Lipomas of the cord and round ligament
Lipomas of the cord and round ligament
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DOI：
10.1097/00000658-200204000-00018
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发表时间：
2002-04-01
影响因子：
9
通讯作者：
Arregui, ME
中科院分区：
文献类型：
--
作者：
Lilly, MC;Arregui, ME
目的探讨精索及圆韧带脂肪瘤的发生率、临床意义及解剖特点。方法回顾性分析1996年1月至2000年1月间同一外科医生（M.E.A.）对217例患者行280例疝修补术的资料。评估脊髓脂肪瘤的发生率及其与腹股沟疝的关系。此外，当在腹腔镜腹膜前疝修补术中发现脂肪瘤时，在手术时和再次回顾录像带时对脂肪瘤的解剖进行了研究。结果腹腔镜下腹股沟疝修补术共199例，男性192例，女性25例。脊髓脂肪瘤63例，发生率为22.5%。总的来说，18例在腹股沟发现脊髓脂肪瘤，无疝，其中10例在手术前被发现（2例通过体格检查，7例通过腹股沟超声检查，1例通过磁共振成像）。其余9例在手术前被误诊为疝气。其中14例患者表现为腹股沟疼痛，4例无症状。45例脂肪瘤伴疝，其中43例经检查为疝。32例（51%）脊髓脂肪瘤合并间接疝，11例（17%）合并直接疝，1例合并下肢疝和股疝。在女性中发现9例脂肪瘤，7例表现为腹股沟疼痛，6例未发现相关腹膜缺损，2例在腹腔镜疝修补后出现症状性脊髓脂肪瘤。精索脂肪瘤是一种脂肪疝出，似乎起源于精索内筋膜外侧和后方的腹膜后脂肪，并通过精索外侧的内环突出。除非人工减少，否则经腹腔检查通常不可见。结论脊髓及圆韧带脂肪瘤发生率高。在没有真正疝（与腹膜缺损相关）的情况下，它们可引起疝型症状。在腹股沟疼痛且检查结果正常的患者中应考虑这些因素，在腹腔镜疝修补术时容易被忽视，从而导致效果不理想。
Objective To determine the incidence, significance, and anatomy of spermatic cord and round ligament lipomas.Methods This was a retrospective review of 280 hernia repairs on 217 patients performed by a single surgeon (M.E.A.) from January 1996 to January 2000. The incidence of cord lipoma and relationship to inguinal hernia were evaluated. Further, when identified at the time of laparoscopic preperitoneal hernia repair, the anatomy of the lipomas was studied both at the time of surgery and again on review of videotapes.Results One hundred ninety-nine laparoscopic and 81 open inguinal hernia repairs were performed on 192 male patients and 25 female patients. Sixty-three lipomas of the cord were identified for an incidence of 22.5%. Overall, 18 cord lipomas were found in groins without hernias, and these were identified before surgery in 10 (2 by physical examination, 7 by groin ultrasound, and 1 by magnetic resonance imaging). The remaining nine were misidentified as a hernia before surgery. Fourteen of these patients presented with groin pain and four were asymptomatic. Forty-five lipomas were associated with hernias and were characterized as a hernia by examination in 43 instances. There were 32 (51%) cord lipomas associated with indirect hernias, 11 (17%) with direct hernias, and 1 each with pantaloon and femoral hernias. Nine lipomas were found in women, seven presenting with groin pain and six found without an associated peritoneal defect, Two patients presented with symptomatic cord lipomas after laparoscopic hernia repair. A lipoma of the cord is herniated fat that appears to originate from the retroperitoneal fat outside and posterior to the internal spermatic fascia and protrudes through the internal ring lateral to the cord. They are generally not visible by transperitoneal inspection unless manually reduced.Conclusions Lipomas of the cord and round ligament occur with a significant incidence. They can cause hernia-type symptoms in the absence of a true hernia (associated with a peritoneal defect). They should be considered in the patient with groin pain and normal examination results, They can be easily overlooked at the time of laparoscopic hernia repair, and this can lead to an unsatisfactory result.