疝气课件——美国西奈山医学院.ppt

HERNIAS Marcelyn Coley Mount Sinai School of Medicine Basic Science Lecture Historical Perspective 15th century - Castration with wound cauterization or hernia sac debridement recommended a truss Father of Modern Inguinal Hernia Repair Hernia Latin for rupture an abnormal protrusion of an organ or tissue through a defect in its surrounding walls Occur at sites where aponeurosis and fascia are not covered by striated muscle Which of the following statements is/are true regarding incidence of the abdominal wall hernia? Two-thrirds of all inguinal hernias are classified as indirect. Femoral hernias are more common in females than in males. Direct hernias are common in females. Hernias generally occur with equal frequency in males and females Premature babies have a 10% incidence of having inguinal hernia. Epidemiology 700,000 hernia repairs year Inguinal hernias -75% of all hernias 2/3 Indirect, remainder are direct Incisional hernias – 15 to 20% Umbilical and epigastric – 10% Femoral – 5% Epidemiology Prevelance of hernias increases with age Most serious complication – strangulation 1 to 3% of groin hernias Femoral – highest rate of complications 15% to 20% recommended all be repaired at time of discovery Abdominal Wall Anatomy Anatomy Inguinal ligament (Poupart’s) – inferior edge of external oblique Lacunar ligament – triangular extension of the inguinal ligament before its insertion upon the pubic tubercle conjoined tendon (5-10%)- Internal oblique fuses with transversus abdominis aponeurosis Cooper’s Ligament - formed by the periosteum and fascia along the superior ramus of the pubis. Inguinal Canal Between deep and superficial inguinal rings Boundaries Superifical – external oblique aponeurosis Superior – internal and transversus Inferior – shelving edge of inguinal ligament and lacunar ligament Posterior (floor) – transversalis fascia and aponeurosis of transversus abdominis muscle Inguinal Canal Contains the spermatic cord and round ligament of the