腹内疝37例临床分析.DOCVIP

临床医学论文-腹内疝37例临床分析 【摘要】? 目的 探讨腹内疝发生的病因，提高对该病的认识、诊断及治疗水平。方法 对我院经手术证实的37例腹内疝临床资料进行回顾分析。结果 剖腹探查手术证实为横结肠系膜裂孔疝1例；闭孔疝1例；盲肠旁疝1例；毕Ⅱ式结肠前吻合术后输出段空肠疝入输入段空肠与横结肠系膜间隙6例；Miles术后盆底腹膜裂开所致内疝5例；Miles术后降结肠与侧腹壁形成的间隙致内疝4例；大网膜与乙状结肠造口肠壁粘连形成内疝1 例；1例在梅克尔憩室基础上发生炎性粘连形成腹内疝；因腹腔粘连带与腹膜、腹腔脏器、肠壁、肠与肠之间的孔隙改变形成内疝17例（48．7%）。结论 腹内疝临床较少见，术前诊断困难，均以肠梗阻收入，对有手术史及腹部外伤史，考虑腹内疝者，应及时手术，以防发生肠绞窄、肠坏死。 【关键词】? 腹内疝；诊断；治疗 　　Abstract： Objective? To discuss the causes of internal abdominal hernia so as to increase the diagnostic and therapeutic ability.Methods? Retrospective analysis was done on 37 patients with internal abdominal hernia comfirmed by surgical operation.Results?One case with transverse mesocolon pore hernia, one with obturator hernia and one with paracecal hernia were confirmed by exploratory laparotomy. There were six cases whose hernias resulted from the fall of export jejuna into import jejuna after Billroth II anastomoses in front of colons, five from the pelvic bottoms peritoneal fissure and four from the fissure appearing between descending colon and lateral abdominal wall after Miles operation, one from greater omental adhesion to sigmoidal wall after sigmoidostomy, and one from inflammatory adhesion on the basis of Meckels diverticulum. The other 17 cases hernias (48.7%) were caused by the fissure among celiac adhesive bands, peritonea, celiac organs, enteric walls and intestines. Conclusion?The patients of internal abdominal hernia with operation or injury history in abdomen, who are inclined to be admitted to hospital as ileus due to diagnostic difficulty, should be surgically operated at early stage so that intestinal strangulation and necrosis can be prevented. 　　Key? words：? internal abdominal hernia; diagnosis; therapy ??? 腹内疝以机械性肠梗阻为主要临床表现，起病急，发展快，严重者可导致肠管绞窄坏死。一旦考虑此病应立即手术治疗，并妥善处理并发症。腹内疝性肠梗阻术前确诊较困难，手术探查是明确诊断与治疗此病的主要手段。腹部各种手术应严格遵守技术要求，防止出现异常孔隙、减少粘连因素是避免术后腹内疝的关键。1998年9月—2005年8月我们共收治腹内疝性肠梗阻37例，现对其病因、诊治及预防问题探讨如下。 　　1? 临床资料 　　11? 一般资料? 　　本组37例，男25例，女12例，年龄16~67岁，平均39岁，发病至手术时间为8 h~2个月，平均4 d。 　　1．2