妊娠期腹股沟疝诊治67例临床研究

Clinical diagnosis and treatment of inguinal hernia during pregnancy:a report of 67 cases

目的:探讨妊娠期腹股沟疝的临床诊治。方法:收集经我科诊治的妊娠期腹股沟疝患者67例,回顾性分析妊娠期腹股沟疝的诊断方法、治疗方法、手术时机、预后等临床资料。结果:未发生嵌顿疝的患者在孕期内腹股沟疝未见明显增大,未出现腹股沟疝的相关并发症。55例患者产后择期行疝无张力修补术。3例患者在孕期出现嵌顿,1例经手法还纳成功后未行手术;余2例均为孕前即出现腹股沟疝的患者,经手法还纳失败后,在硬外麻醉下急诊行巴西尼式疝修补术。孕期初发的腹股沟疝与孕前已确诊的腹股沟疝在孕期发生嵌顿的风险比较,无统计学差异(P=0.249)。孕期出现腹股沟疝的患者中9例(20%)在产后腹股沟包块消失,而孕前发生腹股沟疝的患者无自愈病例(P=0.025)。讨论:妊娠合并腹股沟疝并未给妊娠及分娩带来不利影响,分娩方式可遵循产科指证即可;任何时候不能还纳的嵌顿疝都是急诊手术指证。对妊娠期合并腹股沟疝的患者,孕期观察、产后随诊,对包块、症状持续的患者择期行疝修补术是安全合理的治疗方案。

Objective：Discussion on the the clinical diagnosis and treatment of groin hernia in pregnancy.Methods：67 cases of inguinal hernia during pregnancy diagnosed by our department were collected.The diagnosis,treatment,opportunity of surgical operation and prognosis of inguinal hernia during pregnancy had been retrospectively analyzed.Results：The Volume of inguinal hernia was no significant increase and no complications associated with inguinal hernia during pregnancy happened.55 cases were selected tension-free herniorrhaphy after delivery.There were 3 cases of incarceration during pregnancy.One of the 3 cases was not operated by manipulations,and 2 cases can＇t be reducted and be treated by emergency operation which under emergency epidural anesthesia.The risk of incarcerated in pregnancy had no difference between the cases that the inguinal hernia was found during pregnancy and before pregnancy（P=0.249）;in 9 of primary groin hernia during pregnancy,the bulge had disappeared after delivery.While the women that the was found inguinal hernia pre-pregnancy without disappeared cases（P=0.025）.Conclusion：Pregnancy combined with inguinal hernia has no adverse effects on pregnancy and delivery.Incarcerated hernia at any time should be referred to emergency operation.For patients with inguinal hernia during pregnancy,Watchful waiting strategy in pregnancy and underwent elective repair after delivery is recommended.