手术器械—残端显露器的设计及其应用

发布时间：2018-12-08 07:26

【摘要】：目的:本课题通过设计一种主要应用于小儿外科术中直接暴露鞘状突残端根部的手术器械—残端显露器,并将其运用到临床上,并与血管钳、拉勾比较,得出本器械是否值得临床推广。方法:1.设计出手术器械样图,分小、中、大三种型号,选择不锈钢或铝合金材料进行制作,按流程消毒后并应用于术中暴露鞘状突。如下图所示,该器械包括三个部分:A端、连接体、B端,其中核心为A、B端,A端为带较小凹槽的扁椭圆体,凹槽为逐渐过渡的外大内小术中操作空间,两侧为遮挡板;连接体为头小尾大的长方体,主要连接A、B两端;B端与A端结构一样,为增大的带凹槽的扁椭圆体,凹槽处为增大的术中操作空间,两侧为增大的遮挡板。2.收集2016年1月~2017年4月就诊于山西医科大学第一医院,年龄为0~12岁,诊断为单侧斜疝(63例)或单侧鞘膜积液(30例)的男性患儿93例,按疾病分斜疝组、鞘膜积液组,再根据术中使用暴露鞘状突残端根部器械的不同,随机分实验组、对照组。分析术者主观评价使用残端显露器的效果并记录手术时间。结果:1.本课题所设计的残端显露器,术者主观评价其在暴露鞘状突残端的效果较好(P0.05)。2.患单侧斜疝组术中使用残端显露器暴露残端的手术时间(15.41±3.89)min短于术中使用血管钳及拉勾暴露残端的手术时间(19.68±5.55)min,具有统计学差异(P0.05);患单侧鞘膜积液组术中使用残端显露器暴露残端的手术时间(17.19±4.46)min短于术中使用血管钳及拉勾暴露残端的手术时间(21.00±5.63)min,具有统计学差异(P0.05)。3.患单侧斜疝组及鞘膜积液组术中使用残端显露器暴露残端的手术时间基本一样,差异无统计学意义(P㧐0.05);患单侧斜疝组及鞘膜积液组术中使用止血钳及拉勾暴露残端的手术时间基本一样,差异无统计学意义(P㧐0.05)。结论:本器械—残端显露器,操作简单,能更好的帮助术者暴露鞘状突残端根部,值得临床推广。
[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 卤3.89) min shorter than that with vascular forceps and pull hook (19.68 卤5.55) min, (P0.05). The operative time of stump exposure with stump exposure was (17.19 卤4.46) min in unilateral hydrocele group, shorter than (21.00 卤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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5

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