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摘要: 为探讨闭孔疝性肠梗阻的临床诊断与治疗策略，回顾性分析2006年9月—2021年8月我院诊治过的31例闭孔疝性肠梗阻患者的临床资料，总结其临床诊断及治疗经验，除1例患者拒绝手术要求保守治疗外，30例患者行手术治疗，其中25例接受开腹手术治疗，5例患者接受腹腔镜手术治疗，其中腹腔镜中转开腹1例；15例患者合并肠绞窄肠坏死，行肠切除肠吻合术、疝囊高位结扎术。30例的手术患者中有5例患者为肠管壁疝(Richter疝)，其肠管扩张程度均较轻。疝补片修补手术8例，均发病时间短、无肠绞窄肠坏死，其中经腹开腹手术放置补片4例，经腹腔镜经腹手术放置补片2例，经腹腔镜探查后行腹腔镜腹膜外手术放置补片2例。1例患者拒绝手术治疗并自动出院。28例手术患者治愈出院(住院时间4~31 d，中位11 d)，其中5例患者术后出现肺部感染、切口感染，经治疗后均治愈出院；2例患者术后因感染性休克、肺部感染等并发症出现死亡。出院后患者随访4个月~2年，均未出现补片感染及肠梗阻症状。闭孔疝性肠梗阻是一种临床少见的疾病，其好发于多次妊娠的老年女性，常合并低体重指数，临床症状轻重程度不一，术前临床诊断困难，易延误诊治，术前腹部CT可明确诊断。提示临床多次妊娠的老年女性患者若出现不明原因的肠梗阻，需尽早完善腹部CT检查，早诊断并及时进行外科手术。可采用开腹或腹腔镜手术，根据嵌顿肠管情况，采用疝囊高位结扎或补片修补手术。Abstract: In order to explore the clinical diagnosis and treatment strategy of obturator hernia ileus, the clinical data of 31 patients with obturator hernia intestinal obstruction diagnosed and treated from September 2006 to August 2021 were retrospectively analyzed, and their clinical diagnosis and treatment experience were summarized. One patient refused surgery and requested conservative treatment; 30 patients underwent surgical treatment, of which 25 received laparotomy, 5 patients received laparoscopic surgery, including 1 case of conversion from laparoscopy to laparotomy; 15 patients with intestinal strangulation and necrosis underwent intestinal resection, intestinal anastomosis and high ligation of hernia sac. Of the 30 patients undergoing surgery, 5 patients had intestinal wall hernias(Richter hernia), and the degree of intestinal dilatation was mild. There were 8 cases of hernia patch repair surgery, all of which were short onset time and no intestinal strangulation intestinal necrosis. Among them, 4 cases were placed through abdominal laparotomy, and 2 cases were placed through laparoscopic surgery. 2 case of patch placement under laparoscopic extraperitoneal surgery after laparoscopic exploration. One patient refused surgical treatment and was discharged automatically. 28 surgical patients were cured and discharged(hospitalization time was 4 to 31 days, with a median of 11 days). Among them, 5 patients developed pulmonary infection and incision infection after the operation, and were cured and discharged after treatment; Two patients died of infectious shock, pulmonary infection and other complications after operation. The patients were followed up for 4 months to 2 years after discharge, and no patch infection and intestinal obstruction symptoms were found. Obturator hernia ileus is a rare disease in clinic. It often occurs in elderly women with multiple pregnancies. It is often combined with low body mass index. The severity of clinical symptoms is different. Preoperative clinical diagnosis is difficult and easy to delay diagnosis and treatment. Preoperative abdominal CT can make a definite diagnosis. If the elderly women with multiple pregnancies have unexplained intestinal obstruction, abdominal CT examination should be improved as soon as possible, early diagnosis and timely surgery should be carried out. Laparotomy or laparoscopy can be used. High ligation or patch repair of hernia sac shall be performed according to the condition of incarcerated intestinal tube.
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Key words:
- obturator hernia /
- intestinal obstruction /
- diagnosis /
- treatment
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