Kammori Makoto, Mafune Ken-ichi, Hirashima Tokuji, Kawahara Masaki, Hashimoto Masanori, Ogawa Toshihisa, Ohta Hideaki, Hashimoto Hajime, Kaminishi Michio
Division of Gastrointestinal Surgery and Metabolic and Endocrine Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Am J Surg. 2004 Apr;187(4):549-52. doi: 10.1016/j.amjsurg.2003.12.041.
Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women. Because symptoms are nonspecific, the diagnosis is often delayed until laparotomy is performed form to treat bowel obstruction.
Forty-three patients with obturator hernia undergoing surgery at Tokyo Metropolitan Geriatric Hospital were divided retrospectively into two groups (group A = 23 patients from 1968 to 1986 before computed axial tomography [CAT] was developed; group B = 20 patients from 1987 to 1999 after CAT). Preoperative diagnosis, operative procedures, and postoperative course were reviewed and compared between the 2 groups.
Preoperative diagnostic accuracy was significantly higher in group B at 80.0% (16 of 20 patients) than in group A at 43.5% (10 of 23 patients) (P = 0.0146). Rate of gut resection and mortality were significantly lower in group B at 25.0% (4 of 20) and 5.0% (1 of 20) than in group A at 52.2% (12 and 23) and 30.4% (7 of 23) (P = 0.0295 and P = 0.0385, respectively).
The use of pelvic CAT in cases of suspected obturator hernia significantly enhances preoperative diagnostic accuracy and helps to decrease both intestinal resection rate and surgical mortality.
闭孔疝是一种相对罕见的盆腔疝，通常发生在老年、消瘦、多产的女性身上。由于症状不具有特异性，诊断往往延迟到进行剖腹手术以治疗肠梗阻时才做出。
回顾性地将东京都老年医院接受手术的43例闭孔疝患者分为两组（A组 = 1968年至1986年在计算机断层扫描[CAT]技术出现之前的23例患者；B组 = 1987年至1999年在CAT技术出现之后的20例患者）。对两组患者的术前诊断、手术操作及术后病程进行回顾并比较。
B组术前诊断准确率显著高于A组，分别为80.0%（20例中的16例）和43.5%（23例中的10例）（P = 0.0146）。B组肠切除率和死亡率分别为25.0%（20例中的4例）和5.0%（20例中的1例），显著低于A组的52.2%（23例中的12例）和30.4%（23例中的7例）（P分别为0.0295和0.0385）。
在疑似闭孔疝的病例中使用盆腔CAT显著提高了术前诊断准确率，并有助于降低肠切除率和手术死亡率。
