腹部疝（Abdominal Hernia）

A hernia develops when a weakness that forms in the abdominal wall enables part of the intestine (bowel) or another organ to protrude through it. Among the most common are umbilical hernias that occur at the navel and inguinal hernias that are seen in the groin area. There are 2 types of inguinal hernia, indirect and direct, that may look similar but have different locations of the protruding intestine. Incisional hernias occur where an incision has been made in the abdominal wall for an operation.

当腹壁出现薄弱，肠子或其他内脏经过薄弱的部位突出，就形成“疝”。最常见是脐疝以及腹股沟疝。腹股沟疝有两种：斜疝和直疝。两者看起来很类似，但突出的部位不同。切口疝是腹部手术后在切口部位出现的疝。

SYMPTOMS
症状
The first symptom of a hernia is usually a small bulging under the skin that is generally painless but may produce discomfort and get larger during strenuous activities or coughing. At this stage, the hernia is reducible because its contents (bowel) can be pushed back into the abdomen. However, if the hernia grows, it may become incarcerated (unable to be pushed back). If blood stops flowing through an incarcerated bowel, this results in strangulation, which is accompanied by pain, often with nausea, vomiting, or constipation.

最开始的症状是皮下凸起，没有疼痛，但在活动剧烈或咳嗽时可以增大，产生疼痛。在这个阶段，疝还是可以回复的，也就是疝的内容物可以回到腹腔。但是，随着疝的发展，可能会出现嵌顿（无法回纳）。如果血液无法进入嵌顿的肠管，会导致绞窄，出现疼痛、恶心、呕吐或便秘。

RISK FACTORS

危险因素

Family history of hernia
疝的家族史

Being male
男性
Obesity
肥胖
Pregnancy
妊娠
Weight lifting, coughing, straining during bowel movement
举重、咳嗽、排便费力
Cystic fibrosis and chronic lung infections
囊性纤维化以及慢性肺炎
Previous abdominal surgery

既往腹部手术史

COMPLICATIONS
并发症
A hernia may result in entrapment of other organs (such as the bladder or colon) or nerves, producing constipation or problems with urination or sexual function. A strangulated hernia is a surgical emergency because part of the bowel may become necrotic (dead), resulting in life-threatening peritonitis (inflammation of the abdominal cavity) needing surgical removal of part of the bowel. If you have a hernia and significant abdominal pain, pain over the hernia, or nausea or vomiting, you should seek medical care immediately.

疝可能累及其他器官（如膀胱或结肠）或神经，导致便秘、排尿功能或性功能障碍。绞窄性疝是外科急症，因为肠子会坏死，导致腹膜炎（腹腔里面的炎症），危及生命，需要手术切除部分肠管。如果疝伴有明显腹痛、疝疼痛、恶心、呕吐，应该及时就医。

TREATMENT
治疗
Initial treatment of a minor hernia includes avoiding heavy lifting and strenuous exercises and, sometimes, wearing a support (truss or girdle). It used to be thought that all hernias should be repaired. However, recent evidence suggests that repair should be performed only if significant discomfort or pain is associated with the hernia.

小的疝的初始治疗包括避免举重、用力、或运动，有时可以佩戴支持物。既往认为所有的疝都应该修补。但最新的证据显示只有当疝伴有明显的不适或疼痛时才需要进行修补。

The operation to repair a hernia is called a herniorrhaphy (closing the gap in muscles). When the gap is large, a plastic mesh may be used for reinforcement of muscles of the abdominal wall. Use of mesh reduces the risk of the hernia recurring, but the mesh material can become infected. In some cases, hernia repairs may be performed laparoscopically (through small skin incisions using a fiberoptic tube with a camera and small instruments), although this approach has not been shown to be better than traditional open operations.

手术修补疝的方法叫疝修补术。当缺损比较大，可以采用补片加强肌肉的薄弱区域。使用补片可以减少复发，但补片可能会感染。某些情况下，疝修补术可以通过腹腔镜（通过皮肤的小切口以及带有摄像头的纤维软管、微型器械）来操作，但没有证据显示腹腔镜比传统手术有优势。

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