《腹外疝ENGLISH幻灯片》由会员分享，可在线阅读，更多相关《腹外疝ENGLISH幻灯片（72页珍藏版）》请在金锄头文库上搜索。
1、Abdominal External HerniaZHANG MaoThe first affiliated hospital， chongqing medical university1pgeneral introduction *definition、etiology、anatomy and clinical types pinguinal hernia *definition、anatomy、Clinical manifestation、diagnosis 、Differential diagnosis and treatment pfemoral herniapincisional h
2、ernia2Abdominal External Hernia“Hernia” is derived from the Latin word for “rupture”. 3general consideration - Definitionhernia is defined as an abnormal protrusion of an organ or tissue through a defect in its surrounding walls abdominal External hernia is defined as an abnormal protrusion of intra
3、- abdominal tissue or viscera through a defect in the abdominal wall.mostly occur in the groin1. intensity of abdominal wall decreasescommon factors:1) the site that some tissues pass through the abdominal wall, eg. Spermatic cord, round ligament of uterus.2) bad development of abdominal white line3
4、) incisional infection, trauma. 2. intra-abdominal pressure increaseschronic cough, chronic constipation, dysuria, ascites, pregnancy, cry4general consideration -Etiology5Spermatic cord pass through the abdominal wall 6incisional weakness cause incisional herniacomposition of abdominal external hern
5、ia : 1. covering tissues: skin, subcutanous tissue 2. hernial sac: protrusion of peritoneum,neck of the sac: is narrow where the sac emerges from the abdomen body of the sac 3. hernial contents: small intestine, major omentum7general consideration -anatomy81.reducible hernia is one in which the cont
6、ents of the sac can return to the abdomen spontaneously or with manual pressurewhen the patientis supine. general consideration- -Clinical types2. irreducible hernia is one whose contents or part of contents cannot be returned to the abdomen, without serious symptoms.hernias are trapped by the narro
7、w neckSliding 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), cecum (on the right) or bladder (on either side).Belongs to irreducible hernia9general consideration -Clinical types10Sliding hernia sac3. incarcerated hernia i
8、s one whose contents cannot be returned to the abdomen, with Severe symptoms. 11general consideration -Clinical typesSpecial types of incarcerated hernia Richters hernia (intestinal wall hernia )a hernia involving only one sidewall of the bowel, which can result in bowel strangulation without causin
9、g bowel obstruction or any of its warning signs 12general consideration - Clinical types13general consideration - Clinical typesSpecial types of incarcerated hernia Littre hernia an incarcerated hernia involving a small international diverticulum (usually Meckel diverticulum).14neckIntra-abdominal g
10、angrene intestinesacgeneral consideration - Clinical typesRetrograde incarcerated hernia (maydl) two adjacent loops of small intestine are within a hernial sac with a tight neck. The intervening portion of bowel WITHIN the abdomen is deprived of its blood supply and eventually becomes necrotic. 4. s
11、trangulated herniapressure on the hernial contents may compromise blood supply and cause ischemia, and later necrosis and gangrene, which may become fatal. 15general consideration - Clinical typeshow to understand incarcerated hernia and strangulated hernia p The content of the sac in both types are
12、 incarcerated p incarcerated hernia isnt with ischemia of tissue strangulated hernia is with ischemia of tissue p incarcerated hernia and strangulated hernia are the two stages of a pathologic coursegeneral consideration - Clinical types16 General consideration Clinical manifestation and diagnosis D
13、ifferential diagnosis Treatment17Inguinal herniasDefinition: a protrusion of tissue or viscera of the abdomen through the inguinal region of the abdominal wall.18Inguinal hernias - general considerationInguinal hernias are classified as either direct or indirect Anatomy of inguinal area(The surgeon
14、must have a comprehensive understanding of the anatomy of the groin in order to properly select and utilize various options for hernia repair ) 1.Anatomic layers of abdominal wall in the groin. The abdominal wall is composed of 7 layers. They are (from anterior to posterior) as follows:19Inguinal he
15、rnias - general consideration skin Superficie fascia external oblique muscle and aponeurosis internal oblique muscle Transversus muscle Transversalis fascia peritoneumthere are several special struction that a surgeon should know： Subcutaneous (external) inguinal ring Inguinal ligament Lacunar ligam
16、ent Coopers ligament (pectineal ligament) Conjoined tendon Internal inguinal ring Iliopubic tract27special struction in groin28external (superficial) inguinal ringAn ovoid opening of the external oblique aponeurosis that is positioned superior and slightly lateral to the pubic tubercle 29Inguinal ligament and Lacunar ligamentInguinal ligam
