閉孔疝9例臨床診治分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 王祥峰 ^1,2 ,  劉寶華 ¹ , 葉景旺 ¹ , 王李 ¹ , 趙松 ¹

1. ;
2. ;

Corresponding?author：

劉寶華, Email: LBH57268@163.com

Keywords：

閉孔疝; 腸梗阻; Howship-Romberg征; 診治

DOI：

10.7507/1007-9424.20150095

Video：

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Abstract Full text Figures/Tables Video References Cited by

目的總結閉孔疝的發病原因、臨床特點及診治策略。方法回顧性分析2000年10月至2011年10月期間第三軍醫大學大坪醫院野戰外科研究所和解放軍第三二四醫院收治的9例閉孔疝患者的臨床資料。結果 9例患者的臨床表現均為急性機械性腸梗阻。術前均行腹盆腔CT檢查，診斷為閉孔疝4例，嵌頓性腹股溝疝3例，嵌頓性股疝1例，原因不明的小腸機械性梗阻1例。急診行剖腹探查術4例，行擇期手術5例。所有患者均于術中確診，閉孔疝位于左側4例，右側5例，嵌頓疝內容物均為回腸。均行閉孔疝修補術，其中8例行閉孔管口直接縫合，1例經腹行腹膜外間隙補片無張力修補。手術時間75～150 min，平均116 min。術后所有患者均治愈出院，住院時間7～26 d，平均13.8 d。術后均獲訪，隨訪時間為0.5～2.0年，中位數為1.6年。隨訪期間所有患者均無閉孔疝復發。結論消瘦老年女性出現病因不明的急性機械性腸梗阻時應考慮閉孔疝可能，腹盆腔CT檢查有助于閉孔疝的術前診斷。早期手術是有效的治療措施，術中應注意探查有無合并疝或對側隱匿性閉孔疝，同時應避免損傷閉孔血管神經。

Citation： 王祥峰, 劉寶華, 葉景旺, 王李, 趙松. 閉孔疝9例臨床診治分析. 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.	陳輝, 嚴德輝, 劉志. 閉孔疝5例臨床分析. 中國普外基礎與臨床雜志, 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. 陳輝, 嚴德輝, 劉志. 閉孔疝5例臨床分析. 中國普外基礎與臨床雜志, 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

閉孔疝9例臨床診治分析

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