警惕｜妊娠期的“腹股沟疝”

各位：当你临床上碰到妊娠腹期的妇女考虑为股沟疝时，一定要小心加细心！

因为那可能又是一个“坑”！（坑人又坑爹的“坑”，呵呵！）

尽管，腹股沟疝即可见到，又可触及。而且，你已经做了许多年的外科医生，在诊断上，好像把握性很大，藐视没有多大的问题。但，请切记， 当女性且又在妊娠期，一定要当心！因为有太多的文献（若在Pubmed上以inguinal hernias in pregnancy为主题词搜一下，上百篇的误诊病例可以查到。）提示这时要做个Ｂ超加彩色多普乐检查为妥。

（上图，彩色多普乐示；腹股沟包块为园韧带静脉曲张）

因为有文献指出：目前关于妊娠期的腹股沟区肿块，临床上已经发现园韧带静脉曲张的可能性大过腹股沟疝的可能性。

国外的有很多的临床报告指出，这些女性疑为腹股沟疝的论断，开刀下去的结果是园韧带的静脉曲张。

（想一想，在中国，特别是在当今，如果你是术者，将情何以堪？）

妊娠期由于激素水平的变化，可以使园韧带变粗，园韧带静脉曲张而出现腹股沟区域包块，甚至产生类似嵌疝表现，要你考虑急诊手术。换言之，这种情况诱使外科医生误诊，上当。因此，对疑为妊娠腹股沟疝者的处理须小心！

一定要做彩超和多谱乐检查加以避免。

所以，这里再次强调对妊娠期腹股沟疝的诊断要有辅助检查为妥（不要说小编没有告诉你哟！）

理论上讲妊娠期园韧带静脉曲张是一过性的，可能不需要手术治疗。

若想进一步深究其产生的原因，以下几篇英文原文值得一读。

1)

In a recently published article authors emphasised that groin swelling firstly appeared during pregnancy is due to RLVs more than inguinal hernias.7 Pregnancy causes a predisposition for RLV development yet nearly all of the known cases are pregnant women. Only one non-pregnant case was reported.5Physiopathology can be explained by progesterone-mediated smooth muscle relaxation, increased cardiac output and intravascular fluid volume, increased venous return from lower extremities and compression of veins due to growing uterus.

from:Pak J Med Sci. 2015 Jul-Aug; 31(4): 1012–1014.

2)

Hernia. 2014 Jun;18(3):375-9. :: 10.1007/s10029-013-1082-y. Epub 2013 Apr 5.

Suspected inguinal hernias in pregnancy--handle with care!

Lechner M1, Fortelny R, Ofner D, Mayer F.

Abstract

PURPOSE:

With a newly described diagnostic pathway, we aim to avoid unnecessary surgical exploration for suspected symptomatic groin hernias in pregnancy.

METHODS:

A consecutive series of eighteen pregnant women was referred to our department due to a gradual onset of inguinal swelling and groin ache. In a prospective clinical study, we evaluated these patients clinically and employed grey-scale and colour Doppler sonography (CDS) in all cases--following a newly described pathway. All patients were examined pre- and post-partum by two qualified surgeons. Median follow-up time was 11 months.

RESULTS:

4/18 of the suspected hernias first occurred towards the end of the first, the majority (12/18) in the second, 2/18 in the last trimester and all were suspected after clinical examination only. Most women were referred by their gynaecologists. We found no hernias in any of the women but always noted large varicose veins along the round ligament during CDS. All women gave uncomplicated birth to single children, one by caesarean section. Complaints subsided spontaneously within roughly 2 weeks after delivery. No patient developed a groin hernia until the end of the follow-up period.

CONCLUSION:

The diagnosis of an inguinal hernia with a first symptomatic onset during pregnancy may be wrong in most cases. Anamnesis and clinical examination must be backed by CDS and round ligament varicosity as an important differential diagnosis must always be considered. Our structured diagnostic pathway helps to easily make the correct diagnosis. Surgical exploration of the groin during pregnancy must be avoided.

3)

Ultrasonography. 2014 Jul;33(3):216-21. doi: 10.14366/usg.14006. Epub 2014 Mar 18.

Ultrasonographic diagnosis of round ligament varicosities mimicking inguinal hernia: report of two cases with literature review.

Ryu KH1, Yoon JH.

Author information

Abstract

Round ligament varicosities are rare, and the mass mimics an inguinal hernia. Round ligament varicosities should be considered in the differential diagnosis of a groin swelling in a female, especially during pregnancy. The diagnosis of round ligament varicosities can be established on grayscale and color Doppler ultrasonography. We report two cases of round ligament varicosities in a 33-year-old non pregnant woman and a 28-year-old pregnant woman, and these patients were diagnosed using ultrasonography. We also reviewed the literature on round ligament varicosities including the present cases. Ultrasonography is diagnostic and can prevent unnecessary surgical intervention and associated morbidity.