腹壁疝的诊断和治疗(英文版)课件

,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Abdominal wall hernias,general consideration,inguinal hernias,femoral hernia,incisional hernia,umbilial hernia,hernia of linea alba,Abdominal wall hernias gene,1,general consideration,Definition,Hernia means a sprout, and protrusion.,External abdominal wall hernia,is an abnormal protrusion of intra-abdominal tissue or the whole or part of a viscera through an opening or fascial defect in the abdominal wall.,most occur in the grion,general consideration,2,Etiology,1.,intensity of abdominal wall decreased,common factors:,1) site that some tissues pass through the abdominal wall, eg. Spermatic,cord, round ligament of uterus,2) bad development of abdominal white line,3) incision, trauma, infection et al.,defect in collagen synthesis or turnover,2.,any condition which increases intra-abdominal pressure,chronic cough, chronic constipation, dysuria, ascites, pregnancy, cry,Etiology,3,Pathological anatomy,composed of:,covering tissue,: skin, subcutanous tissue,hernial sac,: protrusion of peritonum,neck of the sac: is narrow where the sac emerges from,the abdomen body of the sac,hernial contents,: small intestine, major omentum,Pathological anatomy,4,Clinical types,1.,reducible hernia,is one in which the contents of the sac return to the abdomen spontaneously or with manual pressure when the patient is recumbent.,2.,irreducible hernia,is one whose contents or part of contents cannot be returned to the abdomen, without serious symptoms.,hernias are trapped by the narrow neck,Sliding hernia,is one in which the wall of a viscus forms a portion of the wall of the hernia sac. It is may be colon ( on the left), caccum (on the right) or bladder (on either side).,Belongs to irreducible hernia,Clinical types,5,3.,incarcerated hernia,: is one whose contents cannot be returned to the abdomen, with severe symptoms.,4.,strangulated hernia,: denotes compromise to the blood supply of the contents of the sac.,incarcerated hernia and strangulated hernia are the two stages of a pathologic course,Richters hernia,(intestinal wall hernia ),a hernia that has strangulated or incarcerated a part of the intestinal wall without compromising the lumen.,Littre hernia,: a hernia that has incarcerated the intestinal diverticulum (usually Meckel diverticulum).,Reductive incarcerated hernia,: reduction of the hernial contents ( intestine ) into abdominal cavity.,3. incarcerated hernia: is on,6,Inguinal hernias,inguinal hernia: a protrusion of part of the contents of the abdomen through the,inguinal region of the abdominal wall.,indirect inguinal hernia: the internal inguinal ring,the inguinal canal,external,inguinal ring,scrotum,direct inguinal hernia: Hesselbachs triangle,Anatomy,1.,Anatomic layers,1) skin, subcutaneous tissue,2) external oblique muscle, aponeurosis,Subcutaneous (external) inguinal ring,:,Triangular opening, in the aponeurosis of the external oblique just superior and lateral to the pubic tubercle.,Inguinal hernias,7,Inguinal ligament,: it is formed as the lateral edge of the aponeurosis of external oblique rolls upon itself and thickens into a cord, extending from the anterior superior iliac spine to the pubic tubercle.,Lacunar ligament,Coopers ligament (pectineal ligament),Sensory nerves: iliohypogastric nerve, ilioinguinal nerve,3),internal oblique muscle and tranverse abdominal muscle,Conjoined tendon ( flax inguinalis),: the lower fibers of the internal oblique muscle fuse with the lower most arching fibers of the transverse muscle of the abdomen and insert with them into the pubic tubercle, forming the conjoined tendon.,Inguinal ligament: it is forme,8,4),Transversalis fascia,Internal inguinal ring,: is the point at which the spermatic cord or round ligament passes through the transversalis fascia to enter the inguinal canal.,surface marking: 2cm superior to the point midway between the anterior superior iliac spine and the pubic tubercle.,Iliopubic tract,: it is the thickest portion of the transversalis fascia in the inguinal region. It parallels and lies just medial to the inguinal ligament.,5) extraperitoneal fat and peritoneum,4) Transversalis fascia,9,2.,Anatomy of inguinal canal,Contents: spermatic cord, round ligament, ilioinguinal nerve,Walls:,anterior: skin, superficial fascia, and external ablique aponeurosis,posterior: transversalis fascia,superior: conjoined tenden,inferior: inguinal ligament,3,Hesselbachs triangle,Bounded by the inguinal ligament, the inferior epigastric vessels, and the lateral edge of rectus muscle.,2. Anatomy of inguinal canal,10,腹壁疝的诊断和治疗(英文版)课件,11,Causes of indirect inguinal hernia,1.,congenital abnormality of anatomy,due to failure of fusion of the processus vaginalis peritonei after the,testis has descended into the scrotum.,2. acquired weakness or defect of abdominal wall,Clinical manifestation and diagnosis,Symptoms: pain, discomfort, dragging sensation,Sign: reducible or irreducible lump, expansile cough impulse,Reducing the hernia fully, compress the internal ring:,be controlled indirect not controlled - direct,Causes of indirect inguinal h,12,腹壁疝的诊断和治疗(英文版)课件,13,Differences between indirect and direct hernia,feature,indirect,direct,age,children, young people,aged people,pathway of protrusion,coming down the inguinal canal, may enter the scrotum,pass through Hesselbachs triangle, rarely enter the scrotum,contours of sac,elliptic, pear-shaped,semispheric, wide base,compress the internal ring after reduced,controlled,controlled,Relationship of spermatic cord with sac,Posterior to the sac,Anterior and lateral to the sac,Relationship of sac neck with inferior epigastric artery,Sac neck is lateral to it,Sac neck is medial to it,Incarcerated incidence,high,low,Differences between indirect a,14,Differential diagnosis,1,dydrocele of testis translucent test (+),2 communicated hydrocele,3 hydrocele of cord: not reducible,4 undescended testis,5 acute intestinal obstruction,Treatment,1.,nonoperative therapy,Indications:,1 year old,elderly patients or with severe systemic disease-truss,Differential diagnosis,15,2.,operations for inguinal hernia,conventional repairs,Principles: excision or reduction of the hernial sac, high ligation of the sac,and repair the walls of the inguinal canal,A: high ligation of hernia sac,Used in infants, and patients with severe local infection,B: repair of walls of the inguinal cancal,I,repair of the anterior wall of the inguinal canal,Ferguson repair,II,Repair of the posterior wall,Bassini repair,Halsted repair,: placing the latter in a subcutanous position,2. operations for inguinal her,16,McVay repair,: lower edge of internal oblique muscle and the conjoined tendon are approximated to Coopers ligament on the iliopectineal line of the pubis.,Shouldice repair,:,the posterior wall of the inguinal canal is repaired by dividing the transversalis fascia from the pubis to adjacent to the inferior epigastric vessel, then imbricate sutures.,Internal ring: pass a fingertip,2),tension-free hernioplasty,insertion of a prosthetic mesh,3),laparoscopic repair of inguinal hernia,McVay repair: lower edge of,17,腹壁疝的诊断和治疗(英文版)课件,18,腹壁疝的诊断和治疗(英文版)课件,19,腹壁疝的诊断和治疗(英文版)课件,20,腹壁疝的诊断和治疗(英文版)课件,21,腹壁疝的诊断和治疗(英文版)课件,22,3.,management rule of incarcerated and strangulated hernia,Indications for manual reduction:,1) duration 40 years,Causes: laxity of groin tissue elevated intra-abdominal canal,Anatomy of femoral canal,Femoral ring fossa ovalis,Anterior: inguinal ligament,Posterior: pectineal ligament,Medial: lacunar ligament,Lateral: femoral vein,Femoral hernia,24,Pathologic anatomy,femoral ring,femoral canal,fossa ovalis,subcutaneous tessue of the thigh,High incidence of strangulation,腹壁疝的诊断和治疗(英文版)课件,25,Clinical findings and diagnosis,Reducible femoral hernia: asymptomatic lump, localized intermittent,discomfort,Irreducible femoral hernia: constant lump and localized discomfort,Strangulated femoral hernia,Differential diagnosis,1.,indirect inguinal hernia,2. lipoma,3. groin lymph nodes,4. long saphenous varix,5. iliolumbar tuberculous abscess,Clinical findings and diagnosi,26,Treatment,Not be treated conservatively,Rule operation: excision or reduction of the hernial sac, and narrowing of the stretched femoral opening,methods:,McVay repair,tension-free hernioplasty,laparoscopic repair of inguinal hernia,Treatment,27,Other abdominal external hernia,Incisional hernia,Incisional hernia: an abnormal protrusion of a viscus through the,musculoaponeurotic layers of a surgical scar.,Wound dehiscence,Etiology,Preoperative factors,Operative factors:,types of incision: vertical incision, transrectus incision, midline,incision, standard parmedian incision,technique of closure,suture materia,Postoperative factors: increased intra-abdominal pressure, et al.,Other abdominal external herni,28,Clinical features and diagnosis,Swelling and mass in the incision,Hernial ring,Rarely incarcerate,Treatment,Operative repair: the same way as a laparotomy wound is repaired, or use mesh,Umbilical hernia,1,infantile umbilical hernia,1) failure of fusion of umbilical ring, or weakened umbilical tissue,2) symptomless, reducible lump,3) usually disappear by the age of 2 years,4) rarely incarcerate,5) surgical repair 2 years,Clinical features and diagnosi,29,2,Adult umbilical hernia,1),acquired hernia,2) more common in females,3) incarceration is common,4) surgical repair: excision of the sac, suture the hernia ring,Hernia of linea alba,Epigastric hernia,It is a protrusion of preperitoneal fat and / or peritoneal sac through a gap,in the decussating fibers of the linea alba, usually the supraumbilical,portion of the linea alba.,Most are asymptomatic, or vague upper abdominal pain and nausea may,be present.,Surgical repair,2 Adult umbilical hernia,30,