Powell B S, Lytle N, Stoikes N, Webb D, Voeller G
UTHSC, 910 Madison Avenue, 2nd floor, Memphis, TN, 38163, USA,
Hernia. 2015 Jun;19(3):513-6. doi: 10.1007/s10029-013-1207-3. Epub 2014 Jan 29.
To describe the incidence and treatment of prevascular and retropsoas hernias in a large-volume general surgery practice.
Femoral hernias are considered uncommon with an incidence between 2 and 8 % of groin hernias. There are no large studies describing the subtypes of femoral hernias or retropsoas hernias, and therefore no reported incidence or standardized treatment recommendations for these hernias exist.
This study is a retrospective review of all patients undergoing total extraperitoneal (TEP) laparoscopic herniorrhaphy between August 1993 and December 2011. A single surgeon performed all the repairs. Demographics and patient outcomes were reported.
2,436 patients underwent 3,242 TEP repairs. The subtypes were: indirect 1,523 (46.9 %), direct 1,473 (45.4 %), femoral 156 (4.8 %), obturator 35 (1.1 %), prevascular 25 (0.77 %), Spigelian 20 (0.61 %), retropsoas 3 (0.09 %). Prevascular hernias accounted for 16 % of femoral hernias. Patients with prevascular hernias had a mean age of 70.3 years and were all male. 13 of the 25 patients (52 %) with prevascular hernias had other associated defects and four (16 %) of the patients had prevascular hernias as a recurrence from a prior hernia operation. There were three patients with retropsoas hernias that only would not have been seen from an anterior open approach. There are no intraoperative complications or known recurrences from this study group.
Prevascular and retropsoas hernias are uncommon, but have a higher incidence than previously believed. Prevascular hernias tend to be associated with older age and other defects. The diagnosis and management of these hernias are readily achieved using the laparoscopic TEP approach.
描述在大量普通外科手术中血管前疝和腰大肌后疝的发病率及治疗情况。
股疝被认为不常见，在腹股沟疝中发病率为2%至8%。尚无大型研究描述股疝或腰大肌后疝的亚型，因此也没有关于这些疝的发病率报告或标准化治疗建议。
本研究是对1993年8月至2011年12月期间所有接受完全腹膜外（TEP）腹腔镜疝修补术的患者进行的回顾性研究。所有修复手术均由一名外科医生完成。报告了患者的人口统计学资料和治疗结果。
2436例患者接受了3242次TEP修补术。疝的亚型为：腹股沟斜疝1523例（46.9%），腹股沟直疝1473例（45.4%），股疝156例（4.8%），闭孔疝35例（1.1%），血管前疝25例（0.77%），半月线疝20例（0.61%），腰大肌后疝3例（0.09%）。血管前疝占股疝的16%。血管前疝患者的平均年龄为70.3岁，均为男性。25例血管前疝患者中有13例（52%）有其他相关缺陷，4例（16%）患者的血管前疝是先前疝修补术后的复发。有3例腰大肌后疝患者，若采用前路开放手术则无法发现。该研究组无术中并发症或已知复发情况。
血管前疝和腰大肌后疝不常见，但发病率高于先前认为的值。血管前疝往往与年龄较大和其他缺陷相关。使用腹腔镜TEP方法可轻松实现对这些疝的诊断和治疗。
