Fakhry S M, Azizkhan R G
Department of Surgery, University of North Carolina School of Medicine, Chapel Hill 27599.
Surg Gynecol Obstet. 1991 Jun;172(6):475-9.
Congenital hernias in the lumbar region are very uncommon. Approximately 10 per cent of all lumbar hernias are congenital and the vast majority are unilateral. We report our experience with seven congenital lumbar hernias in six infants treated during a five year period. All patients presented in the first year of life with abnormal protrusions in the lumbar region. In addition to the lumbar hernia, major associated malformations, including caudal regression anomalies, diaphragmatic hernia, ureteropelvic junction obstruction, cloacal exstrophy and lipomeningocele, were observed in 66 per cent of the infants and were consistent with lumbocostovertebral syndrome. In five patients, unilateral defects were repaired primarily. One patient with bilateral lumbar hernia underwent staged repair. The larger right-sided defect was repaired using a polytetrafluoroethylene prosthesis. At a second operation two months later, the small left-sided hernia was closed primarily. All patients have done well without recurrence with a follow-up period ranging from four to 48 months. Early repair of congenital lumbar hernias in infants after correction of other life-threatening conditions is advocated. Unlike the acquired variety, congenital lumbar hernia may include a more extensive deficiency of the entire lateral abdominal wall extending to the rectus sheath and inguinal ligament and satisfactory closure of the defect without prosthetic material may be difficult or impossible.
先天性腰椎疝非常罕见。所有腰椎疝中约10%为先天性，且绝大多数为单侧。我们报告了在五年期间对6例婴儿的7例先天性腰椎疝的治疗经验。所有患者均在出生后第一年内出现腰椎区域异常突出。除腰椎疝外，66%的婴儿还观察到主要的相关畸形，包括尾椎退化异常、膈疝、输尿管肾盂连接处梗阻、泄殖腔外翻和脂肪瘤样脊膜膨出，这些与腰骶椎综合征一致。5例患者的单侧缺损进行了一期修复。1例双侧腰椎疝患者接受了分期修复。较大的右侧缺损使用聚四氟乙烯假体修复。两个月后的第二次手术中，较小的左侧疝进行了一期缝合。所有患者恢复良好，无复发，随访期为4至48个月。提倡在纠正其他危及生命的情况后，对婴儿先天性腰椎疝进行早期修复。与后天性腰椎疝不同，先天性腰椎疝可能包括整个侧腹壁更广泛的缺损，延伸至腹直肌鞘和腹股沟韧带，可能难以或无法在不使用假体材料的情况下满意地闭合缺损。
