GUO Zheng-tuan,XU Quan,LI Peng,et al.Diagnosis and management of congenital lumbar hernias in children.[J].Journal of Clinical Pediatric Surgery,2010,9(04):0.
小儿先天性腰疝治疗分析
- Title:
- Diagnosis and management of congenital lumbar hernias in children.
- Keywords:
- Hernia; Ventral/DI; Hernia; ventral/TH; Child
- 摘要:
- 目的 探讨小儿先天性腰疝的诊断与治疗方法。方法 1980 ~ 2008年本院共收治先天性腰疝患儿7例。其中男4例，女3例，年龄3 ~ 18个月。7例中，单侧5例，双侧2例。单侧患者中，发生于腰上三角区（Grynfeld Lessshaft三角）3例，腰下三角区（Petit’s三角）2例，双侧2例，表现为弥漫性侧腹壁薄弱。均行手术治疗，5例单侧患儿采用疝囊高位结扎术或缝扎术，直接缝合疝环及其周围肌肉筋膜组织，2例双侧弥漫型患儿采用缝扎疝囊并折叠，侧腹壁薄弱肌层及筋膜交错重叠缝合。 结果 所有患儿经1 ~ 5年随访，效果良好，无一例复发，无并发症发生。 结论 先天性腰疝诊断较为容易，重点在于了解其严重程度及伴发畸形；以早期手术治疗为宜，一般采取疝环一期缝合术，如腹壁缺损较大或为弥漫型腰疝行一期缝合有困难，则可采用疝囊折叠、侧腹壁肌层及筋膜折叠修补术，建议尽可能采用自身组织修补；效果良好。
- Abstract:
- Objective To research the diagnosis and treatment of congenital lumbar hernias(CLHs) in children. Methods Seven patients with nine CLHs were treated in our hospital from 1980 to 2008. The four boys and three girls ranged in age from three months to eighteen months old at diagnosis. All patients presented with abnormal protrusions in the lumbar region. Five CLHs was unilateral, in which three originate in the superior lumbar triangle of Grynfelt-Lesshaft and two in the inferior lumbar triangle of Petit. Two patients had bilateral CLHs identified as diffuse swellings affecting the entire lumbar region. All CLHs were repaired primarily. For five unilateral CLHs, high ligation or transfixion of hernial sac was performed, then hernia ring and its local tissue was sutured. Two patients with bilateral lumbar hernia underwent plicating and overlapping suture of hernial sac and weak muscular layers of lateral abdominal wall. Results All patients have recoveried well without recurrence with a follow-up period ranging from 1 to 5 years. No complications occurred. Conclusions Generally, making a diagnosis of CLH is not difficult, but the most important thing is to investigate it's severity and associated malformations. Early repairing of congenital lumbar hernias in children is advocated. Primary repair with local tissues is the ideal treatment of choice. Plicating and overlapping suture of hernial sac and the weak muscular layers of lateral abdominal wall may be performed when the size of the defect is large or the defect is diffuse and primary suture is impossible. Surgical repair with autologous tissues should be considered as far as possible. Overall, a successful operation offers a good result.
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