医药学论文：小儿腹股沟滑疝的病因、发病机理、诊断和鉴别诊断

【摘要】 目的 探讨小儿腹股沟滑疝的病因、发病机理、诊断和鉴别诊断。方法 从我院收治290例腹股沟斜疝中选取确诊滑疝13例住院资料，结合国内外文献，着重分析其病因、发病机理和诊断鉴别诊断。结果 发现女婴腹股沟滑疝发病率比男婴高得多，且女婴均属卵巢、输卵管伞端滑出，男婴滑出器官均为盲肠、阑尾和/或乙状结肠。其原因除患者腹股沟内环腹膜壁层先天发育不良外，与卵巢、输卵管伞接近腹股沟内环、卵巢悬韧带和盲肠、乙状结肠系膜较活动有关。小儿腹股沟滑疝的临床表现与其他腹股沟斜疝相似，易发生误诊。结论 小儿腹股沟滑疝是由于腹股沟内环先天性发育不良和腹腔内较活动的器官滑出所致。临床表现与一般常见的腹股沟斜疝相似，必须仔细鉴别。从其病因发病方面加以考虑，有助于明确诊断。

 

　　【关键词】 小儿；腹股沟滑疝；病因；发病机理；诊断；鉴别诊断
The etio-pathogenesis,diagnosis and differential diagnosis of inguinal extrasaccular hernia in infants

 

　　【Abstract】 Objective To study the etiopathogenisis, diagnosis and differential diagnosis of inguinal extrasaccular hernia in infants.Methods 13cases of inguinal extrasaccular hernia out of 290 cases of inguinal hernia in our hospital were investigated with referating the leterture, and focused the attention on its etidogy, pathogenisis and diagnosis,differential diagnosis.Results To reveal that the incidence of inguinal extrasaccular heruia in femal infants was much more than that in male infants, and the sliding substance of extrasaccular hernia were ovary and fallopian tube in femal infants and cecum,appendix and sigmoid in male infants.and the ligmenta suspersorium orarii and mesentery of cecum and sigmoid moved more easily. Its etiopathogenesis had relation to that the ovary and fallopian tube approached the inguinal inner circle and the mesentery of cecum and sigmoid moved more easily. The clinical features of inguinal extrasaccular hernia were similar to other inguinal oblique hernia, so that misdiagnosis was easily made.Conclusion Inguinal extrasaccular hernias in infants were due to congenital dysplasia of inguinal inner cirele and movable organs in abdominal cavity slided from abdominal cavity. Its clinical features were similar to general inguinal oblique hernia and that must careful be distinguished. Consideration for its etiopathogenesis can help to make correct diagnosis.

 

　　【Key words】 infants;inguinal extrasaccular hernia;etio-pathogenesis;diagnosis;differential diagnosis

 

　　腹股沟滑疝是腹股沟疝的一种特殊类型，发病率相当低,发病机理尚不十分明确，术前不易诊断，手术处理与其他腹股沟斜疝有所不同。鉴于此，我们收集这方面的病例病因和文献资料，对其病因、发病机理、诊断和鉴别诊断进行分析研究。

 

　　1 对象与方法

 

　　从我院2002年1月～2005年2月收治小儿腹股沟斜疝290例中选取腹股沟滑疝13例的临床病历资料，并查阅国内外有关文献，着重对小儿腹股沟滑疝的病因、发病机理、诊断和鉴别诊断进行分析研究。

 

　　2 结果

 

　　2.1 临床主要表现

 

　　同期收治小儿腹股沟斜疝290例中腹股沟滑疝13例，占4.5%。男3例，女10例，男女比为1:3.3。年龄18天～2岁4个月，平均1岁。病史1天～2年，平均9个月。13例除1例双侧疝（左侧斜疝，右侧滑疝）外，其余12例均为单侧滑疝（左侧7例，右侧5例）。体格检查：男孩疝块较大，约3cm×3cm×5cm～4cm×4cm×5cm；女孩疝块较小，约2cm×2cm×3cm～3cm×3cm×4cm。3例为嵌顿疝，手法复位失败，6例复位困难或难以完全复位，复位后内环及其下方有组织增厚感，疝内容物易再次脱出。B超检查：10例在疝内容物突出的情况下进行了B超检查，其中6例探及混合性回声团，内有气体回声团或肠蠕动；4例仅探及混合性回声团。滑出脏器：女孩均为输卵管和/或卵巢，其中1例右侧卵巢、输卵管及子宫角均滑出。男孩均为盲肠及阑尾。13例均采用Bevan术式，其中1例因滑出阑尾水肿，加阑尾切除术。3例嵌顿疝及8例内环扩大者，缝合缩小内环至1指尖。术中未误伤滑出脏器，切口甲级愈合，未出现伤口血肿、积液等并发症，术后随访1个月～4年，未见复发。