腹橫筋膜在成人鼠蹊部疝氣成因中所可能扮演的角色

Abstract

鼠蹊部疝氣是種常見的疾病。在美國，每年大約施行六十萬例以上的疝氣修補手術。傳統上，大多認為直接型鼠蹊部疝氣是由於腹橫筋膜變得薄弱所造成。但是根據Pans等人的研究，腹橫筋膜的膠原蛋白發生功能性變化可能和腹股溝疝氣生成有關。 本篇研究的重點在探討直接型疝氣病患、間接型疝氣病患的腹橫筋膜所含的膠原蛋白含量，並做比較；同時研究直接型疝氣病患、間接型疝氣病患的腹橫筋膜切片的病理變化。 結果顯示，直接型疝氣病患與間接型疝氣病患的腹橫筋膜所含的膠原蛋白含量並無統計學上有意義的差別，不過間接型疝氣病患的腹橫筋膜膠所含的膠原蛋白含量，比直接型疝氣病患的腹橫筋膜所含的膠原蛋白含量高。這種結果令人意外，而且至今確實的原因並不清楚。可能是由於直接型疝氣患者、間接型疝氣患者的腹橫筋膜所承受的腹內壓力不同，而導致間接型疝氣患者的腹橫筋膜產生較高的膠原蛋白替換率，及較高的膠原蛋白含量。 間接型疝氣患者的腹橫筋膜病理切片，顯示密實的膠原蛋白纖維及完整的彈性纖維。相反地，直接型疝氣患者的腹橫筋膜病理切片卻表現出凝集態的膠原蛋白纖維，斷裂狀的彈性纖維。本研究的結論顯示疝氣病患的腹橫筋膜產生病理變化、及功能性變化可能和鼠蹊部疝氣的形成有關。

Hernia is a common disease. Hernia repair is the most frequent operation after to appendectomy

in the United States. Classically direct hernia is considered the result of weakness of transervalis

fascia. In light of the studies of Pans and Albert, it appeared that collagen pathology of transversalis

fascia could be involved in the genesis of adult groin hernia.

In this work, we focused on investigations including collagen content and pathologic changes of

transversalis fascias from patients with direct or indirect hernias. The collagen content of

transversalis fascias collected from patients did not show significant difference between direct and

indirect hernia patients. The slight increase in collagen content of transversalis fascias from indirect

hernia patients was impressed. However, its explanation remains unclear.

Patients with indirect hernia had compact collagen fibers and intact elastic fibers. In contrast,

patients with direct hernia had aggregated collagen fibers and disrupted elastic fibers. This work

suggests that the functional and pathologic changes of transversalis fascia may probably play a

role in the genesis of adult groin hernias.