發(fā)布時(shí)間：2018-11-05 18:13

【摘要】：目的通過(guò)臨床實(shí)踐中應(yīng)用傳統(tǒng)開(kāi)刀疝囊高位結(jié)扎術(shù)、單純腹腔鏡下小兒疝囊高位結(jié)扎術(shù)和腹腔鏡監(jiān)視下行疝囊高位結(jié)扎術(shù)后使用患側(cè)臍旁皺襞覆蓋、固定于同側(cè)內(nèi)環(huán)口處(自體組織修補(bǔ)術(shù))的比較,不斷的總結(jié)、進(jìn)一步印證臨床中使用腹腔鏡在治療小兒腹股溝斜疝相較于傳統(tǒng)開(kāi)刀治療的優(yōu)勢(shì);探討三種方法治療小兒腹股溝斜疝的長(zhǎng)處與短處,進(jìn)一步印證了腹腔鏡監(jiān)視下行疝囊高位結(jié)扎術(shù)后使用患側(cè)臍旁皺襞覆蓋、固定于同側(cè)內(nèi)環(huán)口處(自體組織修補(bǔ)術(shù))在小兒外科臨床實(shí)踐中的顯著好處。方法系統(tǒng)的回顧臨沂市婦女兒童醫(yī)院小兒外科在2013年6月一2016年6月時(shí)間段內(nèi)患有腹股溝斜疝需要住院行外科治療的患兒,我們依照設(shè)定好的入選標(biāo)準(zhǔn),選擇符合我們要求的病例,其中A組:采用傳統(tǒng)開(kāi)刀行疝囊高位結(jié)扎術(shù)治療201例(其中:男性178例,女性23例,年齡1-12歲,年齡:36.5±10.5月),B組:采用單純腹腔鏡疝囊高位結(jié)扎術(shù)治療281例(其中:男性257例,女性24例,年齡1-12歲,年齡:37.0±13.5月),C組:腹腔鏡輔助下行疝囊高位結(jié)扎術(shù)后使用患側(cè)臍旁皺襞覆蓋、固定于同側(cè)內(nèi)環(huán)口處(自體組織修補(bǔ)術(shù))治療198例(其中:男性患者178例,女性患者20例,年齡1-12歲,年齡35.0±11.5月。觀察并將三組患者治療期間相關(guān)資料做好匯總記錄,做好出院后的隨訪(通過(guò)電話以及門診復(fù)診時(shí)的查體)。比較這三種治療方法在臨床手術(shù)操作所使用的時(shí)間、患兒需要的住院天數(shù)、術(shù)后腹股溝斜疝的復(fù)發(fā)率、術(shù)后恢復(fù)過(guò)程中患兒疼痛表現(xiàn)情況以及術(shù)后并發(fā)癥的發(fā)生情況。結(jié)果依據(jù)所設(shè)定的標(biāo)準(zhǔn),選擇符合的患兒病例,我們按照所使用手術(shù)治療方法的不同將收集的病例分為三個(gè)組:A組:采用傳統(tǒng)開(kāi)刀行疝囊高位結(jié)扎術(shù)治療組。B組:單純腹腔鏡下行小兒疝囊高位結(jié)扎手術(shù)治療組。C組:腹腔鏡監(jiān)視下行疝囊高位結(jié)扎術(shù)后使用患側(cè)臍旁皺襞覆蓋、固定于同側(cè)內(nèi)環(huán)口處(自體組織修補(bǔ)術(shù))治療組。對(duì)所得到的臨床觀察以及資料進(jìn)行對(duì)比分析,這三組患兒臨床痊愈后給予出院,其間的手術(shù)過(guò)程都比較順利,但是在臨床手術(shù)操作所使用的時(shí)間、患兒需要的住院天數(shù)、術(shù)后腹股溝斜疝的復(fù)發(fā)率、術(shù)后恢復(fù)過(guò)程中患兒疼痛表現(xiàn)情況等方面,B、C組患兒治療效果明顯優(yōu)于A組。在術(shù)后復(fù)發(fā)率方面,C組患兒手術(shù)效果好于A、B組患兒的治療效果(P0.05)。結(jié)論腹腔鏡監(jiān)視下行小兒疝囊高位結(jié)扎術(shù)治療小兒腹股溝斜疝,相較傳統(tǒng)的開(kāi)刀行疝囊高位結(jié)扎術(shù)具有手術(shù)操作時(shí)間短,對(duì)組織的所產(chǎn)生的創(chuàng)傷小,患兒在手術(shù)后恢復(fù)的快,并且并發(fā)癥少等優(yōu)勢(shì)。腹腔鏡監(jiān)視下行疝囊高位結(jié)扎術(shù)后使用患側(cè)臍旁皺襞覆蓋、固定于同側(cè)內(nèi)環(huán)口處(自體組織修補(bǔ)術(shù))治療小兒腹股溝斜疝方面,相較單純腹腔鏡監(jiān)視下行小兒疝囊高位結(jié)扎手術(shù)明顯的降低了小兒腹股溝斜疝術(shù)后的復(fù)發(fā)率。
[Abstract]:Objective to apply high ligation of herniorrhaphy sac in traditional operation, high ligation of hernia sac in children under laparoscope and high ligation of hernia sac under laparoscope. The comparison of internal ring fixed at the ipsilateral orifice (autologous tissue repair), the continuous summary, further confirmed the clinical use of laparoscopy in the treatment of indirect inguinal hernia in children compared with the traditional surgical treatment advantages; To explore the advantages and disadvantages of three methods in the treatment of indirect inguinal hernia in children. Fixation of ipsilateral internal ring orifice (autologous tissue repair) is a significant benefit in clinical practice of pediatric surgery. Methods A systematic review of pediatric surgical patients with indirect inguinal hernia in Linyi Women's and Children's Hospital during June 2013 to June 2016 was carried out. In group A, 201 cases were treated with high ligation of hernia sac (male 178, female 23, age 1-12 years, age: 36.5 鹵10.5 months). Group B: 281 cases were treated by laparoscopic high ligation of hernia sac (male 257 cases, female 24 cases, age 1-12 years, age: 37.0 鹵13.5 months). Group C: 198 patients (178 male and 20 female, aged 1-12 years) were treated by laparoscopic assisted high ligation of hernia sac with paracomphal fold covering, fixed at ipsilateral internal ring orifice (autologous tissue repair). Age was 35.0 鹵11.5 months. The data of the three groups of patients during treatment were collected and recorded, and followed up after discharge (by telephone and outpatient examination). The duration of operation, the days of hospitalization, the recurrence rate of indirect inguinal hernia, the pain and complications were compared. Results according to the established criteria, the patients were selected. We divided the patients into three groups according to the operative methods used: group A: high ligation of hernia sac with traditional operation, group B: laparoscopic operation of high ligation of hernia sac in children Group C. Laparoscopic monitoring and high ligation of hernia sac were performed with parachomphal folds covering the affected side after ligation of hernia sac. Fixed at ipsilateral internal ring orifice (autologous tissue repair) treatment group. The clinical observation and data obtained were compared and analyzed. The three groups were discharged after clinical recovery, and the operation process was smooth. However, the duration of the clinical operation, the days of hospitalization, The recurrence rate of indirect inguinal hernia after operation and the pain performance of children in the recovery process after operation were significantly better in group B than in group A. In the aspect of postoperative recurrence rate, the effect of group C was better than that of group A B (P0.05). Conclusion Laparoscopic high ligation of hernia sac in children with indirect inguinal hernia has shorter operation time, less injury to tissues and faster recovery after operation. And less complications and other advantages. Laparoscopic surveillance and high ligation of hernia sac was performed with the treatment of indirect inguinal hernia in children with ipsilateral periumbilical fold covering, fixed at the ipsilateral internal ring orifice (autologous tissue repair). The high ligation of hernia sac significantly reduced the recurrence rate of indirect inguinal hernia in children.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.5

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