大腿ヘルニア手術症例の臨床的検討

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2001年～2011年に施行した大腿ヘルニア手術症例52例を検討した。全例でCT 施行し，大腿ヘルニアの術前診断は41例（CT 正診率80％）だった。嵌頓群は37例（71％）で，イレウス症状は20例（嵌頓群の54％）で認め，全例緊急手術を要した。ヘルニア内容は小腸27例（73％）が最も多かった。腸切除は16例（43％）で施行した。発症から手術までの経過時間は，切除群と非切除群で平均値は同等で有意差を認めなかった（P=0.621）。後壁補強は McVay 法が37例（95％）で施行され，非嵌頓群では各種メッシュ法が53％で選択されていた。術後合併症は嵌頓群で有意に多かったが，腸切除の有無では有意差を認めなかった。腸切除を避けるためには，早期診断・治療が必要であり，発症からできるだけ早いタイミングでの介入が有効と考えられた。［Aim］ Determine the outcome of surgical evaluation of femoral hernias.［Methods］ From 2001 to 2011, 52 patients were retrospectively evaluated according to clinical manifestations.［ Results］ Before surgery, 41 patients（ 80%） were accurately diagnosed by computed tomography. 35 of 37 incarcerated patients（ 95%） and 6 of 15 non-incarcerated patients（ 40%） were accurately diagnosed by CT scan. 19 of 21 resected patients（ 90%） and all non-resected patients（ 100%） were accurately diagnosed. Emergent surgery was performed for 37（ 71%） patients having incarceration and 20 having bowel obstruction（ 54% of those with incarceration）. The hernial sac contained small intestine in 27（ 73%） cases. Intestinal resection was performed for 16 patients（ 43%）, and McVay repair for 37 patients, 95% of whom had incarceration. Mesh repair was performed in 53% of the patients without incarceration. Average time from onset of symptoms to surgery did not differ significantly between the intestinal resection and non-resection groups（ P=0.621）. Postoperative complications were significantly more common in incarcerated patients, but were not significantly different when comparing the resection and non-resection groups.［ Conclusions］ To avoid the need for intestinal resection, early diagnosis and treatment is needed. Surgery should be performed as early as possible after the onset of symptoms.
2013-03-00

大腿ヘルニア手術症例の臨床的検討

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