小儿腹股沟滑疝的病因、发病机理、诊断和鉴别诊断
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【关键词】 小儿;腹股沟滑疝;病因;发病机理;诊断;鉴别诊断
The etio-pathogenesis,diagnosis and differential diagnosis of inguinal extrasaccular hernia in infants
【Abstract】 Objective To study the etiopathogenisis, diagnosis and differential diagnosis of inguinal extrasaccular hernia in ods 13cases of inguinal extrasaccular hernia out of 290 cases of inguinal hernia in our hospital were investigated with referating the leterture, and focused the attention on its etidogy, pathogenisis and diagnosis,differential lts To reveal that the incidence of inguinal extrasaccular heruia in femal infants was much more than that in male infants, and the sliding substance of extrasaccular hernia were ovary and fallopian tube in femal infants and cecum,appendix and sigmoid in male the ligmenta suspersorium orarii and mesentery of cecum and sigmoid moved more easily. Its etiopathogenesis had relation to that the ovary and fallopian tube approached the inguinal inner circle and the mesentery of cecum and sigmoid moved more easily. The clinical features of inguinal extrasaccular hernia were similar to other inguinal oblique hernia, so that misdiagnosis was easily lusion Inguinal extrasaccular hernias in infants were due to congenital dysplasia of inguinal inner cirele and movable organs in abdominal cavity slided from abdominal cavity. Its clinical features were similar to general inguinal oblique hernia and that must careful be distinguished. Consideration for its etiopathogenesis can help to make correct diagnosis.
【Key words】 infants;inguinal extrasaccular hernia;etio-pathogenesis;diagnosis;differential diagnosis
腹股沟滑疝是腹股沟疝的一种特殊类型,发病率相当低,发病机理尚不十分明确,术前不易诊断,手术处理与其他腹股沟斜疝有所不同。鉴于此,我们收集这方面的病例病因和文献资料,对其病因、发病机理、诊断和鉴别诊断进行分析研究。
1 对象与方法
从我院2002年1月~2005年2月收治小儿腹股沟斜疝290例中选取腹股沟滑疝13例的临床病历资料,并查阅国内外有关文献,着重对小儿腹股沟滑疝的病因、发病机理、诊断和鉴别诊断进行分析研究。
2 结果
2.1 临床主要表现
同期收治小儿腹股沟斜疝290例中腹股沟滑疝13例,占4.5%。男3例,女10例,男女比为1:3.3。年龄18天~2岁4个月,平均1岁。病史1天~2年,平均9个月。13例除1例双侧疝(左侧斜疝,右侧滑疝)外,其余12例均为单侧滑疝(左侧7例,右侧5例)。体格检查:男孩疝块较大,约3cm×3cm×5cm~4cm×4cm×5cm;女孩疝块较小,约2cm×2cm×3cm~3cm×3cm×4cm。3例为嵌顿疝,手法复位失败,6例复位困难或难以完全复位,复位后内环及其下方有组织增厚感,疝内容物易再次脱出。B超检查:10例在疝内容物突出的情况下进行了B超检查,其中6例探及混合性回声团,内有气体回声团或肠蠕动;4例仅探及混合性回声团。滑出脏器:女孩均为输卵管和/或卵巢,其中1例右侧卵巢、输卵管及子宫角均滑出。男孩均为盲肠及阑尾。13例均采用Bevan术式,其中1例因滑出阑尾水肿,加阑尾切除术。3例嵌顿疝及8例内环扩大者,缝合缩小内环至1指尖。术中未误伤滑出脏器,切口甲级愈合,未出现伤口血肿、积液等并发症,术后随访1个月~4年,未见复发。
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