Brissot Hervé N, Dupré Gilles P, Bouvy Bernard M
Clinique Fregis, Arcueil, France.
Vet Surg. 2004 Jul-Aug;33(4):412-21. doi: 10.1111/j.1532-950X.2004.04060.x.
To evaluate the value of laparotomy as the initial step in the treatment of bilateral or complicated perineal hernia (PH) in dogs.
Retrospective study.
Forty-one dogs with PH.
Dogs with bilateral or complicated PH treated by a 2-step approach between November 1997 and December 2001 were studied. Inclusion criteria for complicated PH were: recurrence of PH, unilateral PH with a major rectal dilatation, PH with a concurrent surgical prostatic disease, and PH with retroflexed bladder. Colopexy, vas deferens pexy, cystopexy, and prostatic omentalization were performed during laparotomy as needed. Later, PH was performed by internal obturator muscle flap (IOMF) or if there was a perineal rent or weakness on the contralateral side, appositional herniorrhaphy was performed. Outcome was followed for >/=6 months.
PH were bilateral (20 dogs) or unilateral (21). Twenty-one (51%) dogs had prostatic disease (clinical or ultrasonography diagnosis; 17 confirmed histologically) and 12 (29%) had urinary bladder retroflexion. Forty-one colopexies, 32 vas deferens pexies, 6 cystopexies, and 9 prostatic surgeries (omentalization or perineal cyst resection) were performed. PH was performed 2-20 days (median, 6 days) later: 61 IOMF transpositions, 13 appositional. Mean follow-up time was 26.6 months (range, 6-54 months, median, 27 months). PH was resolved in 37 (90%) dogs; 4 dogs had recurrence, and all occurred within 6 months. Thirty-eight (92%) dogs had an improved quality of life (good in 34 dogs, fair in 4 dogs). Wound complications occurred in 7 dogs (17%). Postoperative urine dribbling occurred in 15 dogs (37%) and was irreversible in 7 dogs (17%). Postoperative fecal straining persisted in 18 dogs (44%), and was permanent in 4 dogs (10%). Fecal incontinence did not occur.
In bilateral or complicated PH, fixation of the urinary bladder and colon, and treatment of prostatic disease increase the chances of resolution. Emptying of the perineal space by organ pexy allows improved observation during herniorrhaphy. Despite a 90% clinical resolution, dogs with complicated PH treated by a 2-step protocol may have persistent urinary and fecal disorders.
To improve the prognosis of bilateral or complicated PH, investigation and treatment of concomitant lesions (rectal, prostatic, bladder) should be part of a rational surgical strategy using a 2-step protocol.
评估剖腹手术作为犬双侧或复杂性会阴疝（PH）治疗初始步骤的价值。
回顾性研究。
41只患有PH的犬。
对1997年11月至2001年12月间采用两步法治疗的双侧或复杂性PH犬进行研究。复杂性PH的纳入标准为：PH复发、伴有严重直肠扩张的单侧PH、伴有手术性前列腺疾病的PH以及膀胱后屈的PH。剖腹手术期间根据需要进行结肠固定术、输精管固定术、膀胱固定术和前列腺网膜化术。随后，通过内收肌皮瓣（IOMF）进行PH修复，或者如果对侧存在会阴撕裂或薄弱，则进行对合疝修补术。随访结果≥6个月。
PH为双侧（20只犬）或单侧（21只犬）。21只（51%）犬患有前列腺疾病（临床或超声诊断；17只经组织学证实），12只（29%）犬存在膀胱后屈。进行了41次结肠固定术、32次输精管固定术、6次膀胱固定术和9次前列腺手术（网膜化或会阴囊肿切除术）。2至20天（中位数为6天）后进行PH修复：61次IOMF移位，13次对合修补。平均随访时间为26.6个月（范围为6至54个月，中位数为27个月）。37只（90%）犬的PH得到解决；4只犬复发，且均在6个月内发生。38只（92%）犬的生活质量得到改善（34只犬良好，4只犬一般）。7只犬（17%）出现伤口并发症。15只犬（37%）出现术后尿滴沥，7只犬（17%）不可逆。18只犬（44%）术后持续排便困难，4只犬（10%）为永久性。未发生大便失禁。
在双侧或复杂性PH中，膀胱和结肠固定以及前列腺疾病的治疗可增加治愈机会。通过器官固定术排空会阴间隙可在疝修补术中改善观察。尽管临床治愈率为90%，但采用两步法治疗的复杂性PH犬可能仍存在持续性泌尿和排便障碍。
为改善双侧或复杂性PH的预后，对伴随病变（直肠、前列腺、膀胱）的检查和治疗应成为采用两步法的合理手术策略的一部分。
