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- Posterior Wall Defects in 413 Consecutive Patients with Groin Hernias--A Prospective Study in 507 Sides
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題名 | Posterior Wall Defects in 413 Consecutive Patients with Groin Hernias--A Prospective Study in 507 Sides=鼠蹊部疝氣後腹壁缺損之觀察 |
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作者 | 黃清水; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 26:5 民82.09-10 |
頁次 | 頁1982-1988 |
分類號 | 416.242 |
關鍵詞 | 鼠蹊部疝氣; 後腹壁缺損; |
語文 | 英文(English) |
中文摘要 | 為了解國人鼠蹊部疝氣(groin hernia)後腹壁缺損的情況,著者自1988年7月1日起至1991年6月30日止三年問對親自手術的413位初發疝氣病人的507側後腹壁(posterior wall)做一前瞻性的研究。手術時每側疝氣的後腹壁都經系統性的仔細探查並立刻詳加記錄,所有的資料以"Microsoft Excel"加以分析,其結果如下:507側的疝氣,右側194例,左側125例,兩側94例,男性421側,女性86側,男女比例約5:1。主要的疝氣分類為間接型腹股溝疝氣366側(72.2%),直接型121側(23.9%),股疝氣18側(3.6%)。130側(25%)的疝氣同時合併有第二種疝氣,年紀愈大直接型愈多,兩側性愈高,合併第二種疝氣也愈多,間接型疝氣的疝氣袋平均長度為6.5cm,直接型為3.0cm,內環的直徑間接型大多(70%)超過2.0cm,純直接型的內環很少大於1cm。直接型疝氣的發生位置最多位於Hasselbach三角的中央佔49.5%,其次是內側佔23%,外側佔15%,多處缺損6%,瀰漫性薄弱佔5%,59側(16%)的間接型疝氣屬於"精索束外型" (extrafunicular type),除內環破壞外其後腹壁缺損不亞於直接型疝氣,由以上的觀察,著者相信不完全的後腹壁探查,過於簡單的疝氣分額以及以單一方法修補所有疝氣必然導致不完全或不恰當的修補而成為復發的主要原因。 |
英文摘要 | To understand the posterior wall defects in groin hernia, the author undertook prospective study of 507 sides of primary groin hernia in 413 Chinese adult patients (421 men and 86 women) from July 1, 1988 to June 30, 1991. Details of the posterior wall defect in each patient were examined systematically during operation, recorded and analysed. These hernias included indirect inguinal hernias in 366 (72.2%), direct inguinal hernias in 121 (23.9%), femoral hernias in 18 (3.6%) and spigelian hernias in 2 (0.4%). A secondary or tertiary hernia was present in 130 out of the 507 hernias (25.6%). There was a trend toward more direct components, bilateral involvement and presence of a secondary hernia at older ages, in contrast to the pure indirect inguinal hernias of the young adult. The average length of the indirect hernia sac was 6.5 cm, and 3.0 cm in direct hernia. The diameter of deep rings was more than 2 cm in 70% of indirect hernias, and less than 1 cm in most direct hernias. The locations of transversalis defects were 49.5% in the middle portion of Hasselbach triangle, 23% in medial; 15% in lateral; 6% had multiple defects; 5% had diffuse weakness. 59 sides (16%) of indirect hernias belonged to the extrafunicular type, where posterior walls were severely atrophied, if not even defective. These observations suggest that inadequate posterior wall exploration, oversimplified classification and the repair of all groin hernias by a single method frequently lead to incomplete and inadequate repair and are the main reasons for recurrence. |
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