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..Incisional Hernia 切口疝

An incisional hernia develops as a late complication of abdominal surgery. It also has been seen after laparoscopic procedures. Most incisional hernias will present within the first year; however, some go unnoticed by the patient and are incidentally detected on sonography or computed tomography. Sonography is very useful in ruling out a hernia at surgical sites and in monitoring the integrity of wire mesh implants (Figure 7 )
切口疝是腹部外科手术的晚期并发症，也可见于腹腔镜操作后。大多数切口疝发生于一年内，然而，一些病人没引起注意，只是偶尔做超声检查或CT时被发现。超声检查在外科手术部位的疝的排除和置入的金属网完整性的监测方面是非常有用的（图7）。

Figure 7. A, Large incisional hernia containing bowel loops. B, Incisional hernia, extended view. C, Incisional hernia at the site of laparoscopy.
图7，A，包含肠管的较大的切口疝。B，切口疝，扩展示图。C，腹腔镜操作处的切口疝。

Inguinal Hernia 腹股沟疝

An indirect inguinal hernia occurs as a result of protrusion of the peritoneal sac and contents through the internal inguinal ring into the inguinal canal and sometimes into the scrotum.12 The internal inguinal ring is a defect in the transversalis fascia anterior to the femoral vessels, lateral to the inferior epigastric artery, and above the inguinal ligament. The superficial inguinal ring is a defect in the external oblique aponeurosis. Direct inguinal hernias protrude through a weakened inguinal canal floor, medial to the inferior epigastric artery. Depending on the content, namely, fluid, air-containing bowel, or fluid-containing bowel, inguinal hernias will have different appearances on sonography (Figure 8, A–C ). Distended, adynamic bowel indicates obstructed loops (Figure 8D ). The inferior epigastric artery can be visualized on color Doppler sonography, and then differentiation of a direct or an indirect inguinal hernia is possible (Figure 8, E–G ).13,14 In female neonates and infants, ovaries may prolapse into the hernia and can be identified by their typical appearance (Figure 9 ).
腹股沟疝的原因是腹膜囊和内容物通过腹股沟内环进入腹股沟管，有时进入阴囊。腹股沟内环是股血管前面腹横筋膜的缺损，位于腹壁下动脉外侧，腹股沟韧带上方。腹股沟外环是腹外斜肌的缺损。直疝经薄弱的腹股沟管壁，从腹壁下动脉内侧突出，根据其内容物，也就是肠管液－气含量或液体含量不同，腹股沟疝在超声上有不同的表现（图8A –C ）。肠管膨胀、蠕动无力表示发生肠梗阻（图8D），在彩色多普勒超声上可见腹壁下动脉，可鉴别直接或间接腹股沟疝（图8，E－G）。女性新生儿或婴儿的卵巢可脱入疝，通过其典型的表现能予以确定（图9）。

Figure 8. A, Inguinal hernia with sac containing only fluid. B, Inguinal hernia containing bowel loops. C, Inguinal hernia, extended view. D, Inguinal hernia containing obstructed bowel loop. E, Inguinal hernia, longitudinal section. Arrows outline the small hernial sac. F, Direct right inguinal hernia medial to theInferior epigastric artery. G, Indirect right inguinal hernia lateral to the inferior epigastric artery.
图8，A，疝囊内只有液体的腹股沟疝。B，包含肠管的腹股沟疝。C，腹股沟疝的扩展示图。D，肠管梗阻的腹股沟疝。E，腹股沟疝纵切面，箭头示小的疝囊。F，位于腹壁下动脉内侧的右侧直疝。 G，位于腹壁下动脉外侧的右侧直疝。