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【交流】腹股沟疝手术讨论（1） - Welcome to DXY.CN Forum - feim2008 ...

英文叫做（saddle hernia , pantaloon hernia）有人译为马鞍疝或马裤疝。第三点，在临床上，外科医生在做腹股沟疝手术时常常满足于找到了疝囊而忽略了彻底探查，常造成修补后疝的复发。就这个病人老板给我们讲：术中如果不全面检查可能病人很快就有疝的复发而 再次来诊，也可能会有医疗纠纷的出现。 .... 就开放手术而言，腹膜前修补的关键之处在于要找对解剖层面即腹膜前间隙，（在腹股沟区的偏内，这一间隙又称为Bogros间隙是一相对少血管的间隙）在这一间隙中进行分离，建立一大小适当的空间，放入补片。 ...

【交流】腹股沟疝手术讨论（1） - Welcome to DXY.CN Forum

Dissection of this space during a laparoscopic hernia repair is mandatory to enable proper mesh overlap of the hernial defect to aid in proper mesh placement/ fixation. 权当补充 gz007001 wrote: Bogros间隙为腹壁和腹膜间隙的一部分, ...

Inguinal Hernia

56 INGUINAL HERNIA
Gregory P. Victorino M.D., Jyoti Arya M.D., James Bascom M.D.

1. “Groin” hernia refers to which three hernias?

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Direct and indirect inguinal hernias and femoral hernias.
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Inguinal Hernia. Controversies

CONTROVERSIES

36. What are some of the anatomic issues related to inguinal hernias?

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At issue is the iliopubic tract, which is central to the Anson/McVay anatomic description of the inguinal area and featured in the McVay Cooper’s ligament repair. Although the McVay repair is used in England, the iliopubic tract is not referred to or described in English anatomic texts.
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Congenital Diaphragmatic Hernia

86 CONGENITAL DIAPHRAGMATIC HERNIA
Denis D. Bensard M.D., Richard J. Hendrickson M.D.

1. What is the most common type of congenital diaphragmatic hernia (CDH)?

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Congenital abnormalities of the diaphragm include a posterolateral defect (Bochdalek hernia), an anteromedial defect (Morgagni hernia), or the eventration (central weakening) of the diaphragm. The Bochdalek hernia is the most common variant and generally occurs on the left (80%). Approximately 20% occur on the right, and < 1% are bilateral.
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Properties In Evaluation Of The Acute Abdomen

14 PRIORITIES IN EVALUATION OF THE ACUTE ABDOMEN
Alden H. Harken M.D.

1. What is the surgeon’s responsibility when confronted by a patient with an acute abdomen?

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1. To identify how sick the patient is
2. To determine whether the patient (a) needs to go directly to the operating room, (b) should be admitted for resuscitation or observation, or (c) can be sent safely home

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Risks Of Bloodborne Disease

101 RISKS OF BLOODBORNE DISEASE
Caesar M. Ursic M.D., Doru I. E. Georgescu M.D.

1. What infectious diseases are transmissible via blood transfusion?

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Congenital Cysts & Sinuses Of The Neck

88 CONGENITAL CYSTS AND SINUSES OF THE NECK
Frederick M. Karrer M.D., Denis D. Bensard M.D.

1. What are branchial cleft anomalies?

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Cysts, sinuses, and fistulas that result from incomplete obliteration of the first, second, or third branchial clefts, and are present in early fetal development.

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Intestinal Obstruction Of Neonates & Infants

83 INTESTINAL OBSTRUCTION OF NEONATES AND INFANTS
Richard J. Hendrickson M.D., Denis D. Bensard M.D.

1. What signs or symptoms suggest intestinal obstruction in the neonate?

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Signs and symptoms vary according to the level of obstruction. Proximal intestinal obstruction leads to the early onset of bilious emesis, generally with minimal abdominal distention. In contrast, neonates with distal intestinal obstruction present after the first day of life with bilious vomiting and pronounced abdominal distention. Bilious emesis should always be interrogated further in infants and children.
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Diverticular Disease Of The Colon

48 DIVERTICULAR DISEASE OF THE COLON
Gregory P. Victorino M.D., Jyoti Arya M.D., Lawrence W. Norton M.D.

1. What is a colonic diverticulum?

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A protrusion of mucosa and submucosa through the muscular layers of the bowel wall. It has no muscular covering. Because diverticula do not involve all layers of the bowel wall, they are really “false” diverticula. Diverticulum formation may be related either to weakness of the bowel wall at the sites of vessel perforation or to increased intraluminal pressure caused by low dietary fiber and constipation.
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Diagnosis & Therapy of Chronic Pancreatitis

41 DIAGNOSIS AND THERAPY OF CHRONIC PANCREATITIS
Clay Cothren M.D., Jon M. Burch M.D.

1. What is chronic pancreatitis?

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The classic syndrome consists of smoldering abdominal pain and evidence of pancreatic insufficiency. Histologically, chronic inflammation results in destruction of the functioning endocrine and exocrine pancreatic cells.
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Basic Care Of Hand Injuries

34 BASIC CARE OF HAND INJURIES
Michael J.V. Gordon M.D., Lawrence L. Ketch M.D.

1. What are the goals of hand repair?

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Functional considerations override cosmesis in the treatment of hand trauma. There are no minor hand injuries. Initial diagnosis and management determine the final result; expert secondary repair cannot overcome primary errors in diagnosis or decision making.
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Hepatic & Biliary Trauma. Operative Management Of Liver Injury

OPERATIVE MANAGEMENT OF LIVER INJURY

11. How are acute liver injuries classified?

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Liver wounds are generally graded on a scale of I to VI according the depth of parenchymal laceration and involvement of the hepatic veins or retrohepatic portion of the inferior vena cava. Optimal methods of obtaining hemostasis vary with the severity of the injury.
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Hepatic & Biliary Trauma. Surgical Anatomy Of The Liver

SURGICAL ANATOMY OF THE LIVER

7. How many anatomic lobes are present in the liver? What is their topographic boundary?

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The liver is divided into two anatomic lobes, the right and the left. Their boundary lies in an oblique plane extending from the gallbladder fossa anteriorly to the inferior vena cava posteriorly. The three hepatic veins define the division between the lobar segments and the planes of surgical resection. Lobar segments are numbered I-VIII, according to Couinaud’s nomenclature. (See Figure 25-1.)
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Surgical Infectious Disease. Management Of Surgical Infections

MANAGEMENT OF SURGICAL INFECTIONS

21. What is the drug of choice for the treatment of an abscess?

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A knife. Surgically drain the abscess. Abscesses have no circulation of blood within them to deliver an antibiotic. The antibiotic, even if injected directly into the abscess, would be worthless because the abscess contains a soup of dead microorganisms and white blood cells (WBCs). Even if the organisms were barely alive, they would not be reproducing and incorporating the antibiotic. The drug most likely would not work at all at the pH and pKa conditions of the abscess environment.
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Properties In Evaluation Of The Acute Abdomen. Surgical Treatment

SURGICAL TREATMENT

22. If the patient is sick (and not getting better), what should be done?

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After fluid resuscitation, the patient’s abdomen should be explored. An exploratory laparotomy has been touted as the logical conclusion of a complete physical examination.

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Properties In Evaluation Of The Acute Abdomen. Lab Stadies

LABORATORY STUDIES

15. How is a complete blood count helpful?

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1. Hematocrit. If the hematocrit is high (> 45%), the patient is most likely dry or may have chronic obstructive pulmonary disease. If it is low (< 30%), the patient probably has a more chronic disease (associated with blood loss-always do a rectal and test the stool for blood).
2. White blood cell count. It takes hours for inflammation to release cytokines and elevate the white blood cell count. A normal white blood cell count is entirely consistent with significant abdominal trouble. Read more

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