腰疝9例临床诊治分析

Diagnosis and treatment of lumbar hernia:a report of 9 cases

目的探讨腰疝的发病因素、临床表现、诊断和治疗方法。方法对1997年1月至2007年1月第二军医大学附属长海医院普外科经治的9例腰疝病例进行回顾性总结分析。结果9例中先天性因素1例,外伤性因素2例,另外6例均为非外伤性因素所致。9例均出现腰背部可复性肿块,伴有腰背部疼痛不适5例,恶心、呕吐2例,合并肠梗阻出现腹胀、腹痛、停止排便排气1例。由上腰三角突出7例,其中l例合并从下腰三角突出;由下腰三角突出2例。疝内容物为脂肪块、结肠或嵌顿坏死小肠。除1例保守治疗外,余8例行手术治疗,手术病人中利用自身组织缝合修补3例,5例使用人工(聚丙烯网片)补片修补。结论腰疝比较罕见,临床体征是诊断腰疝的关键,多普勒超声及CT或MR I检查可协助诊断。外科手术是治疗腰疝的有效手段。

Objective To study the pathogeny, clinical manifestlation,diagnosis and treatment of lumbar hernia. Methotis The clinical data of 9 cases of lumber hernia admitted from January 1997 to January 2007 in the Department of General Surgery Affiliated Changhai Hospital of the Second Military Medical University were analyzed retrospectively. Results Among 9 cases, 1 case was caused by nature. Two cases were caused by traumatic factors and 6 cases were caused by other factors. The clinical manifestation of lumbar hernia included lumbar bump in 9 cases,lumbar pain in 5 cases,nausea and vomiting in 2 cases,gut incarcerated with bowel obstruction in 1 case. The typical sign was a painful flank bulging in the superior or inferior triangle. Seven cases had hernia in superior lumbar triangle;one of them had hernia in both inferior lumbar triangle and superior lumbar triangle. Hernioplasty included by using contiguity tissue and synthetic patch were performed in 8 of all the cases. Conclusion The diagnosis could be made according to clinical symptoms and signs. Doppler ultrasound examination, CT and MRI scanning are helpful for diagnosing lumbar hernia. Excision of the sac and repairing with surrounding tissue or by prosthetic material may show satisfactory results.