【摘要】：目的:本課題通過設(shè)計一種主要應(yīng)用于小兒外科術(shù)中直接暴露鞘狀突殘端根部的手術(shù)器械—殘端顯露器,并將其運用到臨床上,并與血管鉗、拉勾比較,得出本器械是否值得臨床推廣。方法:1.設(shè)計出手術(shù)器械樣圖,分小、中、大三種型號,選擇不銹鋼或鋁合金材料進行制作,按流程消毒后并應(yīng)用于術(shù)中暴露鞘狀突。如下圖所示,該器械包括三個部分:A端、連接體、B端,其中核心為A、B端,A端為帶較小凹槽的扁橢圓體,凹槽為逐漸過渡的外大內(nèi)小術(shù)中操作空間,兩側(cè)為遮擋板;連接體為頭小尾大的長方體,主要連接A、B兩端;B端與A端結(jié)構(gòu)一樣,為增大的帶凹槽的扁橢圓體,凹槽處為增大的術(shù)中操作空間,兩側(cè)為增大的遮擋板。2.收集2016年1月~2017年4月就診于山西醫(yī)科大學(xué)第一醫(yī)院,年齡為0~12歲,診斷為單側(cè)斜疝(63例)或單側(cè)鞘膜積液(30例)的男性患兒93例,按疾病分斜疝組、鞘膜積液組,再根據(jù)術(shù)中使用暴露鞘狀突殘端根部器械的不同,隨機分實驗組、對照組。分析術(shù)者主觀評價使用殘端顯露器的效果并記錄手術(shù)時間。結(jié)果:1.本課題所設(shè)計的殘端顯露器,術(shù)者主觀評價其在暴露鞘狀突殘端的效果較好(P0.05)。2.患單側(cè)斜疝組術(shù)中使用殘端顯露器暴露殘端的手術(shù)時間(15.41±3.89)min短于術(shù)中使用血管鉗及拉勾暴露殘端的手術(shù)時間(19.68±5.55)min,具有統(tǒng)計學(xué)差異(P0.05);患單側(cè)鞘膜積液組術(shù)中使用殘端顯露器暴露殘端的手術(shù)時間(17.19±4.46)min短于術(shù)中使用血管鉗及拉勾暴露殘端的手術(shù)時間(21.00±5.63)min,具有統(tǒng)計學(xué)差異(P0.05)。3.患單側(cè)斜疝組及鞘膜積液組術(shù)中使用殘端顯露器暴露殘端的手術(shù)時間基本一樣,差異無統(tǒng)計學(xué)意義(P㧐0.05);患單側(cè)斜疝組及鞘膜積液組術(shù)中使用止血鉗及拉勾暴露殘端的手術(shù)時間基本一樣,差異無統(tǒng)計學(xué)意義(P㧐0.05)。結(jié)論:本器械—殘端顯露器,操作簡單,能更好的幫助術(shù)者暴露鞘狀突殘端根部,值得臨床推廣。
[Abstract]:Objective: the purpose of this study was to design a surgical instrument, the stump exposure apparatus, which was mainly used in pediatric surgery to expose the root of the stump of the sheath process directly, and to apply it to the clinical practice, and compare it with the blood canal forceps. It is concluded that this instrument is worthy of clinical promotion. Methods: 1. A sample diagram of surgical instruments was designed, which was divided into three types: small, medium and large. Stainless steel or aluminum alloy materials were selected to be made, then disinfected according to the procedure and applied to expose sheath process during operation. As shown in the following figure, the instrument consists of three parts: a end, a connecting body, a B end, in which the core is Acab end, A end is a flat ellipsoid with smaller grooves, the groove is a small operation space of the outer and inner operation, and the two sides are a baffle; The connective body is a large cuboid with a small head and tail, which is mainly connected to the ends of AHB, and the B end, like the structure of the A-terminal, is an enlarged flat ellipsoid with grooves, with an enlarged intraoperative space at the grooves and an enlarged baffle on both sides. 2. From January 2016 to April 2017, 93 male patients, aged 0 to 12 years, who were diagnosed as unilateral oblique hernia (63 cases) or unilateral hydrocele (30 cases), were divided into oblique hernia group and hydrocele group. According to the different instruments used in the operation, the rats were randomly divided into two groups: experimental group and control group. Objective to evaluate the effect of stump exposure and record the time of operation. Results: 1. The stump exposed device designed in this paper has a good effect on exposing the stump of sheath process (P0.05). 2. In unilateral oblique hernia group, the operative time of stump exposure with stump exposure was (15.41 鹵3.89) min shorter than that with vascular forceps and pull hook (19.68 鹵5.55) min, (P0.05). The operative time of stump exposure with stump exposure was (17.19 鹵4.46) min in unilateral hydrocele group, shorter than (21.00 鹵5.63) min, using blood forceps and pulling hook during operation. There was statistical difference (P0.05). The operative time of stump exposure in unilateral oblique hernia group and hydrocele group was the same (P 0.05). The operative time of stump exposed by hemostatic forceps and pull hook in unilateral oblique hernia group and hydrocele group was the same (P 0.05). Conclusion: this instrument-stump exposure device is easy to operate and can better help the operator to expose the root of the sheath stump, which is worth popularizing clinically.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.5

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