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医学科普

上腹疝(白线疝)Epigastric Hernias

发表者:孙俊杰 人已读

疝气是常见于成人的疾病,但孩子也会有。最常见的类型是腹部疝。根据它们出现的位置来分类,可有多种。它们是由脂肪组织通过腹壁的弱点推出引起的。其结果是,在腹部出现一个小且软的包块。上腹疝出现在肚脐与胸部之间上腹部正中。

为什么孩子会有上腹部疝?

它们被认为是遗传的。如果兄弟姐妹或父母患有上腹部疝,孩子发生它的几率也会升高。胎儿发育期间,这些腹壁结缔组织或肌肉组织的薄弱点就出现了。根据薄弱点早已存在的性质,有时打开一个疝气所需要的只是孩子的一次嚎啕大哭,或者是一次用力排便。

上腹疝气是严重的疾病吗?

这并不严重;实际上,它被认为是一个相对轻的医学问题。大多数疝被称为可复性疝,意思是该凸起间断出现和消失。罕见疼痛,并能够自行缓解,很少或者根本不需要医疗干预。然而,家长应牢记在心的是:并发症还是可能会发生的。如果它足够大,一段肠或胃可以滑入疝然后被卡住。这会是一种非常严重的并发症,因为如果流至器官的血液受到任何损害,就有发生坏疽的风险。紧急手术是解决这个问题的唯一方法。

疝气的症状和体征是什么?

顺着上腹部的中心向下是一个称为白线的结缔组织细条。这个在那些腹肌轮廓分明的人身上会很容易看到;向下穿过六块隆起腹肌的中心,呈现低平,或凹陷。如果在白线上突然出现一个小包块,这极有可能是上腹疝。家长应注意包块的外观。如果是红色或看起来淤青,家长应该带孩子给医生检查。变色的包块可能是肠管已被卡住的迹象。这被称为绞疝气。如果这种外观与呕吐及发热同时出现,家长应主动就医,不要拖延。

上腹部疝选择什么治疗?

治疗选项取决于儿童的年龄和病变的大小。对于病变小的婴儿,医生可能会采取等待和观望的办法。随着孩子的成长,腹壁变成熟和加强。时间可以看到这个问题永久性自行解决。手术通常是几年后的选项。这是因为幼儿会比婴儿更好地耐受手术。

上腹疝修补术包含什么?

病情轻微时家长可以选择延迟手术,而嵌顿疝需要紧急手术干预。

外科手术修复可以在全身麻醉下进行。切口通常选在疝部位的腹壁上。首先处理疝囊,将内容回纳入腹部。然后加强腹壁薄弱区。这可以通过用不吸收线缝合或者在原位缝补片修补来实现;再用可吸收缝线关闭切口。

也可以采用微创腹腔镜外科技术。只是需要腹部小切口来解决问题。如果疝很小,那么外科医生只是简单地把进入的脂肪推回来,然后将疝缝合起来。如果疝很大,外科医生将进入的肠或胃推回去,然后使用外科补片来修补疝。恢复时间取决于儿童的年龄和整体健康状况。在较大修补的情况下,可能会禁止他或她几周的剧烈活动。

手术有什么风险/并发症?

伤口血肿 - 皮肤下出血可以产生像挫伤一样的质硬肿块。这可能只是简单到逐渐消散,或者是通过伤口流出来。如果有大量的出血,这偶尔让你不得不返回到手术室去处理它。

伤口感染 - 轻微的伤口感染不需要特殊处理。

复发幸运的是,疝手术后很少复发(1-5%)。

当医生要你签署同意书时,会和你说明、讨论这些风险/并发症的。

Epigastric Hernias in Children

A hernia is a condition often associated with adults, but children can get them, too. The most common types are abdominal. There are a variety, which are classified according to where they appear. They are caused by fatty tissue pushing through a soft spot in the abdominal wall. The result is that a small, tender lump appears on the abdomen. An epigastric hernia appears in the upper center of the abdomen between the belly button and the chest.

Why Do Children Get Epigastric Hernias?

They are believed to be genetic. A child's odds of developing one increases if siblings or parents have suffered from them. These weak spots in the connective or muscular tissue of the abdominal wall arise during fetal development. Depending on the nature of the weak spot that is already there, sometimes all it takes to open up a hernia in a child is having a good cry or straining during a bowel movement.

Is an Epigastric Hernia a Serious Medical Condition?

It is not serious; in fact, it is considered to be a relatively mild medical condition. Most hernias are referred to as reducible, meaning that the bulge appears and disappears intermittently. This is rarely painful and is able to resolve itself with little or no need of medical intervention. However, parents should keep in mind that complications can occur. If it is big enough, a section of the bowel or the stomach could slip through the hernia and get stuck. This is potentially a very serious complication, because if the blood flow to the organ is compromised in any way, there is the risk of gangrene developing. The only way to fix this is emergency surgery.

What Are the Signs and Symptoms of a Hernia?

Running down the center of the upper abdomen is a thin line of connective tissue called the linea alba. It is easy to see on someone who has well defined abdominal muscles; it is the depression, or valley, that runs down the center of the six-pack. Should a small lump suddenly appear on the linea alba, it is very likely a epigastric hernia. A parent should note the appearance of the lump. If it is red or looks bruised, the parent should have the child checked out by a doctor. A discolored lump could be a sign that some bowel has become stuck. This is known as a strangulated hernia. If the appearance of this coincides with vomiting and a fever, a parent should seek medical attention without delay.

What Are the Treatment Options for Epigastric Hernias?

Treatment options depend on the age of the child and the size of the problem. For small problems with infants, the doctor might take a wait and see approach. As the child grows, the abdominal wall matures and strengthens. Time could see that the problem resolves itself permanently. Surgery is an option that is usually kept off the table for a few years. This is because toddlers tolerate surgery better than infants.

What Does an Epigastric Hernia Repair Entail?

While parents can choose to delay surgery in minor cases, an incarcerated hernia needs emergency surgical intervention.

Surgical repair can be carried out under general anaesthetic. The incision is usually made in the abdominal wall overlying the site of the hernia. The pouch (hernia sac) is first dealt with and the contents returned back into the abdomen. Then the weakness in the abdominal wall is strengthened. This is done using either permanent stitches or a patch of mesh that is stitched in place; the wound is then closed using a dissolvable stitch.

The minimally invasive laparoscopic surgical technique can also be employed. Only tiny incisions in the abdomen are necessary to access the problem. If it is small, the surgeon simply pushes the intruding fat back and then stitches up the hernia. If it is large, the surgeon pushes back the invading section of bowel or stomach and then patches the hernia using a surgical mesh. The success rate of this surgery is 98 percent. The recovery time depends on the child's age and overall health. In the cases of a significant repair, he or she may be barred from physical activity for several weeks.

What are the risks/complications of surgery?

Wound haematoma – bleeding under the skin can produce a firm swelling like a bruise. This may simply dissipate gradually or leak out through the wound. If there is a lot of fluid this may occasionally result in you having to return to theatre in order for it to be dealt with.

Wound infection – minor wound infections do not need any specific treatment.

Recurrence – fortunately recurrence after hernia surgery should be rare (1-5%).

These risks/complications will be explained and discussed with you when the surgeon asks you to sign the consent form.

中山大学附属第一医院小儿外科

孙俊杰医生

Department of Pediatric Surgery, the First Affiliated Hospital of Sun Yat-Sen University

Dr. SUN Junjie

本文是孙俊杰版权所有,未经授权请勿转载。
本文仅供健康科普使用,不能做为诊断、治疗的依据,请谨慎参阅

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发表于:2015-06-18