【摘要】：目的:疝囊高位結扎術是治療小兒腹股溝斜疝的一個經(jīng)典術式,傳統(tǒng)經(jīng)腹橫紋切口手術方式技術成熟,但術后常見陰囊腫脹、復發(fā)、對側新發(fā)疝等并發(fā)癥�，F(xiàn)在腔鏡技術用于治療小兒腹股溝斜疝也日趨成熟,因具有操作簡單、可發(fā)現(xiàn)對側隱匿性疝、術后陰囊腫脹發(fā)生率低等優(yōu)勢受到業(yè)內人士及患兒家屬的歡迎。本研究旨在通過探討單孔腹腔鏡與傳統(tǒng)腹橫紋小切口手術在治療兒童腹股溝斜疝上的療效,討論其臨床應用的可行性。方法:回顧性分析我科2014年6月-2016年6月收治356例兒童腹股溝斜疝的臨床資料,根據(jù)所施行的手術方法分為兩組,其中302例采用腹腔鏡(腹腔鏡組)輔助下的手術治療,54例采用腹橫紋小切口(傳統(tǒng)手術組)手術治療。腹腔鏡組由同一手術者在單孔腹腔鏡輔助下使用特制疝針完成經(jīng)皮穿刺腹膜外內環(huán)口結扎術,比較兩種術式的療效及并發(fā)癥,所有病人予以術后隨訪,收集資料包括手術時間、術后住院時間、圍手術期并發(fā)癥、是否復發(fā)、是否合并術后醫(yī)源性隱睪或者睪丸萎縮,并對所收集數(shù)據(jù)做出比較分析。結果:262例單側腹股溝斜疝患兒經(jīng)腹腔鏡探查后發(fā)現(xiàn)43例對側內環(huán)口未閉,同時予以手術處理。腹腔鏡組、傳統(tǒng)手術組單側手術平均耗時分別為14.5±3.1min、34.2±4.4min,P0.05;雙側手術時間分別為22.7±7.9min、46.3+6.7min,P0.05;術后住院時間分別為3.5±0.5天、2.8±0.6天,P0.05,腹腔鏡組有3例發(fā)生術后陰囊腫脹,無陰囊血腫和醫(yī)源性隱睪病例;隨訪期間有2例復發(fā)而有1例在對側新發(fā)。傳統(tǒng)手術組無醫(yī)源性隱睪及睪丸萎縮病例,有22例發(fā)生了陰囊腫脹,5例發(fā)生陰囊血腫,2例發(fā)生切口線結反應,1例在同側復發(fā),有10例在對側新發(fā)斜疝。結論:1.采用腹腔鏡手術治療小兒腹股溝疝與傳統(tǒng)腹橫紋小切口手術比較,前者具有損傷小、復發(fā)率低以及并發(fā)癥少的優(yōu)勢,降低了患兒的痛苦和家屬的心理負擔。2.單孔腹腔鏡下應用特制疝針經(jīng)皮腹膜外內環(huán)口結扎術,經(jīng)腹壁刺入和導出結扎線可基本保持在同一路徑,能夠確保腹膜外間隙無張力緊密結扎;同時可于腹腔鏡下觀察對側內環(huán)口,發(fā)現(xiàn)隱性斜疝可一次行手術處理,且對于小兒復發(fā)疝、隱性直疝及鞘膜積液的治療有其獨到優(yōu)勢。
[Abstract]:Aim: high ligation of hernia sac is a classical procedure for treatment of indirect inguinal hernia in children. The technique of traditional transabdominal transverse incision is mature, but the complications such as scrotal swelling, recurrence and contralateral new hernia are common after operation. At present, endoscopic technique is becoming more and more mature in treating indirect inguinal hernia in children. Because of its simple operation, occult hernia of contralateral side can be found, and the lower incidence of scrotum swelling after operation has been welcomed by insiders and their families. The purpose of this study was to investigate the efficacy of single-hole laparoscopy and traditional small abdominal rhabdometer incision in the treatment of indirect inguinal hernia in children, and to discuss the feasibility of its clinical application. Methods: the clinical data of 356 children with indirect inguinal hernia treated in our department from June 2014 to June 2016 were retrospectively analyzed. According to the surgical methods performed, 302 cases were treated with laparoscopy (laparoscopy group). 54 cases were treated with small incision of abdominal stria (traditional operation group). The laparoscopy group was performed with a special hernia needle assisted by a single hole laparoscope. The curative effect and complications of the two methods were compared. All the patients were followed up after operation, and the data including the operation time were collected. Postoperative hospital stay, perioperative complications, recurrence, combined iatrogenic cryptorchidism or testicular atrophy were compared and analyzed. Results: after laparoscopic exploration of 262 cases of unilateral indirect inguinal hernia, 43 cases of contralateral internal circumferential closure were found and treated surgically at the same time. In the laparoscopy group, the average time of unilateral operation was 14.5 鹵3.1 min, 34.2 鹵4.4 min, P 0.05, and the bilateral operation time was 22.7 鹵7.9min, 46.6.7min, P 0.05, respectively, and that of the conventional operation group was 14.5 鹵3.1min, 34.2 鹵4.4min, P0.05, respectively. The postoperative hospitalization time was 3.5 鹵0.5 days, 2.8 鹵0.6 days, P 0.05, respectively. In the laparoscopic group, scrotum swelling, no scrotum hematoma and iatrogenic cryptorchidism were found in 3 cases in the laparoscopy group, and 2 cases recurred and 1 case newly occurred in the contralateral side during the follow-up period. In the traditional operation group, there were no iatrogenic cryptorchidism and testicular atrophy. There were 22 cases of scrotum swelling, 5 cases of scrotum hematoma, 2 cases of incision linear reaction, 1 case of recurrence on the ipsilateral side, and 10 cases of new oblique hernia on the contralateral side. Conclusions: 1. The laparoscopic operation for inguinal hernia in children has the advantages of less injury, lower recurrence rate and fewer complications, and reduces the pain of the children and the psychological burden of their families. 2. The former has the advantages of less injury, lower recurrence rate and fewer complications compared with the traditional small abdominal striated incision operation. 2. Under single-hole laparoscopy, a special-made hernia needle was used to ligate the extraperitoneal inner circumferential orifice through the abdominal wall, and the ligating line could be basically maintained in the same path, so that the extraperitoneal space could be closely ligated without tension. At the same time, the contralateral inner circumferential orifice can be observed under laparoscopy. It is found that recessive oblique hernia can be operated once, and it has its unique advantages in the treatment of recurrent hernia, recessive direct hernia and hydrocele in children.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R726.5

【參考文獻】

相關期刊論文 前10條

1 侯崇智;馮雪;施偉棟;;腹腔鏡疝囊高位結扎術治療小兒腹股溝嵌頓斜疝163例[J];中華疝和腹壁外科雜志(電子版);2016年05期

2 陳易;趙軍鋒;林杰;楊洪濤;王復然;鐘紅繼;;應用腹腔鏡治療小兒對側未閉隱匿性鞘狀突[J];中華小兒外科雜志;2016年10期

3 費川;張永婷;劉雪來;孫馳;劉林;李萌;李索林;;單孔腹腔鏡腹膜外結扎術治療小兒腹股溝疝相關并發(fā)癥分析[J];臨床小兒外科雜志;2016年04期

4 孫永鋒;;經(jīng)皮橫紋小切口疝囊高位結扎術治療小兒腹股溝斜疝體會[J];河南外科學雜志;2015年06期

5 劉潔;段光琦;王嘯;唐睿;隨幫志;;單孔腹腔鏡下特制疝針治療兒童腹股溝斜疝的問題及處理[J];臨床小兒外科雜志;2015年03期

6 劉楊樺;鄧洪強;;腹腔鏡治療小兒腹股溝斜疝的研究進展[J];中國臨床新醫(yī)學;2014年08期

7 唐忠斌;趙艾君;戴耀華;;腹腔鏡與傳統(tǒng)手術治療小兒腹股溝斜疝對比研究[J];中國醫(yī)藥導報;2014年01期

8 張友波;潘東山;鄭志剛;徐曉明;朱洪凱;李聰;;腹腔鏡技術診治小兒腹股溝直疝2例[J];臨床小兒外科雜志;2013年06期

9 劉楊樺;吳鴻根;吳東波;鄧洪強;黃紅藝;;腹腔鏡小兒腹股溝斜疝高位結扎術對患兒外周血C-反應蛋白的影響[J];微創(chuàng)醫(yī)學;2013年04期

10 段啟新;吳天鵬;易小春;許明偉;;小兒鞘膜積液的循證治療[J];武漢大學學報(醫(yī)學版);2013年04期

相關碩士學位論文 前1條

1 劉林;疝鉤針的改進及其在小兒單孔腹腔鏡經(jīng)皮腹膜外疝內環(huán)結扎術中的應用[D];河北醫(yī)科大學;2013年

，

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