【摘要】：目的:疝囊高位結(jié)扎術(shù)是治療小兒腹股溝斜疝的一個(gè)經(jīng)典術(shù)式,傳統(tǒng)經(jīng)腹橫紋切口手術(shù)方式技術(shù)成熟,但術(shù)后常見陰囊腫脹、復(fù)發(fā)、對(duì)側(cè)新發(fā)疝等并發(fā)癥。現(xiàn)在腔鏡技術(shù)用于治療小兒腹股溝斜疝也日趨成熟,因具有操作簡(jiǎn)單、可發(fā)現(xiàn)對(duì)側(cè)隱匿性疝、術(shù)后陰囊腫脹發(fā)生率低等優(yōu)勢(shì)受到業(yè)內(nèi)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(shù)在治療兒童腹股溝斜疝上的療效,討論其臨床應(yīng)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(shù)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(shù)治療,54例采用腹橫紋小切口(傳統(tǒng)手術(shù)組)手術(shù)治療。腹腔鏡組由同一手術(shù)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(nèi)環(huán)口結(jié)扎術(shù),比較兩種術(shù)式的療效及并發(fā)癥,所有病人予以術(shù)后隨訪,收集資料包括手術(shù)時(shí)間、術(shù)后住院時(shí)間、圍手術(shù)期并發(fā)癥、是否復(fù)發(fā)、是否合并術(shù)后醫(yī)源性隱睪或者睪丸萎縮,并對(duì)所收集數(shù)據(jù)做出比較分析。結(jié)果:262例單側(cè)腹股溝斜疝患兒經(jīng)腹腔鏡探查后發(fā)現(xiàn)43例對(duì)側(cè)內(nèi)環(huán)口未閉,同時(shí)予以手術(shù)處理。腹腔鏡組、傳統(tǒng)手術(shù)組單側(cè)手術(shù)平均耗時(shí)分別為14.5±3.1min、34.2±4.4min,P0.05;雙側(cè)手術(shù)時(shí)間分別為22.7±7.9min、46.3+6.7min,P0.05;術(shù)后住院時(shí)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(shù)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(fù)發(fā)而有1例在對(duì)側(cè)新發(fā)。傳統(tǒng)手術(shù)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(jié)反應(yīng),1例在同側(cè)復(fù)發(fā),有10例在對(duì)側(cè)新發(fā)斜疝。結(jié)論:1.采用腹腔鏡手術(shù)治療小兒腹股溝疝與傳統(tǒng)腹橫紋小切口手術(shù)比較,前者具有損傷小、復(fù)發(fā)率低以及并發(fā)癥少的優(yōu)勢(shì),降低了患兒的痛苦和家屬的心理負(fù)擔(dān)。2.單孔腹腔鏡下應(yīng)用特制疝針經(jīng)皮腹膜外內(nèi)環(huán)口結(jié)扎術(shù),經(jīng)腹壁刺入和導(dǎo)出結(jié)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(jié)扎;同時(shí)可于腹腔鏡下觀察對(duì)側(cè)內(nèi)環(huán)口,發(fā)現(xiàn)隱性斜疝可一次行手術(shù)處理,且對(duì)于小兒復(fù)發(fā)疝、隱性直疝及鞘膜積液的治療有其獨(dú)到優(yōu)勢(shì)。
[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(xué)位授予單位】：皖南醫(yī)學(xué)院
【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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