Spangen L
World J Surg. 1989 Sep-Oct;13(5):573-80. doi: 10.1007/BF01658873.
The diagnosis of spigelian hernia presents greater difficulties than its treatment. The clinical presentation varies, depending on the contents of the hernial sac and the degree and type of herniation. The pain, which is the most common symptom, varies and there is no typical pain of spigelian hernia. Findings to facilitate diagnosis are palpable hernia and a palpable hernial orifice. Large, easily palpable spigelian hernias are not a diagnostic problem. It is small hernias and hernial orifices that are overlooked because they are masked by the subcutaneous fat and an intact external aponeurosis. In the absence of a palpable orifice or sac, persistent point tenderness in the spigelian aponeurosis with a tensed abdominal wall most strongly suggests the diagnosis. Spigelian hernia can be ruled out in patients without palpable tenderness. Ultrasonic scanning can be recommended for verification of the diagnosis in both palpable and nonpalpable spigelian hernia. The hernial orifice and sac can also be demonstrated by computed tomography, which gives more detailed information on the contents of the sac than does ultrasonic scanning. The treatment of spigelian hernia is surgical, and the risk of recurrence is small. A gridiron incision is excellent for operations for palpable hernias. If the hernia cannot be palpated preoperatively, preperitoneal dissection through a vertical incision is recommended. This gives good exposure, facilitates hernioplasty, and permits preperitoneal exploration and treatment of other abdominal wall hernias. The incision is also suitable for exploratory laparotomy, which should be performed on patients with abnormal ultrasonographic or computed tomographic findings in whom no palpable hernia can be detected preoperatively.
半月线疝的诊断比其治疗更具难度。临床表现因人而异，取决于疝囊内容物以及疝出的程度和类型。疼痛是最常见的症状，其表现多样，半月线疝并无典型疼痛。有助于诊断的体征是可触及的疝块和疝环。大的、易于触及的半月线疝不存在诊断问题。小疝块和疝环容易被忽视，因为它们被皮下脂肪和完整的腹外腱膜所掩盖。若未触及疝环或疝囊，半月线腱膜处持续的压痛点且腹壁紧张，则强烈提示半月线疝的诊断。无压痛的患者可排除半月线疝。对于可触及和不可触及的半月线疝，均可推荐超声扫描以核实诊断。计算机断层扫描也可显示疝环和疝囊，它能比超声扫描提供更多关于疝囊内容物的详细信息。半月线疝的治疗方式为手术，复发风险较小。对于可触及的疝，采用麦氏切口进行手术效果良好。若术前无法触及疝块，建议通过垂直切口进行腹膜前解剖。这样可获得良好的暴露，便于疝修补术，还能进行腹膜前探查及治疗其他腹壁疝。该切口也适用于探查性剖腹术，对于术前超声或计算机断层扫描结果异常但未触及疝块的患者应实施此手术。
