下腹部有突出腫塊 醫師籲小心是成人疝氣
2022-08-21 記者陳宜琳／嘉義報導
有位五十多歲男性，平時的工作需要常搬重物，因感到下腹疼痛及腹脹的症狀，只好到急診求助。患者自訴左側腹股溝有腫塊的情形已有多年，但是大多在躺下時會消失，偶爾需要用手將腫塊推回，最近發現腫塊日漸趨大、甚至陰囊的部分也愈來愈腫大，想用手推卻怎麼樣也推不回去。經電腦斷層檢查，有一部分腸子卡在腫塊內，且腸子已有腫脹及缺血之情形。中榮嘉義分院一般外科醫師張奎亨評估，診斷為「嵌頓性疝氣」，緊急安排手術處理，幸好處理得早，還不需要切除腸子。
50多歲男性左側股溝有腫塊，台中榮總嘉義分院一般外科醫師張奎亨診斷是嵌頓性疝氣（圖：台中榮總嘉義分院提供）
中榮嘉義分院一般外科醫師張奎亨表示，根據醫學臨床統計疝氣，在台灣嬰幼兒、青少年的發生率是7%，男女發生的比例相近、成人疝氣有90%都是腹股溝疝氣，意指發生在腹股溝部位的疝氣，俗稱「脫腸」或「墜腸」，是最常見的一種疝氣，且成年男性是女性的9倍及70歲以上男性；高齡者也是常見的族群。
疝氣是一種「腹壁因強度不足形成缺口，造成腹腔內器官向外突出」之疾病，少部分的病人是先天就有腹壁缺口，大部分則是因為長期腹壓較大引起腹壁強度愈來愈差，所以任何會造成腹壓增加的原因都可能是危險因子，例如：不正確的健身模式、長期從事搬運重物工作、慢性咳嗽、體重較重、腹水等。
張醫師補充說明，疝氣的狀況一開始發生，大多是較小的突出物，像是腫塊但會縮回去。若是沒有症狀，病人常常不以為意，但若長期不處理，腹壁缺口會愈來愈大，也會有愈多的器官(最常見是腸子)掉進缺口，當太多腸子掉進去時，可能會卡在裡面，影響腸子的血液循環，若缺血時間太長腸子將腫脹甚至壞死，形成嵌頓性疝氣，就需要立即進行手術，進而增加感染風險，嚴重則有致命危險。
張奎亨醫師補充說明，當有疝氣的情形，一般建議要手術處理，除了修補腹壁缺口，通常會放置人工網膜以增加腹壁強度，大大降低復發的機會；手術的方式除了傳統修補術，若是需要接受雙側手術或復發型疝氣的手術，也可以評估用腹腔鏡的方式做修補。提醒民眾若有疝氣的狀況，建議還未發展成嵌頓性疝氣之前，安排手術做修補，可以避免後續更嚴重的問題發生。
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