Chapman W H, Barcia P J
Department of Surgery, Tripler Army Medical Center, Honolulu, HI 96859-5000.
Mil Med. 1991 Nov;156(11):631-3.
Femoral hernias are of very rare occurrence at any age, but are exceedingly rare in the pediatric population. A 10-year survey, 1979-1989, of our experience with pediatric hernias produced a total of 1,134 inguinal hernias and 6 femoral hernias, supporting an incidence of 0.5% for femoral hernias in our population. The correct diagnosis was made in only two cases preoperatively. These two patients had undergone inguinal herniorrhaphies less than 6 months prior to presenting with recurrent groin masses. Femoral hernias were most frequently misdiagnosed as inguinal hernias. Inclusion of this entity in the differential diagnosis of groin masses, an accurate preoperative physical exam, and a careful surgical exploration will allow one to make the correct diagnosis and prevent unnecessary reoperations. In addition, early recurrence of a groin mass after inguinal exploration and herniorrhaphy should make one suspicious of a femoral hernia. At surgery, our recommendations include a simple infra-inguinal exploration medial to the femoral vessels when an inguinal hernia is unexpectedly not found at groin exploration and a Cooper's ligament repair when a femoral hernia is encountered. All six cases in our review were repaired with Cooper's ligament repair without complication.
股疝在任何年龄都极为罕见，在儿科人群中更是极其罕见。对我们1979年至1989年期间小儿疝诊治经验的一项为期10年的调查显示，共有1134例腹股沟疝和6例股疝，表明我们所诊治人群中股疝的发生率为0.5%。术前仅两例做出了正确诊断。这两名患者在出现复发性腹股沟肿块前不到6个月接受过腹股沟疝修补术。股疝最常被误诊为腹股沟疝。将该疾病纳入腹股沟肿块的鉴别诊断、进行准确的术前体格检查以及仔细的手术探查，将有助于做出正确诊断并避免不必要的再次手术。此外，腹股沟探查和疝修补术后腹股沟肿块早期复发应使人怀疑为股疝。在手术中，我们的建议包括：当腹股沟探查未意外发现腹股沟疝时，在股血管内侧进行简单的腹股沟下探查；当发现股疝时，进行库珀韧带修补。我们回顾的所有6例病例均采用库珀韧带修补，无并发症发生。
