单孔腹腔镜和传统腹横纹小切口治疗儿童腹股沟斜疝临床对比研究

发布时间：2019-04-26 18:12

【摘要】：目的:疝囊高位结扎术是治疗小儿腹股沟斜疝的一个经典术式,传统经腹横纹切口手术方式技术成熟,但术后常见阴囊肿胀、复发、对侧新发疝等并发症。现在腔镜技术用于治疗小儿腹股沟斜疝也日趋成熟,因具有操作简单、可发现对侧隐匿性疝、术后阴囊肿胀发生率低等优势受到业内人士及患儿家属的欢迎。本研究旨在通过探讨单孔腹腔镜与传统腹横纹小切口手术在治疗儿童腹股沟斜疝上的疗效,讨论其临床应用的可行性。方法:回顾性分析我科2014年6月-2016年6月收治356例儿童腹股沟斜疝的临床资料,根据所施行的手术方法分为两组,其中302例采用腹腔镜(腹腔镜组)辅助下的手术治疗,54例采用腹横纹小切口(传统手术组)手术治疗。腹腔镜组由同一手术者在单孔腹腔镜辅助下使用特制疝针完成经皮穿刺腹膜外内环口结扎术,比较两种术式的疗效及并发症,所有病人予以术后随访,收集资料包括手术时间、术后住院时间、围手术期并发症、是否复发、是否合并术后医源性隐睾或者睾丸萎缩,并对所收集数据做出比较分析。结果:262例单侧腹股沟斜疝患儿经腹腔镜探查后发现43例对侧内环口未闭,同时予以手术处理。腹腔镜组、传统手术组单侧手术平均耗时分别为14.5±3.1min、34.2±4.4min,P0.05;双侧手术时间分别为22.7±7.9min、46.3+6.7min,P0.05;术后住院时间分别为3.5±0.5天、2.8±0.6天,P0.05,腹腔镜组有3例发生术后阴囊肿胀,无阴囊血肿和医源性隐睾病例;随访期间有2例复发而有1例在对侧新发。传统手术组无医源性隐睾及睾丸萎缩病例,有22例发生了阴囊肿胀,5例发生阴囊血肿,2例发生切口线结反应,1例在同侧复发,有10例在对侧新发斜疝。结论:1.采用腹腔镜手术治疗小儿腹股沟疝与传统腹横纹小切口手术比较,前者具有损伤小、复发率低以及并发症少的优势,降低了患儿的痛苦和家属的心理负担。2.单孔腹腔镜下应用特制疝针经皮腹膜外内环口结扎术,经腹壁刺入和导出结扎线可基本保持在同一路径,能够确保腹膜外间隙无张力紧密结扎;同时可于腹腔镜下观察对侧内环口,发现隐性斜疝可一次行手术处理,且对于小儿复发疝、隐性直疝及鞘膜积液的治疗有其独到优势。
[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 卤3.1 min, 34.2 卤4.4 min, P 0.05, and the bilateral operation time was 22.7 卤7.9min, 46.6.7min, P 0.05, respectively, and that of the conventional operation group was 14.5 卤3.1min, 34.2 卤4.4min, P0.05, respectively. The postoperative hospitalization time was 3.5 卤0.5 days, 2.8 卤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.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5

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