老年嵌顿性闭孔疝患者的诊治

doi:10.3877/cma.j.issn.1674-392X.2026.05.008

目的

探讨老年嵌顿性闭孔疝的临床特点及诊疗方法。

方法

回顾分析2013年10月至2022年10月安徽医科大学安庆医学中心收治的37例急诊嵌顿性闭孔疝患者的临床资料，并分析其诊疗过程及临床表现。

结果

患者均为老年女性，来自安庆农村地区，所有患者都因肠梗阻症状急诊入院，经术前急诊CT扫描诊断明确，4例放弃治疗，33例急诊行剖腹探查术，均行闭孔疝缝合修补术，其中32例恢复良好，痊愈出院，平均住院时间12.3 d。1例患者术后第2天因感染性休克、多器官衰竭无法纠正导致死亡；随访期间1例患者2年后复发；1例患者异时性闭孔疝嵌顿再次手术。

结论

腹盆腔CT扫描是诊断嵌顿性闭孔疝的一种有效检查方法，嵌顿性闭孔疝患者急诊手术是关键，手术推荐经腹腔内途径，对闭孔管进行缝合修补是一种简单易行、安全可靠的手术方式，适合在基层医院开展。术中应仔细探查对侧，在不增加风险的同时对高危患者建议预防性缝合修补。

关键词: 肠梗阻, 嵌顿性闭孔疝, 外科手术, 回顾性分析

Objective

To investigate the clinical characteristics, diagnosis, and treatment of incarcerated obturator hernia in elderly patients.

Methods

The clinical data of 37 patients with incarcerated obturator hernia who were admitted to Anqing Medical Center of Anhui Medical University for emergency treatment between October 2013 and October 2022 were retrospectively analyzed. The diagnostic and therapeutic procedures and clinical manifestations were analyzed.

Results

All 37 patients were elderly women from rural areas of Anqing and were admitted to the emergency department with symptoms of intestinal obstruction. The diagnosis was confirmed by emergency preoperative computed tomography (CT) in all patients. Four patients declined further treatment, while the remaining 33 underwent emergency exploratory laparotomy and suture repair of the obturator hernia. Of these, 32 patients recovered well and were discharged after recovery, with a mean hospital stay of 12.3 days. One patient died on the second postoperative day due to refractory septic shock and multiple organ failure. During follow-up, one patient experienced recurrence two years after surgery, and another required reoperation for metachronous incarceration of an obturator hernia.

Conclusion

Abdominal and pelvic CT is an effective imaging modality for diagnosing incarcerated obturator hernia. Emergency surgical intervention is essential for patients with incarcerated obturator hernia. A transabdominal approach is recommended, and suture repair of the obturator canal is a simple, feasible, safe, and reliable surgical technique suitable for use in primary hospitals. The contralateral side should be carefully explored during surgery, and prophylactic suture repair is recommended for high-risk patients, provided that it does not increase surgical risk.

Key words: Intestinal obstruction, incarcerated obturator hernia, surgical treatment, retrospective study

表1 37例急诊嵌顿性闭孔疝患者一般临床资料

患者	年龄(岁)	体重(kg)	身高(cm)	体重指数(kg/m²)	部位	顺产次数	手术方式	住院时间(d)
1	76	36	142	17.85	左	5	A	14
2	71	38	145	18.07	右	4	B	11
3	77	40	150	17.78	左	3	A	10
4	87	42	149	18.92	右	7	B	14
5	72	41	151	17.98	右	4	A	15
6	64	39	146	18.3	右	4	A	5
7	75	46	160	17.97	右	5	B	13
8	78	42	152	18.18	右	5	B	13
9	80	41	150	18.22	左	6	B	12
10	73	42	150	18.67	右	5	A	8
11	64	36	140	18.37	右	4	A	14
12	77	36	143	17.6	右	5	B	13
13	84	38	150	16.89	右	4	B	16
14	66	40	148	18.26	右	3	B	12
15	82	45	150	20.00	左	6	A	14
16	84	31	130	18.34	左	8	A	10
17	85	40	148	18.26	右	5	A	8
18	68	38	157	15.42	左	4	A	13
19	74	40	163	15.06	左	4	A	17
20	79	35	145	16.65	右	5	B	12
21	81	40	150	17.78	右	6	B	10
22	83	35	145	16.65	左	5	B	13
23	84	38	145	18.07	左	4	A	17
24	83	41	146	19.23	左	6	A	15
25	70	40.5	155	16.86	右	3	A	12
26	84	30	135	16.46	右	6	A	13
27	86	31	140	15.82	左	5	B	22
28	87	34.7	150	15.42	右	6	A	14
29	86	41	151	17.98	右	4	A	11
30	86	36	150	16.00	右	6	A	1
31	75	26	120	18.06	左	4	A	8
32	76	24.6	120	17.08	右	4	B	15
33	88	37	151	16.23	右	4	A	11
34	85	35	150	15.56	左	3	未手术	1
35	83	33	140	16.84	右	5	未手术	1
36	66	32	135	17.56	左	3	未手术	1
37	81	36	142	17.85	右	4	未手术	1

表1 37例急诊嵌顿性闭孔疝患者一般临床资料

患者	年龄(岁)	体重(kg)	身高(cm)	体重指数(kg/m²)	部位	顺产次数	手术方式	住院时间(d)
1	76	36	142	17.85	左	5	A	14
2	71	38	145	18.07	右	4	B	11
3	77	40	150	17.78	左	3	A	10
4	87	42	149	18.92	右	7	B	14
5	72	41	151	17.98	右	4	A	15
6	64	39	146	18.3	右	4	A	5
7	75	46	160	17.97	右	5	B	13
8	78	42	152	18.18	右	5	B	13
9	80	41	150	18.22	左	6	B	12
10	73	42	150	18.67	右	5	A	8
11	64	36	140	18.37	右	4	A	14
12	77	36	143	17.6	右	5	B	13
13	84	38	150	16.89	右	4	B	16
14	66	40	148	18.26	右	3	B	12
15	82	45	150	20.00	左	6	A	14
16	84	31	130	18.34	左	8	A	10
17	85	40	148	18.26	右	5	A	8
18	68	38	157	15.42	左	4	A	13
19	74	40	163	15.06	左	4	A	17
20	79	35	145	16.65	右	5	B	12
21	81	40	150	17.78	右	6	B	10
22	83	35	145	16.65	左	5	B	13
23	84	38	145	18.07	左	4	A	17
24	83	41	146	19.23	左	6	A	15
25	70	40.5	155	16.86	右	3	A	12
26	84	30	135	16.46	右	6	A	13
27	86	31	140	15.82	左	5	B	22
28	87	34.7	150	15.42	右	6	A	14
29	86	41	151	17.98	右	4	A	11
30	86	36	150	16.00	右	6	A	1
31	75	26	120	18.06	左	4	A	8
32	76	24.6	120	17.08	右	4	B	15
33	88	37	151	16.23	右	4	A	11
34	85	35	150	15.56	左	3	未手术	1
35	83	33	140	16.84	右	5	未手术	1
36	66	32	135	17.56	左	3	未手术	1
37	81	36	142	17.85	右	4	未手术	1

图1 同一患者2次术前CT表现注：1A为右侧嵌顿闭孔疝；1B为右侧复发，左侧闭孔管增大。

图2 同一患者2次住院术前CT情况注：2A为左侧嵌顿性闭孔疝，右侧正常；2B为右侧嵌顿性闭孔疝，左侧正常。

图3 嵌顿性闭孔疝患者行嵌顿疝松解复位＋部分小肠切除术＋闭孔疝缝合修补术注：3A为术中见右侧闭孔管内肠管嵌顿；3B为复位后见小肠坏死；3C为探查增大的闭孔管；3D为缝合修补后创面。

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Diagnosis and treatment of incarcerated obturator hernia in elderly patients

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Diagnosis and treatment of incarcerated obturator hernia in elderly patients