闭孔疝的临床诊断与治疗

Diagnosis and treatment of obturator hernia

目的：虽然闭孔疝是较为少见的盆腔疝,但极易误诊、漏诊,甚至导致死亡,尤其是老年病人。本文就伴有基础疾病、一般情况欠佳的老年病人,总结了闭孔疝的诊断、治疗和围手术期处理经验。方法：对我院2000年至2010年收治的8例闭孔疝病人的临床资料进行回顾性分析。结果：8例病人均为女性,平均年龄83（77~92）岁,平均体质量指数（BMI）为17.3,术前均以肠梗阻收治入院。2例病人Howship-Romberg征阳性;3例病人通过盆腔CT确诊。8例病人均患有严重的冠心病、高血压和房颤,平均心脏风险指数为34;7例病人ASA-PS评分为3.0~3.5,另1例为4.0。术中发现所有疝的内容物均为小肠肠管;其中4例行小肠肠段切除。全部病人经积极治疗后完全康复;术后随访59个月未见复发。结论：对老年、瘦弱、多产的女性病人,如反复出现不完全性肠梗阻,应高度怀疑闭孔疝,并行腹部和盆腔CT以明确诊断,及早行剖腹探查术可显著降低闭孔疝病人的肠切除率和病死率。

Objective Obturator hernia is a rare type of abdominal hernia which can lead to catastrophic results with delay in diagnosis and treatment,especially for the elders.Difficulty in diagnosis and treatment is analyzed in this paper.Methods 8 patients with obturator hernia were confirmed during a 10-year period.The clinical presentation,anesthetic,and perioperative management were retrospectively summarized.Results The average age of the patients was 83,and all were females,while the body mass index（BMI） was 17 in average.The Howship-Romberg sign was positive in 2 patients.A correct diagnosis was established in 3 of 5 patients who underwent pelvic CT scanning.In all of these 8 cases,serious coronary syndrome,arterial hypertension and chronic atrial fibrillation were confirmed.The evaluation of perioperative risk revealed a mean Cardiac Risk Index of 34.7 patients had ASA-PS score of 3 to 3.5,and 4.0 for the last.All cases had herniation of the small intestine loop into the obturator canal;and 4 underwent small bowel resection.All patients recovered completely.No recurrence was detected during a mean follow-up of 59 months.Conclusions Facing an elderly emaciated female with recurrent small bowel obstruction,there is a high risk of having an obturator hernia.A definite early diagnosis can be facilitated by CT scanning.Surgical intervention at early stage with satisfactory support is essential to decreasing the risk for undergoing bowel resections and mortality.