股疝的诊断和治疗（英文版）.pptVIP

Femoral Hernia Femoral Hernia-Significance Femoral hernias compromise about 6% of hernias. This is about 1/10 the incidence of inguinal hernias. About 85 % of direct and indirect hernias are male. However about 85% of femoral hernias occur in females. Femoral hernias are a not uncommonly missed source of SBO. Always check the inguinal area carefully for femoral hernias which are easily missed unless actively looked for. You will save a life! Femoral hernia- etiology All are acquired. Are secondary to an expanded femoral ring. Probably due to increased intraabdominal pressure.As an example of this femoral hernias are much more common in nulliparous women Femoral hernia -Diagnosis Diagnosis by physical exam. A fixed mass is noted just below the inguinal ligament . If incarcerated chronically it will be medial to the femoral vessels. Differential diagnosis includes lymph node, lipoma or saphenous varicosity The masses may be differentiated by clinical characteristics Femoral hernia -Diagnosis Femoral hernia – Chronically incarcerated. Mobile inferiorly, medially and laterally but appears fixed to the inguinal ligament. Femoral hernia-Reducible. Will be obvious due to the ability to reduce the mass and the gurgling sensation if bowel is present within it Lymph node- Usually more mobile in all directions .It is not fixed at the top. Also more superficial. If fixed usually deep. LIpoma –Can be lifted off the deep fascia Saphenous varix-Collapse completely on lying down . Do not have as firm a character as femoral hernia. Femoral Hernia- Diagnosis CT scan or Ultrasound may be useful in some cases. Femoral hernia- Surgical Repair Anatomy is key. External iliac vessels run along the surface of the iliopsoas muscle in the pelvis, pass between the iliopubic tract and Coopers ligament and course beneath the inguinal ligament The opening of femoral canal is a musculoaponeurotic ring consisting of coopers ligament inferiorly,the femoral vein laterally and the ileopubic tra