腹腔镜治疗小儿腹股沟斜疝的临床研究
发布时间：2018-11-05 18:13
【摘要】：目的通过临床实践中应用传统开刀疝囊高位结扎术、单纯腹腔镜下小儿疝囊高位结扎术和腹腔镜监视下行疝囊高位结扎术后使用患侧脐旁皱襞覆盖、固定于同侧内环口处(自体组织修补术)的比较,不断的总结、进一步印证临床中使用腹腔镜在治疗小儿腹股沟斜疝相较于传统开刀治疗的优势;探讨三种方法治疗小儿腹股沟斜疝的长处与短处,进一步印证了腹腔镜监视下行疝囊高位结扎术后使用患侧脐旁皱襞覆盖、固定于同侧内环口处(自体组织修补术)在小儿外科临床实践中的显著好处。方法系统的回顾临沂市妇女儿童医院小儿外科在2013年6月一2016年6月时间段内患有腹股沟斜疝需要住院行外科治疗的患儿,我们依照设定好的入选标准,选择符合我们要求的病例,其中A组:采用传统开刀行疝囊高位结扎术治疗201例(其中:男性178例,女性23例,年龄1-12岁,年龄:36.5±10.5月),B组:采用单纯腹腔镜疝囊高位结扎术治疗281例(其中:男性257例,女性24例,年龄1-12岁,年龄:37.0±13.5月),C组:腹腔镜辅助下行疝囊高位结扎术后使用患侧脐旁皱襞覆盖、固定于同侧内环口处(自体组织修补术)治疗198例(其中:男性患者178例,女性患者20例,年龄1-12岁,年龄35.0±11.5月。观察并将三组患者治疗期间相关资料做好汇总记录,做好出院后的随访(通过电话以及门诊复诊时的查体)。比较这三种治疗方法在临床手术操作所使用的时间、患儿需要的住院天数、术后腹股沟斜疝的复发率、术后恢复过程中患儿疼痛表现情况以及术后并发症的发生情况。结果依据所设定的标准,选择符合的患儿病例,我们按照所使用手术治疗方法的不同将收集的病例分为三个组:A组:采用传统开刀行疝囊高位结扎术治疗组。B组:单纯腹腔镜下行小儿疝囊高位结扎手术治疗组。C组:腹腔镜监视下行疝囊高位结扎术后使用患侧脐旁皱襞覆盖、固定于同侧内环口处(自体组织修补术)治疗组。对所得到的临床观察以及资料进行对比分析,这三组患儿临床痊愈后给予出院,其间的手术过程都比较顺利,但是在临床手术操作所使用的时间、患儿需要的住院天数、术后腹股沟斜疝的复发率、术后恢复过程中患儿疼痛表现情况等方面,B、C组患儿治疗效果明显优于A组。在术后复发率方面,C组患儿手术效果好于A、B组患儿的治疗效果(P0.05)。结论腹腔镜监视下行小儿疝囊高位结扎术治疗小儿腹股沟斜疝,相较传统的开刀行疝囊高位结扎术具有手术操作时间短,对组织的所产生的创伤小,患儿在手术后恢复的快,并且并发症少等优势。腹腔镜监视下行疝囊高位结扎术后使用患侧脐旁皱襞覆盖、固定于同侧内环口处(自体组织修补术)治疗小儿腹股沟斜疝方面,相较单纯腹腔镜监视下行小儿疝囊高位结扎手术明显的降低了小儿腹股沟斜疝术后的复发率。
[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 卤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 卤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 卤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.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5
本文编号：2312924
[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 卤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 卤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 卤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.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5
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