外科-腹外疝PPT.ppt

腹外疝 HERNIA What is a hernia? Hernia is an abnormal protrusion of an organ or tissue through a defect in the abdominal wall. Most hernias occur when a piece of intestine slips through a weakness in the abdominal wall, creating a bulge you can see and feel. 什么是疝？ 疝：体内某脏器或组织离开其正常解剖部位，通过先天或后天形成的薄弱点、缺损或孔隙进入另一部位 腹外疝：由腹腔内脏器或组织连同腹膜壁层，经腹壁薄弱点或孔隙，向体表突出所成 Why the hernia occur in the human body？ 人体站立后腹股沟管发生了根本性变化 嵌顿疝 → 绞窄疝 Strangulated 解剖Anatomy 腹股沟管 Inguinal canal 直疝三角 Hesselbach’s triangle 股管 Femoral canal Fruchaud’s hole 耻骨肌孔 腹股沟管Inguinal canal 腹股沟管结构 内环Internal inguinal ring 外环External inguinal ring 前壁 Anteriorly 后壁 Posteriorly 上壁 Above 下壁 Below 人体的腹股沟管 直疝三角 Hesselbach’s triangle 内侧缘 Medially:border of rectus muscle 外侧缘Laterally: inferior epigastric vessels 底边Fundus:inguinal Ligament 腹壁下血管Epigastric Vessels 精索血管 Testicular Vessels 腹腔镜观察（左侧） 股管 Femoral canal 特殊类型疝 肠管壁疝（Richter’s h.） Littre疝( Littre’s h.) 逆行性嵌顿（Maydl’s h.） 疝内容物为阑尾（Amyand’s h） INDIRECT DIRECT INGUINAL HERNIAS Indirect : Entering the internal ring and traversing the inguinal canal Direct: Pushing through the posterior wall of the inguinal canal Diagnosis Differential Diagnosis inferior epigastric vessels Press internal ring Treatment Inguinal hernias should always be repaired unless there are specific contraindications. It for to patients of all the ages Type of repair Tension repair (classic repair) Tension free repair Tension repair Bassini Marcy Halsted Ferguson Shouldice Tension repair Disadvantages Discomfort A 4-6 weeks recovery period A 10-15% chance that the hernia will be Recurrence