Skandalakis Panagiotis N, Zoras Odyseas, Skandalakis John E, Mirilas Petros
Centers for Surgical Anatomy, Emory University, Atlanta, Georgia 30322, USA.
Am Surg. 2006 Jan;72(1):42-8.
Spigelian hernia (1-2% of all hernias) is the protrusion of preperitoneal fat, peritoneal sac, or organ(s) through a congenital or acquired defect in the spigelian aponeurosis (i.e., the aponeurosis of the transverse abdominal muscle limited by the linea semilunaris laterally and the lateral edge of the rectus muscle medially). Mostly, these hernias lie in the "spigelian hernia belt," a transverse 6-cm-wide zone above the interspinal plane; lower hernias are rare and should be differentiated from direct inguinal or supravescical hernias. Although named after Adriaan van der Spieghel, he only described the semilunar line (linea Spigeli) in 1645. Josef Klinkosch in 1764 first defined the spigelian hernia as a defect in the semilunar line. Defects in the aponeurosis of transverse abdominal muscle (mainly under the arcuate line and more often in obese individuals) have been considered as the principal etiologic factor. Pediatric cases, especially neonates and infants, are mostly congenital. Embryologically, spigelian hernias may represent the clinical outcome of weak areas in the continuation of aponeuroses of layered abdominal muscles as they develop separately in the mesenchyme of the somatopleura, originating from the invading and fusing myotomes. Traditionally, repair consists of open anterior herniorraphy, using direct muscle approximation, mesh, and prostheses. Laparoscopy, preferably a totally extraperitoneal procedure, or intraperitoneal when other surgical repairs are planned within the same procedure, is currently employed as an adjunct to diagnosis and treatment of spigelian hernias. Care must be taken not to create iatrogenic spigelian hernias when using laparoscopy trocars or classic drains in the spigelian aponeurosis.
半月线疝（占所有疝的1%-2%）是腹膜前脂肪、腹膜囊或器官通过半月线腱膜（即腹横肌腱膜，外侧由半月线、内侧由腹直肌外侧缘限定）的先天性或后天性缺损突出。大多数情况下，这些疝位于“半月线疝带”，即棘间平面上方一个横向6厘米宽的区域；低位疝很少见，应与腹股沟直疝或膀胱上疝相鉴别。尽管半月线疝以阿德里安·范·德·斯皮格尔（Adriaan van der Spieghel）的名字命名，但他在1645年只描述了半月线（斯皮格尔线）。1764年，约瑟夫·克林科施（Josef Klinkosch）首次将半月线疝定义为半月线的缺损。腹横肌腱膜缺损（主要在弓状线以下，在肥胖个体中更常见）被认为是主要病因。小儿病例，尤其是新生儿和婴儿，大多是先天性的。从胚胎学角度看，半月线疝可能是分层腹肌腱膜在体壁中胚层分别发育时，由于侵入和融合的肌节导致腱膜延续处薄弱区域的临床结果。传统上，修复方法包括开放前路疝修补术，采用直接肌肉对合、补片和假体。腹腔镜检查，最好是完全腹膜外手术，或者在同一手术中计划进行其他手术修复时采用腹腔内手术，目前被用作半月线疝诊断和治疗的辅助手段。在半月线腱膜使用腹腔镜套管针或经典引流管时，必须小心避免造成医源性半月线疝。
