Hutson John M, Kearsey Irene
F Douglas Stephens Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Urology, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia.
F Douglas Stephens Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia.
J Pediatr Surg. 2016 Jul;51(7):1197-200. doi: 10.1016/j.jpedsurg.2015.09.014. Epub 2015 Sep 25.
BACKGROUND/AIM: How testes descend through the inguinal canal is well described, but how the ovaries appear inside an inguinal hernia remains controversial. We reviewed the literature to determine whether ovarian 'descent' has been described.
The English literature from 1950 to 2014 was reviewed via PubMed, Medline and Web of Science to identify papers describing an ovary in the hernia sac: reports were examined to find whether the ovary prolapsed or 'descended', and the anatomy of its supporting ligaments, cranial suspensory ligament (CSL) and round ligament (female gubernaculum, RL).
In forty reports of >7140 inguinal herniotomies and/or imaging studies in females the hernia contains an ovary in 15-20%, often with the ipsilateral fallopian tube. The RL and ovary were aligned along the same path as testicular descent only rarely in Müllerian anomalies with an isolated uterine horn preceding the ovary into the sac. The ligament usually found inside the hernia sac was the CSL, not the RL.
The high frequency of incarcerated ovary, along with the close proximity of the CSL to the internal ring in females is consistent with a sliding hernia pulling the CSL (and ovary) into the hernia sac, not ovarian 'descent' by traction on the RL.
背景/目的：睾丸如何通过腹股沟管下降已有详尽描述，但卵巢在腹股沟疝内的表现仍存在争议。我们回顾文献以确定卵巢“下降”是否有相关描述。
通过PubMed、Medline和科学网检索1950年至2014年的英文文献，以识别描述疝囊内卵巢的论文：检查报告以确定卵巢是脱垂还是“下降”，以及其支持韧带、颅悬韧带（CSL）和圆韧带（女性引带，RL）的解剖结构。
在超过7140例女性腹股沟疝修补术和/或影像学研究的40份报告中，15% - 20%的疝内含有卵巢，通常伴有同侧输卵管。仅在苗勒管异常且卵巢前方有孤立子宫角进入疝囊的情况下，RL和卵巢才极少沿着与睾丸下降相同的路径排列。疝囊内通常发现的韧带是CSL，而非RL。
卵巢嵌顿的高发生率，以及女性CSL与内环的紧密相邻，符合滑动疝将CSL（和卵巢）拉入疝囊，而非通过牵拉RL导致卵巢“下降”。
