嵌顿疝的外科处理原则

Principles of the surgical management of incarcerated hernia

疝外科急腹症主要指嵌顿疝,是临床上常见的急腹症。影像学检查对嵌顿疝的诊断具有重要作用。嵌顿疝若不及时、正确处理有可能会进一步发展成为绞窄疝,导致肠坏死、穿孔,甚至危及患者生命。对于复位低风险患者可尝试手法复位,复位不成功或复位风险高的患者应积极手术。越来越多的证据表明,腹腔镜微创治疗急性嵌顿疝具有切实可行的临床疗效和较少的术后并发症。补片在嵌顿疝手术中的使用也被证实是安全可行的,只要选择得当,即使在行肠切除的嵌顿疝修补中,补片的使用也并未增加手术区域感染的风险,并且大大降低了术后复发的可能性。同时以加速康复外科理念加强围手术期管理,减少并发症发生,促进患者康复。

The acute abdomen of hernia mainly refers to an incarcerated hernia,which is a common acute abdomen in clinic.CT plays an important role in the diagnosis of incarcerated hernia.If incarcerated hernia is not handled timely and correctly,it may further develop into strangulated hernia,leading to intestinal necrosis,perforation and even endangering the patient′s life.Manual reduction can be attempted for patients with low risk of reduction,and active surgery should be performed for patients with unsuccessful reduction or high risk of manipulative reduction.More and more evidence shows that laparoscopic minimally invasive treatment of acute incarcerated hernia has practical clinical efficacy and fewer postoperative complications.The use of mesh in incarcerated hernia surgery has also been shown to be safe and feasible,as long as it is properly selected,even in incarcerated hernia repair during enterectomy,mesh does not increase the risk of infection in the surgical area and greatly reduces the likelihood of postoperative recurrence.At the same time,the concept of accelerated rehabilitation surgery was used to strengthen perioperative management,reduce complications and promote rehabilitation of patients.