腹股沟斜疝合并肠破裂5例诊治体会

Diagnosis and Treatment of Inguinal Hernia with Intestinal Rupture:Experience with 5 Cases

目的探讨腹股沟斜疝合并肠破裂的原因、临床特点和治疗方式。方法回顾性分析2012年10月至2013年4月收治的5例腹股沟斜疝合并肠破裂患者的临床资料。结果 5例中,外伤致肠破裂3例,暴力手法复位2例;伴弥漫性腹膜炎4例,局限性腹膜炎1例;全腹部CT检查发现存在腹腔游离气体4例,漏诊率20%(1/5);立位腹部X线平片膈下见游离气体1例,漏诊率80%(4/5)。手术发现小肠破裂4例、乙状结肠破裂1例,小肠破裂者均一期行修补术,乙状结肠破裂者行乙状结肠双腔造口术,腹股沟斜疝均行经腹缩小耻骨肌孔手术。治愈5例。结论 1)合并有腹股沟斜疝的急腹症需考虑肠破裂,全腹部CT有助于早期诊断;2)嵌顿性疝粗暴还纳、外伤是腹股沟斜疝合并小肠破裂的常见原因;3)经腹行肠破裂修补或结肠造口术加耻骨肌孔缩小手术是治疗腹股沟斜疝合并肠破裂较好的手术方式。

Objective To investigate the causes,clinical features and treatment of inguinal hernia with intestinal rupture. Methods Clinical data of 5 patients treated for inguinal hernia with intestinal rupture between October 2012 and April 2013 were retrospectively analyzed. Results Traumatic intestinal rupture occurred in 3 patients and forced manipulative reduction was performed in 2 patients.In addition,diffuse peritonitis was found in 4 patients and localized peritonitis in 1 patient.Abdominal CT revealed free intraperitoneal air in 4 patients [missed diagnosis rate,20%（1/5）].Upright abdominal X-ray film revealed free air below the diaphragm in 1 patient [missed diagnosis rate,80%（4/5）].Operative findings showed small intestine rupture in 4 patients who were treated with primary repair and sigmoid colon rupture in 1 patient who was treated with sigmoid colostomy.Patients with oblique inguinal hernia underwent transabdominal reduction of pubic muscle hole.All the 5 patients were cured and no patients died after treatment. Conclusion Intestinal rupture should be considered in patients with acute abdomen and oblique inguinal hernia.Whole abdominal CT contributes to early diagnosis.Forced reduction of incarcerated hernia and trauma are the common causes of oblique inguinal hernia with small intestinal rupture.Transabdominal repair of intestinal rupture or colostomy combined with transabdominal reduction of pubic muscle hole is effective for inguinal hernia with intestinal rupture.