Η σπαστική ανεπάρκεια της inguinal γωνίας προκαλείται κυρίως από δύο πτυχές, η ανοιχτή ή η κλειστή σπαστική οπίσθιας προεξοχής είναι μια σημαντική προϋπόθεση για την εμφάνιση της σπαστικής ανεπάρκειας, η οποία προκαλείται από κληρονομικούς παράγοντες. Επειδή υπάρχει ανισορροπία στην περιοχή της inguinal γωνίας, η οποία προκαλείται από μεταγενέστερους παράγοντες, θα σας εξηγήσω λεπτομερώς παρακάτω.
First, congenital factors
In the early stages of the embryo, the testicle is located on both sides of the spine, corresponding to the2-3At the lumbar spine, between the transversalis fascia and the peritoneum on the posterior abdominal wall, it gradually moves downwards. In the embryo3Around one month, the testicle moves to the iliac fossa7Around one month, close to the internal ring of the inguinal canal, before birth1Around one month, the testicle enters the inguinal canal at the internal ring, usually descending into the scrotum before birth. If the testicle still stays on the posterior abdominal wall or the inguinal canal after birth, it is called cryptorchidism.
During the descent of the testicle, a part of the peritoneum close to the front of the testicle, that is, with the testicle, passes through the inguinal canal and descends into the scrotum, thus forming the peritoneal processus vaginalis that communicates with the abdominal cavity. During normal development, soon after birth, except for the part surrounding the testicle, which forms the inherent tunica vaginalis of the testicle, the rest of it atrophies, closes, and leaves a very thin fibrous cord or disappears. If this peritoneal processus vaginalis remains open and does not close, still communicating with the abdominal cavity, it forms a congenital hernial sac. According to the principle of mechanical force of abdominal pressure, the weakest point bears the greatest pressure, that is, the so-called 'focus pressure'. Therefore, when the abdominal pressure increases or the abdominal wall muscles relax due to certain factors, it is easy to form congenital indirect inguinal hernia.
If only the lower segment of the processus vaginalis is closed, and the upper segment remains open, it can also induce congenital indirect hernia. Because the descent speed of the right testicle is slower than that of the left, the time of the closed processus vaginalis is longer, so the opportunity to induce congenital indirect hernia is more than that of the left side. Therefore, the opening or closing of the processus vaginalis is one of the important conditions for the occurrence of hernia, and Russel once unilaterally believed that 'there is no peritoneal sac without hernia'.
Second, acquired factors
The pathogenesis of acquired indirect hernia is completely different, and it is caused by an anatomical defect in the inguinal canal area. Because the peritoneal processus vaginalis has been closed, and a new hernial sac has been formed through the inguinal canal. First, the inguinal canal area was originally a weak part of the abdominal wall without muscle protection, with the spermatic cord passing through. If the inferior border of the transversalis fascia arch and the internal oblique muscle are high or underdeveloped, it can further weaken the resistance of this area. Secondly, the failure of the protective mechanism in physiology. Normally, there are two physiological defense functions:
The first is the sphincteric action of the transversus abdominis and internal oblique muscles on the internal ring. When the transversus abdominis and transversalis fascia contract, the transversalis fascia thickens to form an intermuscular ligament, which is pulled upwards and outwards along with the internal ring.
To is the opening and closing action of the transversalis fascia arch. During normal rest, the transversalis fascia arch (or the conjoint tendon) bulges upwards, but when the abdominal muscles are stimulated and the transversus abdominis and internal oblique muscles are tense, the transversalis fascia arch can be flattened, drawn closer to the inguinal ligament, and close the inguinal ring to prevent the occurrence of hernia. If the transversalis fascia or transversus abdominis is underdeveloped, the muscles become relaxed. If the inferior border of the arch separates from the inguinal ligament, it will be more prone to induce acquired indirect hernia. Clinically, acquired indirect hernia is more common than congenital hernia.
Η ηλικία, η εξάντληση, η παχυσαρκία, η έλλειψη εκπαιδεύσεως της κοιλιακής μυϊκής δύναμης και άλλες καταστάσεις μπορεί να προκαλέσουν την αδυναμία της κοιλιακής επιφάνειας και να προκαλέσουν την κήλη inguinalis. Η ανώμαλη μεταβολισμός της κολλαγόνου έχει στενή σχέση με την εξωκοιλιακή κήλη.
Συνοψίζοντας, η μηχανισμός ανάπτυξης της κήλης inguinalis είναι πολύ περίπλοκος, συντομογραφικά, η ανάπτυξη της κήλης inguinalis έχει δύο κύριους παράγοντες, την αδυναμία της κοιλιακής επιφάνειας και την αύξηση της κοιλιακής πίεσης, είτε είναι κληρονομική είτε κτητική κήλη, είναι το αποτέλεσμα της κοινής δράσης αυτών των δύο παραγόντων, η κλινική πρέπει να κατανοήσει τη συγκεκριμένη μοναδική μηχανισμό ανάπτυξης του ασθενούς και να προχωρήσει σε στόχευση χειρισμό.
