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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (06) : 706 -710. doi: 10.3877/cma.j.issn.1674-392X.2023.06.010

论著

闭孔疝的诊断与治疗：10年73例患者诊疗经验总结
姜明†(), 罗锐, 龙成超   
  1. 638000　四川大学华西广安医院胃肠外科
  • 收稿日期:2023-08-17 出版日期:2023-12-18
  • 通信作者: 姜明

Diagnosis and treatment of obturator hernia: An experience of 73 cases over 10 years

Ming Jiang†(), Rui Luo, Chengchao Long   

  1. Department of Gastrointestinal Surgery, Guang'an People's Hospital, Guang'an 638000, China
  • Received:2023-08-17 Published:2023-12-18
  • Corresponding author: Ming Jiang
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引用本文：

姜明, 罗锐, 龙成超. 闭孔疝的诊断与治疗：10年73例患者诊疗经验总结[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 706-710.

Ming Jiang, Rui Luo, Chengchao Long. Diagnosis and treatment of obturator hernia: An experience of 73 cases over 10 years[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(06): 706-710.

目的

总结讨论闭孔疝的临床特点、诊疗方法及预后复发情况。

方法

回顾性分析2009年1月至2019年6月四川大学华西医院及四川大学华西广安医院所有因闭孔疝入院行手术治疗患者的临床资料，包括人口学特征、手术时间、出血量、术后并发症、死亡率、住院时间等。

结果

两院数据库共检索出73例患者，年龄59~103岁，其中59例急诊患者，14例平诊患者；女性患者71例（94.2%），孕产次数1~12次，平均（4.86±2.64）次。70例（95.9%）患者术前CT明确诊断，合并肠梗阻者55例（75.3%）；所有患者中30 d内再入院者5例（6.8%）；30 d内死亡者4例（5.5%）。急诊手术的手术时间长于择期手术[（101.4±28.9）min vs（68.6±17.0）min]，差异有统计学意义（P<0.001），出血量较择期手术多[（21.3±22.7）ml vs（9.6±5.4）ml]，差异有统计学意义（P=0.013）。59例急诊手术患者采用下腹正中切口，44例（74.6%）术中发现合并嵌顿，疝囊内容物为小肠者50例（84.7%），行肠切除者24例（40.7%），14例（23.7%）患者出现术后并发症，住院时间2~32 d，平均（9.3±5.3）d，3例（5.1%）患者在随访过程中复发；14例择期手术患者也采用下腹正中切口，疝内容物为脂肪者8例（57.1%），无行肠切除者，术后1例（7.1%）患者出现并发症，住院时间2~31 d，平均（8.4±6.8）d，无30 d内死亡患者，3例（21.4%）患者术后出现复发。

结论

闭孔疝引起的嵌顿性肠梗阻是患者急诊就诊的主要原因，CT可在术前准确诊断该病，嵌顿性闭孔疝诊疗的关键在于及早的诊断和探查以避免肠管坏死所带来的不良后果。

关键词: 疝，闭孔, 诊断, 治疗, 预后, 复发
Objective

To summarize the clinical characteristics, diagnosis and treatment of obturator hernia and its prognosis and recurrence.

Methods

The clinical data of all patients with obturator hernia who underwent surgery from January 2009 to June 2019 in West China Hospital of Sichuan University and Guang'an People's Hospital were retrospectively analyzed, including demographic characteristics, operation time, blood loss, postoperative complications, mortality, length of stay, etc.

Results

A total of 73 patients (age 59-103 y) were retrieved from the databases of the two hospitals, including 59 cases of emergency patients and 14 cases of elective patients. There were 71 female patients (94.2%), the average number of pregnancies was 4.86±2.64 ( range 1-12). 70 cases (95.9%) were diagnosed by CT before operation, 55 cases (75.3%) were complicated with intestinal obstruction; 5 cases (6.8%) were readmitted within 30 days; 4 cases (5.5%) died within 30 days. The operation time of emergency operation was significantly longer than that of elective operation [(101.4±28.9) min vs (68.6±17.0) min, P<0.001)], and the amount of blood loss was significantly higher than that of elective operation [(21.3±22.7) ml vs (9.6±5.4) ml, P=0.013)]. 59 cases of emergency patients underwent lower abdominal midline incision. Incarceration was found in 44 cases (74.6%). 50 cases (84.7%) of hernia sac contained small intestine, 24 cases (40.7%) underwent intestinal resection, and 14 cases (23.7%) had postoperative complications. The average length of stay was (9.3±5.3) d (range 2-32 d), and 3 (5.1%) patients had recurrence during the follow-up. All 14 cases of elective patients underwent lower abdominal midline incision, and 8 (57.1%) patients had hernia contents with fat, and there was no intestinal resection. One patient (7.1%) had postoperative complications, and the average length of stay was (8.4±6.8) d (range 2-31 d). No patients died within 30 days. 3 patients (21.4%) had postoperative recurrence.

Conclusion

Incarcerated intestinal obstruction caused by obturator hernia is the main reason for emergency treatment; CT can accurately diagnose the disease before operation. The key to diagnosis and treatment of incarcerated obturator hernia is early diagnosis and exploration to avoid the adverse consequences of intestinal necrosis.

Key words: Hernia, obturator, Diagnosis, Treatment, Prognosis, Recurrence
表1 急诊与择期手术相关指标比较
项目 急诊(n=59) 择期(n=14) P 项目 急诊(n=59) 择期(n=14) P
ASA分级[例(%)]     1.000 其他部位疝(腹股沟疝、股疝、腰疝)[例(%)] 5( 8.5) 1( 7.1) 0.676
Ⅱ 22(37.3) 5(35.7)   坏死肠段切除[例(%)] 24(40.7) 0 0.030
Ⅲ 36(61.0) 9(64.3)   术后并发症[例(%)] 14(23.7) 1( 7.1) 0.311a
Ⅳ 1( 1.7) 0   肺部感染 5 1  
出现症状至手术时间[d, M(Q1~Q3)] 3(1.0~9.0) 7.5(3.0~365.0) - 术后胃肠道功能障碍 3 0  
手术时间(min,±s,范围) 101.4±28.9(60~180) 68.6±17.0(60~120) <0.001 切口感染 2 0  
失血量(ml,±s,范围) 21.3±22.7( 5~100) 9.6±5.4(5~20) 0.013 感染性休克 2 0  
合并肠梗阻[例(%)] 53(89.8) 0 <0.001 慢性阻塞性肺疾病急性加重 1 0  
嵌顿[例(%)] 44 74.6) 0 <0.001 多器官功能衰竭 1 0  
疝囊内容物[例(%)]     <0.001 并发症Clavien-Dindo分级[例(%)]     -
无 0 2(14.3)   Ⅰ~Ⅱ 5(35.7) 1(100.0) -
小肠 55(85.9) 2(14.3)   Ⅲ~Ⅳ 7(50.0) 0  
大网膜 2( 3.1) 2(14.3)   Ⅴ 2(14.3) 0  
肠系膜 3( 4.7) 0   术后转入ICU[例(%)] 22(37.3) 1( 7.1) 0.029b
大肠 1( 1.6) 0   术后住院天数(d,±s,范围) 8.3±5.3(1~31) 7.3±6.8 (1~30) 0.534
脂肪 3( 4.7) 8(57.1)   总住院天数(d,±s,范围) 9.3±5.3(2~32) 8.4±6.8(2~31) 0.576
有无对侧隐匿性疝[例(%)]     <0.001 术后30 d内死亡[例(%)] 4( 6.8) 0  
有 10(16.9) 1( 7.1)   术后复发[例(%)] 3( 5.5) 3(21.4) 0.173a
无 46(78.0) 6(42.9)   出院到复发时间[月, M(Q1~Q3)] 3(2~12) 8(6~14) -
初诊即为双侧 3( 5.1) 7(50.0) -
[1]
Ziegler DW, Rhoads JE. Obturator hernia needs a laparotomy, not a diagnosis[J]. Am J Surg, 1995, 170(1): 67-68.
[2]
Nasir BS, Zendejas B, Ali SM, et al. Obturator hernia: the Mayo Clinic experience[J]. Hernia, 2012, 16(3): 315-319.
[3]
Gilbert JD, Byard RW. Obturator hernia and the elderly[J]. Forensic Sci Med Pathol, 2019, 15(3): 491-493.
[4]
Caine EA, Newman TH, Marzouk O, et al. Subacute bowel obstruction secondary to an obturator hernia: case report and a review of the literature[J]. J Surg Case Rep, 2017, 2017(4): rjx061.
[5]
Liu KL, Shih IL, Chang CC. Small-Bowel Obstruction Due to Obturator Hernia[J]. Am J Gastroenterol, 2016, 111(4): 453.
[6]
Rodriguez-Hermosa JI, Codina-Cazador A, Maroto-Genover A, et al. Obturator hernia: clinical analysis of 16 cases and algorithm for its diagnosis and treatment[J]. Hernia, 2008, 12(3): 289-297.
[7]
Chan KV, Chan CK, Yau KW, et al. Surgical morbidity and mortality in obturator hernia: a 10-year retrospective risk factor evaluation[J]. Hernia, 2014, 18(3): 387-392.
[8]
Marchal F, Parent S, Tortuyaux J, et al. Obturator hernias - report of seven cases[J]. Hernia, 1997, 1(1): 23-26.
[9]
Kammori M, Mafune K, Hirashima T, et al. Forty-three cases of obturator hernia[J]. Am J Surg, 2004, 187(4): 549-552.
[10]
Karasaki T, Nomura Y, Tanaka N. Long-term outcomes after obturator hernia repair: retrospective analysis of 80 operations at a single institution[J]. Hernia, 2014, 18(3): 393-397.
[11]
Mahendran B, Lopez PP. obturator, hernia[J/OL]. StatPearls [Internet],[2023-01-30],

URL    
[12]
Stamatiou D, Skandalakis LJ, Zoras O, et al. Obturator hernia revisited: surgical anatomy, embryology, diagnosis, and technique of repair[J]. Am Surg, 2011, 77(9): 1147-1157.
[13]
Sa NC, Silva VCM, Carreiro PRL, et al. Rare case of incarcerated obturator hernia: Case report and review of literature[J]. Int J Surg Case Rep, 2017, 37: 157-160.
[14]
Light D, Razi K, Horgan L. Computed tomography in the investigation and management of obturator hernia[J]. Scott Med J, 2016, 61(2): 103-105.
[15]
Ijiri R, Kanamaru H, Yokoyama H, et al. Obturator hernia: the usefulness of computed tomography in diagnosis[J]. Surgery, 1996, 119(2): 137-140.
[16]
Wu TC, Lu Q, Liang XH. Efficacy of emergency exploratory laparotomy in incarcerated obturator hernia[J]. Acta Chir Belg, 2018, 118(2): 105-109.
[17]
Hisamatsu Y, Yamagata M, Miyazaki M, et al. Impact of bowel resection on postoperative mortality in patients with obturator hernias[J]. Hernia, 2019, 23(2): 317-322.
[18]
Dimitrios S, Lee JS, Odysseas Z, et al. Obturator hernia revisited: surgical anatomy, embryology, diagnosis, and technique of repair[J]. Am Surg, 2011, 77(9): 1147-1157.
[19]
Bergstein JM, Condon RE. Obturator hernia: current diagnosis and treatment[J]. Surgery, 1996, 119(2): 133-136.
[20]
Yokoyama T, Kobayashi A, Kikuchi T, et al. Transabdominal preperitoneal repair for obturator hernia[J]. World J Surg, 2011, 35(10): 2323-2327.
[21]
Chihara N, Suzuki H, Sukegawa M, et al. Is the Laparoscopic Approach Feasible for Reduction and Herniorrhaphy in Cases of Acutely Incarcerated/Strangulated Groin and Obturator Hernia?: 17-Year Experience from Open to Laparoscopic Approach[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(5): 631-637.
[22]
陈革, 唐健雄. 盆底疝中闭孔疝的手术治疗[J/OL]. 中华疝和腹壁外科杂志(电子版), 2012, 6(3): 826-827.
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