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小兒腹股溝滑疝的病因、發(fā)病機理、診斷和鑒別診斷
【關(guān)鍵詞】 小兒;腹股溝滑疝;病因;發(fā)病機理;診斷;鑒別診斷
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 infants.Methods 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 diagnosis.Results 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 infants.and 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 made.Conclusion 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
腹股溝滑疝是腹股溝疝的一種特殊類型,發(fā)病率相當(dāng)?shù)?發(fā)病機理尚不十分明確,術(shù)前不易診斷,手術(shù)處理與其他腹股溝斜疝有所不同。鑒于此,我們收集這方面的病例病因和文獻資料,對其病因、發(fā)病機理、診斷和鑒別診斷進行分析研究。
1 對象與方法
從我院2002年1月~2005年2月收治小兒腹股溝斜疝290例中選取腹股溝滑疝13例的臨床病歷資料,并查閱國內(nèi)外有關(guān)文獻,著重對小兒腹股溝滑疝的病因、發(fā)病機理、診斷和鑒別診斷進行分析研究。
2 結(jié)果
2.1 臨床主要表現(xiàn)
同期收治小兒腹股溝斜疝290例中腹股溝滑疝13例,占4.5%。男3例,女10例,男女比為1:3.3。年齡18天~2歲4個月,平均1歲。病史1天~2年,平均9個月。13例除1例雙側(cè)疝(左側(cè)斜疝,右側(cè)滑疝)外,其余12例均為單側(cè)滑疝(左側(cè)7例,右側(cè)5例)。體格檢查:男孩疝塊較大,約3cm×3cm×5cm~4cm×4cm×5cm;女孩疝塊較小,約2cm×2cm×3cm~3cm×3cm×4cm。3例為嵌頓疝,手法復(fù)位失敗,6例復(fù)位困難或難以完全復(fù)位,復(fù)位后內(nèi)環(huán)及其下方有組織增厚感,疝內(nèi)容物易再次脫出。B超檢查:10例在疝內(nèi)容物突出的情況下進行了B超檢查,其中6例探及混合性回聲團,內(nèi)有氣體回聲團或腸蠕動;4例僅探及混合性回聲團;雠K器:女孩均為輸卵管和/或卵巢,其中1例右側(cè)卵巢、輸卵管及子宮角均滑出。男孩均為盲腸及闌尾。13例均采用Bevan術(shù)式,其中1例因滑出闌尾水腫,加闌尾切除術(shù)。3例嵌頓疝及8例內(nèi)環(huán)擴大者,縫合縮小內(nèi)環(huán)至1指尖。術(shù)中未誤傷滑出臟器,切口甲級愈合,未出現(xiàn)傷口血腫、積液等并發(fā)癥,術(shù)后隨訪1個月~4年,未見復(fù)發(fā)。
2.2 病理檢查結(jié)果
其中5例疝囊組織送病理科檢查。4例顯示疝囊壁主要由纖維結(jié)締組織構(gòu)成,血管擴張充血和輕度水腫,1例除上述改變外,尚發(fā)生粘液變性。
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