[Abdominal wall hernias of unusual presentation].
[Abdominal wall hernias of unusual presentation].
复制标题
[异常表现的腹壁疝]。
DOI：
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发表时间：
2006
期刊：
影响因子：
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通讯作者：
Alberto Ramos
中科院分区：
文献类型：
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作者：
Antonio M Satorras;Javier Vázquez;Luis Pigni;Ali M Salem;Alberto Ramos
引言
不常见的腹壁突出症包括脊柱突出症(SH)、闭孔突出症(OH)、腰椎间盘突出症(LH)和顶内突出症(IPH)等。他们的诊断需要高度怀疑和频繁使用影像检查。
患者和方法
我们对1990-2004年间治疗的AWH进行了回顾。在2973例中，16例(0.53%)位于罕见部位：SH12例(0.4%)，OH2例(0.06%)，LH1例(0.03%)，IPH 1例(0.03%)。所有的SH都有明显的肿块。男性更常见(7名男性和5名女性)。急诊手术占25%。当进行影像研究时，超声检查只证实了20%，而计算机断层扫描(CT)证实了100%。在所有接受HS手术的患者中，术前诊断为HS。7例行单纯缝合(1例复发)，5例行经腹膜外前入路聚丙烯网锥修补。50%与其他AWH有关。2例OH术前CT诊断为肠梗阻。1例IPH同时表现为肠梗阻，术前经超声确诊；2例行肠切除网状修补。经CT检查，黄体生成素诊断为脂肪瘤。
结论
异常表现的AWH可表现为急性并发症。确诊后即可进行治疗。外科修复可通过一期缝合或经开腹或腹腔镜途径进行网片修补术。应选择最适合每种类型的疝修补术。
INTRODUCTION
Abdominal wall hernias (AWH) of unusual presentation include Spigelian hernia (SH), obturator hernia (OH), lumbar hernia (LH) and intraparietal hernia (IPH), among others. Their diagnosis requires of a high index of suspicion and frequent use of imaging studies.
PATIENTS AND METHOD
We performed a retrospective review of the AWH treated between 1990 and 2004. Of a total of 2,973 hernias, 16 (0.53%) were in infrequent locations: 12 SH (0.4%), 2 OH (0.06%), 1 LH (0.03%), 1 IPH (0.03%). All the SH showed a palpable mass. They were more frequent in men (7 men and 5 women). Emergency surgery was performed in 25%. When imaging studies were carried out, ultrasonography confirmed only 20% while computed tomography (CT) confirmed 100%. In all patients who underwent surgery for HS, the diagnosis was made preoperatively. Seven small defects were repaired by simple closure (with 1 recurrence); 5 were repaired by a polypropylene mesh cone through the anterior extraperitoneal route. Fifty percent were associated with other AWH. Two OH presented with intestinal obstruction and preoperative diagnosis was made by CT. One IPH also presented with intestinal obstruction and preoperative diagnosis was made by ultrasonography; in 2 patients intestinal resections were performed with mesh repair. The LH had a preoperative diagnosis of lipoma by CT.
CONCLUSIONS
AWH of unusual presentation can present as acute complications. Treatment is indicated after diagnosis. Surgical repair can be performed by primary closure or mesh repair through the open or laparoscopic route. The most suitable repair technique for each type of hernia should be selected.