 15:280-283.
10.	Le HT, Burg MD. An obscure cause of hip pain. J Emerg Med, 2012, 42(6):e129-e131.
11.	陈辉, 严德辉, 刘志. 闭孔疝5例临床分析. 中国普外基础与临床杂志, 2013, 20(9):1058-1059.
12.	Kammori M, Mafune K, Hirashima T, et al. Forty-three cases of obturator hernia. Am J Surg, 2004, 187(4):549-552.
13.	Yokoyama Y, Yamaguchi A, Isogai M, et al. Thirty-six cases of obturator hernia:does computed tomography contribute to postoperative outcome?. World J Surg, 1999, 23(2):214-217.
14.	Murai S, Akatsu T, Yabe N, et al. Impacted obturator hernia treated successfully with a Kugel repair:report of two cases. Surg Today, 2009, 39(9):821-824.
15.	Shigemitsu Y, Akagi T, Morimoto A, et al. The maneuver to release an incarcerated obturator hernia. Hernia, 2012, 16(6):715-717.
16.	Tchupetlowsky S, Losanoff J, Kjossev K. Bilateral obturator hernia-a new technique and a new prosthetic material for case-report and review of the liteature. Surgery, 1995, 117(1):109-112.
17.	Fritz T, Teklote J, Kraus T. Pubic osteotomy in obturator gliding hernia. Chirurg, 1997, 68(12):1301-1303.
18.	Mandarry MT, Zeng SB, Wei ZQ, et al. Obturator hernia-a condi-tion seldom thought of and hence seldom sought. Int J Colorectal Dis, 2012, 27(2):133-141.
19.	Kaneta T, Takanami K, Mitamura A, et al. FDG accumulation in obturator herniation of the bladder mimicking metastatic disease. Clin Nucl Med, 2009, 34(6):395-397.
20.	Izzo M, Regusci L, Fasolini F. Obturator hernia with ureteral entrapment. Case Rep Gastroenterol, 2014, 8(2):156-161.
21.	Camerlinck M, Vanhoenacker F, De Vuyst D, et al. Appendicitis in an obturator hernia. Abdom Imaging, 2011, 36(2):170-173.
22.	Rodriguez-Hermosa JI, Codina-Cazador A, Maroto-Genover A, et al. Obturator hernia:clinical analysis of 16 cases and algorithm for its diagnosis and treatment. Hernia, 2008, 12(3):289-297.
23.	Karasaki T, Nomura Y, Tanaka N. Long-term outcomes after obturator hernia repair:retrospective analysis of 80 operations at a single institution. Hernia, 2014, 18(3):393-397.
24.	Togawa Y, Muronoi T, Kawaguchi H, et al. Minimal incision transinguinal repair for incarcerated obturator hernia. Hernia, 2014, 18(3):407-411.
25.	Mantoo SK, Mak K, Tan TJ. Obturator hernia:diagnosis and treatment in the modern era. Singapore Med J, 2009, 50(9):866-870.

1. Green BT. Strangulated obturator hernia:still deadly. South Med J, 2001, 94(1):81-83.
2. Nasir BS, Zendejas B, Ali SM, et al. Obturator hernia:the Mayo Clinic experience. Hernia, 2012, 16(3):315-319.
3. Galketiya K, Sakrepatna S, Gananadha S. Obturator hernia-an uncommon cause of small bowel obstruction. J Gastrointest Surg, 2013, 17(4):840-841.
4. Takada T, Ikusaka M, Ohira Y, et al. Paroxysmal hip pain. Lancet, 2011, 377(9775):1464.
5. Petrie A, Tubbs RS, Matusz P, et al. Obturator hernia: anatomy, embryology, diagnosis, and treatment. Clin Anat, 2011, 24(5):562-569.
6. Burt BM, Cevasco M, Smink DS. Clinical images. Classic presenta-tion of a type Ⅱ obturator hernia. Am J Surg, 2010, 199(6):e75-e76.
7. Igari K, Ochiai T, Aihara A, et al. Clinical presentation of obturator hernia and review of the literature. Hernia, 2010, 14(4):409-413.
8. Losanoff JE, Richman BW, Jones JW. Obturator hernia. J Am Coll Surg, 2002, 194(5):657-663.
9. Tokushima M, Aihara H, Tago M, et al. Obturator hernia:a diagnostic challenge. Am J Case Rep, 2014, 15:280-283.
10. Le HT, Burg MD. An obscure cause of hip pain. J Emerg Med, 2012, 42(6):e129-e131.
11. 陈辉, 严德辉, 刘志. 闭孔疝5例临床分析. 中国普外基础与临床杂志, 2013, 20(9):1058-1059.
12. Kammori M, Mafune K, Hirashima T, et al. Forty-three cases of obturator hernia. Am J Surg, 2004, 187(4):549-552.
13. Yokoyama Y, Yamaguchi A, Isogai M, et al. Thirty-six cases of obturator hernia:does computed tomography contribute to postoperative outcome?. World J Surg, 1999, 23(2):214-217.
14. Murai S, Akatsu T, Yabe N, et al. Impacted obturator hernia treated successfully with a Kugel repair:report of two cases. Surg Today, 2009, 39(9):821-824.
15. Shigemitsu Y, Akagi T, Morimoto A, et al. The maneuver to release an incarcerated obturator hernia. Hernia, 2012, 16(6):715-717.
16. Tchupetlowsky S, Losanoff J, Kjossev K. Bilateral obturator hernia-a new technique and a new prosthetic material for case-report and review of the liteature. Surgery, 1995, 117(1):109-112.
17. Fritz T, Teklote J, Kraus T. Pubic osteotomy in obturator gliding hernia. Chirurg, 1997, 68(12):1301-1303.
18. Mandarry MT, Zeng SB, Wei ZQ, et al. Obturator hernia-a condi-tion seldom thought of and hence seldom sought. Int J Colorectal Dis, 2012, 27(2):133-141.
19. Kaneta T, Takanami K, Mitamura A, et al. FDG accumulation in obturator herniation of the bladder mimicking metastatic disease. Clin Nucl Med, 2009, 34(6):395-397.
20. Izzo M, Regusci L, Fasolini F. Obturator hernia with ureteral entrapment. Case Rep Gastroenterol, 2014, 8(2):156-161.
21. Camerlinck M, Vanhoenacker F, De Vuyst D, et al. Appendicitis in an obturator hernia. Abdom Imaging, 2011, 36(2):170-173.
22. Rodriguez-Hermosa JI, Codina-Cazador A, Maroto-Genover A, et al. Obturator hernia:clinical analysis of 16 cases and algorithm for its diagnosis and treatment. Hernia, 2008, 12(3):289-297.
23. Karasaki T, Nomura Y, Tanaka N. Long-term outcomes after obturator hernia repair:retrospective analysis of 80 operations at a single institution. Hernia, 2014, 18(3):393-397.
24. Togawa Y, Muronoi T, Kawaguchi H, et al. Minimal incision transinguinal repair for incarcerated obturator hernia. Hernia, 2014, 18(3):407-411.
25. Mantoo SK, Mak K, Tan TJ. Obturator hernia:diagnosis and treatment in the modern era. Singapore Med J, 2009, 50(9):866-870.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

闭孔疝9例临床诊治分析

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