摘要
嵌顿性和绞窄性腹股沟疝需要急诊治疗,其诊断主要根据临床症状和体征,CT检查可确定疝内容物的性质并有助于判断嵌顿肠管的活性。对于嵌顿时间4~6 h以内病人可尝试手法复位,复位成功病人应尽快手术;对可疑肠坏死及手法复位失败病人建议急诊手术。手术方式可先采用腹腔镜探查明确有无肠坏死,如无肠坏死可考虑应用大网孔轻量型补片或生物补片行经腹腹膜前疝修补术(TAPP)、全腹膜外疝修补术(TEP)或开放无张力疝修补术,如腔镜探查见肠坏死或术前已明确肠坏死的病人,建议正中切口行肠切除吻合,二期再行疝修补。
Incarcerated and strangulated inguinal hernias require emergency treatment,and their diagnosis is mainly made on the basis of clinical signs and symptoms,and CT examination identifies the nature of the herniated contents and helps to judge the activity of the incarcerated bowel.For patients with incarceration time less than 4 to 6 h,the manual reduction can be attempted,and patients with a successful reduction should be operated on as soon as possible;Emergency surgery is recommended for patients with suspected intestinal necrosis and failure of manual reduction.The surgical approach may be initiated by laparoscopic exploration for the definite presence or absence of bowel necrosis,patients with no intestinal necrosis can be considered using large mesh light-weight mesh,or biological mesh for TAPP,TEP or open tension-free hernia repair;In patients with intestinal necrosis on endoscopic exploration or in whom preoperative bowel necrosis has been clearly established,median incision with bowel resection and anastomosis with secondary hernia repair is recommended.
作者
翁山耕
陈易平
刘国忠
张翔
WENG Shan-geng;CHEN Yi-ping;LIU Guo-zhong(Department of Hepatopancreatobiliary and Hernia Surgery,Fujian Abdominal Surgery Research Institute,the First Afiliated Hospital of Fujian Medical University,The National Regional Medical Center of Binhai Hospital,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2023年第6期671-675,共5页
Chinese Journal of Practical Surgery
基金
福建省医疗“创双高”建设项目(闽财指[2021]662号)。
关键词
腹股沟疝
嵌顿
绞窄
急诊手术
inguinal hernia
incarceration
strangulation
emergency surgery
