摘要
目的探讨套管内推结法行腹腔镜下小儿疝囊高位结扎术的可行性及优势。方法选取我院2013年12月至2016年10月间收治的96例双侧斜疝患儿，在两侧分别采用套管内推结法（套管内推结法组）和常规穿刺结扎法（常规穿刺结扎法组）进行手术。根据患儿入院先后依次编号，奇数者以内环宽大侧为套管内推结法组，对侧为常规穿刺结扎法组，偶数者以内环宽大侧为常规穿刺结扎法组，对侧为套管内推结法组，两组患儿在年龄、性别、病程、斜疝侧别、内环口大小等方面无明显差异。比较两侧结扎环大小、切口大小、手术时间和术后并发症情况等指标。结果所有患儿手术均获成功，无中转开腹手术患儿。套管内推结法组切口大小、结扎环大小和手术时间分别为（2.5±0.5）mm、（1.3±0.3）mm和（31.2±4.6）min，常规穿刺结扎法组分别为（1.6±0.4）mm、（2.1±0.6）mm和（18.6±3.6）min，两组比较，差异有统计学意义（P〈0.05）。套管内推结法组术后无并发症，常规穿刺结扎法组出现1例鞘膜积液和3例切口异物感或异物瘘。两组均无术后阴囊血肿或水肿、切口感染、睾丸高位及复发。结论套管内推结法行腹腔镜下疝囊高位结扎术实现了腹膜外间隙无张力高位结扎疝囊，符合传统疝嚢高位结扎术的解剖要求，结扎确切，并发症少，但操作时间长及切口稍大，其科学性、合理性和安全性还需要长时间、大病例数的临床试验来验证。
ObjectiveTo explore the feasibility and advantages of internal push -knot high-ligation of hernial sac under laparoscope in children.MethodsA total of 96 cases of bilateral oblique hernia were selected from December 2013 to October 2016.They were divided sequentially into odd or even number groups.In odd number group, the greater side of internal ring was used for internal push-knot while the other side routine puncture ligation; in even number group, the greater side of internal ring for routine puncture ligation while the other side internal push-knot.No significant inter-group differences existed in age, gender, course of disease, oblique inguinal region or size of inner ring.Size of ligation ring, size of incision, operative duration and postoperative complications were compared.
ResultsAll procedures were successfully completed without laparotomy.The ligature ring size, incision size and operative duration were （2.5±0.5） mm, （1.3±0.3） mm and （31.2±4.6） min in internal push-knot group versus （1.6±0.4） mm, （2.1±0.6） mm and （18.6±3.6） min in conventional puncture ligation group.The inter-group differences were statistically significant （P〈0.05）. No complication occurred after internal push-knot.Hydrocele （n=1） and foreign body feeling or foreign body fistula （n=3） were found in routine puncture ligation group.There was no onset of hematoma/edema of scrotum, incision infection, high testis or recurrence.ConclusionsLaparoscopic high-ligation of hernia sac with internal push-knot is tension-free and anatomically accurate with fewer complications.However, operative duration is longer and incision slightly larger.Its scientific rationales and safety require further validations through clinical trials of a larger sample size.
出处
《中华小儿外科杂志》
CSCD
2017年第9期698-703,共6页
Chinese Journal of Pediatric Surgery
关键词
腹股沟疝
腹腔镜治疗
儿童
Inguinal hernia
Therapeutic laparoscopy
Child
