Callaghan C J, Whitaker R H
Department of Anatomy, University of Cambridge, Cambridge CB2 3DY, United Kingdom.
Clin Anat. 2002 Jun;15(4):276-9. doi: 10.1002/ca.10025.
Although obturator hernias are rare, they are associated with a high mortality, as diagnosis is often delayed and the condition tends to occur in the elderly. Previous researchers have postulated that obturator hernias begin with invagination of pre-peritoneal fat through the pelvic orifice of the obturator canal, forming a fat plug. With chronically raised intra-abdominal pressure, or sudden weight loss, this can progress to a clinical obturator hernia. We dissected 95 Caucasian cadaveric hemi-pelvises (47 males; 48 females) in order to investigate the frequency of fat plugs and examine the validity of the current hypothesis regarding obturator hernia pathogenesis. The mean age (SD) of the specimens was 83 (9) years, with 48 (24 male; 24 female) from the left side and 47 (23 male; 24 female) from the right side. A fat plug was found in 21 canals (22%); the majority were female (71%, P = 0.03), and right sided (62%, P = 0.20). The mean (SD) length was 20.0 mm (6.3 mm), with mean diameter 5.9 mm (1.8 mm). A shallow peritoneal dimple was also found overlying fat plugs in two specimens. No visceral herniations were found. The sex and side distribution of the obturator canal fat plugs we found are similar to those of obturator hernias reported in the literature, supporting the hypothesis that fat plugs are pre-hernial. It is unlikely that fat plugs are a high-risk condition, but dimples over these plugs may be a marker of potential hernia formation.
虽然闭孔疝很少见，但它们与高死亡率相关，因为诊断往往延迟，而且这种情况往往发生在老年人身上。以前的研究人员推测，闭孔疝始于腹膜前脂肪通过闭孔管的骨盆口内陷，形成一个脂肪栓。随着腹腔内压力长期升高或体重突然减轻，这可能会发展为临床闭孔疝。我们解剖了95个白种人的半骨盆尸体（47例男性；48例女性），以调查脂肪栓的发生率，并检验当前关于闭孔疝发病机制假说的有效性。标本的平均年龄（标准差）为83（9）岁，其中48个（24例男性；24例女性）来自左侧，47个（23例男性；24例女性）来自右侧。在21个管腔中发现了脂肪栓（22%）；大多数为女性（71%，P = 0.03），且右侧居多（62%，P = 0.20）。平均（标准差）长度为20.0毫米（6.3毫米），平均直径为5.9毫米（1.8毫米）。在两个标本中，还发现脂肪栓上方有浅的腹膜凹陷。未发现内脏疝。我们发现的闭孔管脂肪栓的性别和侧别分布与文献中报道的闭孔疝相似，支持了脂肪栓是疝前病变的假说。脂肪栓不太可能是一种高危情况，但这些脂肪栓上方的凹陷可能是潜在疝形成的一个标志。
