单孔腹腔镜下改良双钩疝针经皮腹膜外结扎术治疗小儿腹股沟疝的疗效观察
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摘要
目的:探讨单孔腹腔镜改良双钩疝针经皮腹膜外结扎术治疗小儿腹股沟疝的临床效果。方法:纳入2014年10月至2016年10月收治的120例腹股沟疝患儿作为研究对象,根据手术方式分为三组,每组40例。其中A组行单孔腹腔镜下硬膜外针法经皮腹膜外结扎术,B组行单孔腹腔镜下单钩疝针法经皮腹膜外结扎术,C组行改良双钩疝针经皮腹膜外结扎术。观察3组手术情况、疼痛情况、家长满意度及并发症、复发情况。结果:三组住院时间、住院费用及面部疼痛表情量表评分差异均无统计学意义(P>0.05); C组手术时间短于B组,B组短于A组,差异有统计学意义(P<0.05)。A、B、C组家长满意度分别为75.0%、77.5%与97.5%,A、B两组满意度差异无统计学意义(P>0.05); C组高于A、B两组,差异有统计学意义(P<0.05)。A、B、C组并发症发生率分别为37.5%、15.0%与2.5%,复发率分别为5.0%、5.0%与2.5%; C组并发症发生率低于B组,B组低于A组,差异有统计学意义(P<0.05); 3组复发率差异无统计学意义(P>0.05)。结论:单孔腹腔镜下改良双钩疝针经皮腹膜外结扎术治疗小儿腹股沟疝效果良好,手术时间短,术后家属满意度高,并发症发生率低,值得临床推广应用。
Objective:To study the clinical effect of single-site laparoscopy-assisted percutaneous extraperitoneal ligation with improveddouble hernia needle therapy for children with inguinal hernia.Methods: From Oct.2014 to Oct.2016,120 children with inguinal hernia were selected anddivided into three groups with 40 cases in each group.Group A received the single-site laparoscopy-assisted percutaneous extraperitoneal ligation with epidural needle therapy.Group B underwent single-site laparoscopy-assisted percutaneous extraperitoneal ligation with single hernia needle therapy.Group C received the single-site laparoscopy-assisted percutaneous extraperitoneal ligation with improveddouble hernia needle therapy.The operation condition,paindegree,family member's satisfaction,incidence of complications and recurrence were observed.Result: The hospitalization time,hospitalization costs and facial pain scale-revised points of the three groups were not significantlydifferent(P>0.05).The operation time of Group C was shorter than that of Group B,the operation time of Group B was shorter than that of Group A(P<0.05).The family member's satisfaction in Group A,Group B and Group C was 75.0%,77.5% and 97.5%,respectively,the satisfaction of Group A and Group B was not significantlydifferent(P>0.05),the satisfaction of Group C was significantly higher than that of Group A and Group B(P<0.05),the incidence of complications in Group A,Group B and Group C was 37.5%,15.0% and 2.5%,respectively,the recurrence rate in the three groups was 5.0%,5.0% and 2.5%,respectively.The incidence of complications ranged from low to high was Group C,Group B,Group A(P<0.05),the recurrence rate of the three groups was not significantlydifferent(P>0.05). Conclusions: The single-site laparoscopy-assisted percutaneous extraperitoneal ligation with improveddouble hernia needle therapy has an obvious effect in children with inguinal hernia,can shorten the operation time,improve the family member's satisfaction and reduce the incidence of complications.Itdeserves to be recommended in the clinical application.
Objective:To study the clinical effect of single-site laparoscopy-assisted percutaneous extraperitoneal ligation with improveddouble hernia needle therapy for children with inguinal hernia.Methods: From Oct.2014 to Oct.2016,120 children with inguinal hernia were selected anddivided into three groups with 40 cases in each group.Group A received the single-site laparoscopy-assisted percutaneous extraperitoneal ligation with epidural needle therapy.Group B underwent single-site laparoscopy-assisted percutaneous extraperitoneal ligation with single hernia needle therapy.Group C received the single-site laparoscopy-assisted percutaneous extraperitoneal ligation with improveddouble hernia needle therapy.The operation condition,paindegree,family member's satisfaction,incidence of complications and recurrence were observed.Result: The hospitalization time,hospitalization costs and facial pain scale-revised points of the three groups were not significantlydifferent(P>0.05).The operation time of Group C was shorter than that of Group B,the operation time of Group B was shorter than that of Group A(P<0.05).The family member's satisfaction in Group A,Group B and Group C was 75.0%,77.5% and 97.5%,respectively,the satisfaction of Group A and Group B was not significantlydifferent(P>0.05),the satisfaction of Group C was significantly higher than that of Group A and Group B(P<0.05),the incidence of complications in Group A,Group B and Group C was 37.5%,15.0% and 2.5%,respectively,the recurrence rate in the three groups was 5.0%,5.0% and 2.5%,respectively.The incidence of complications ranged from low to high was Group C,Group B,Group A(P<0.05),the recurrence rate of the three groups was not significantlydifferent(P>0.05). Conclusions: The single-site laparoscopy-assisted percutaneous extraperitoneal ligation with improveddouble hernia needle therapy has an obvious effect in children with inguinal hernia,can shorten the operation time,improve the family member's satisfaction and reduce the incidence of complications.Itdeserves to be recommended in the clinical application.
引文
[1]夏东亮,张丽华,李庆浩,等.单孔腹腔镜和雪橇针治疗儿童腹股沟斜疝手术经验与技巧[J/CD].中华疝和腹壁外科杂志(电子版),2014,8(3):265-270.
[2]费川,张永婷,李索林,等.单孔腹腔镜双钩疝针内环结扎并脐内侧襞遮盖术[J/CD].中华腔镜外科杂志(电子版),2016,9(5):277-280.
[3]刘素君,王帆,朱熠林,等.钳式针辅助单孔腹腔镜治疗儿童腹股沟疝微创分析[J/CD].中华疝和腹壁外科杂志(电子版),2014,8(1):17-20.
[4] Xu C,Xiang B,Jin SG,et al.Transumbilical two-port laparoscopic percutaneous extraperitoneal closure:a new technique for inguinal hernia repair in children[J].J Laparoendosc Adv Surg Tech A,2013,23(4):392-396.
[5]张斌,马国卫,胡利民,等.单孔腹腔镜辅助双钩疝针治疗小儿腹股沟疝的临床体会[J/CD].中华疝和腹壁外科杂志(电子版),2017,11(4):310-311.
[6]吴瑞萍,胡亚美,江载芳.诸福棠实用儿科学[M].6版.北京:人民卫生出版社,1996:1165.
[7]李正,王慧兰,吉士俊.实用小儿外科学[M].北京:人民卫生出版社,2001:531-535.
[8]马亚贞,李索林,于增文,等.单孔腹腔镜监视下经阴囊入路睾丸固定术[J].中华小儿外科杂志,2013,34(2):116-118.
[9] Rossignol F,Mespoulhes-Rivière C,Vitte A,et al.Standing laparoscopic inguinal hernioplasty using cyanoacrylate for preventing recurrence of acquired strangulated inguinal herniation in 10 stallions[J].Vet Surg,2014,43(1):6-11.
[10]费川,张永婷,刘雪来,等.单孔腹腔镜腹膜外结扎术治疗小儿腹股沟疝相关并发症分析[J].临床小儿外科杂志,2016,15(4):328-331.
[11]张荣斌,李祥世.自制带线硬膜外穿刺针在单孔腹腔镜小儿疝高位结扎术中的应用[J].微创医学,2015,10(6):840-841.
[12]刘雪来,费川,张永婷,等.小儿腹腔镜单部位腹内缝扎与单孔腹膜外结扎关闭腹股沟内环的疗效对比[J].中华普通外科杂志,2017,32(4):328-331.
[13]郭伟,王佾,李铁军,等.单孔腹腔镜下双通道深静脉穿刺针治疗小儿斜疝[J].中华小儿外科杂志,2013,34(3):233-234.
[14]阿布都赛米·阿布都热依木,玉苏甫·阿克木,李凯,等.单孔腹腔镜治疗女儿童腹股沟疝的体会[J/CD].中华疝和腹壁外科杂志(电子版),2016,10(5):349-351.
[15]张世伟,张浩然,马计超,等.改良单孔疝针经皮腹膜外结扎术治疗小儿腹股沟疝[J].中华小儿外科杂志,2016,37(10):754-757.
[16] Zhao J,Chen Y,Lin J,et al.Potential value of routine contralateral patent processus vaginalis repair in children with unilateral inguinal hernia[J].Br J Surg,2017,104(1):148-151.
[17] Weaver KL,Poola AS,Gould JL,et al.The risk of developing a symptomatic inguinal hernia in children with an asymptomatic patent processus vaginalis[J].J Pediatr Surg,2017,52(1):60-64.
[18] Shalaby R,Ismail M,Shehata S,et al.Shalaby technique for efficient single incision laparoscopic pediatric inguinal hernia repair[J].J Pediatr Surg,2015,50(11):1995-2000.
[19] Shalaby R,Elsayaad I,Alsamahy O,et al.One trocar needlescopic assisted inguinal hernia repair in children:a novel technique[J].J Pediatr Surg,2017,pii:S0022-3468(17)30516-X.
[20] Li S,Li M,Wong KK,et al.Laparoscopically assisted simple suturing obliteration(LASSO)of the internal ring using an epidural needle:a handy single-port laparoscopic herniorrhaphy in children[J].J Pediatr Surg,2014,49(12):1818-1820.
[21] Li S,Liu L,Li M.Single-port laparoscopic percutaneous extraperitoneal closure using an innovative apparatus for pediatric inguinal hernia[J].J Laparoendosc Adv Surg Tech A,2014,24(3):188-193.
[22] Pelizzo G,Bernardi L,Carlini V,et al.Laparoscopy in children and its impact on brain oxygenation during routine inguinal hernia repair[J].J Minim Access Surg,2017,13(1):51-56.
[2]费川,张永婷,李索林,等.单孔腹腔镜双钩疝针内环结扎并脐内侧襞遮盖术[J/CD].中华腔镜外科杂志(电子版),2016,9(5):277-280.
[3]刘素君,王帆,朱熠林,等.钳式针辅助单孔腹腔镜治疗儿童腹股沟疝微创分析[J/CD].中华疝和腹壁外科杂志(电子版),2014,8(1):17-20.
[4] Xu C,Xiang B,Jin SG,et al.Transumbilical two-port laparoscopic percutaneous extraperitoneal closure:a new technique for inguinal hernia repair in children[J].J Laparoendosc Adv Surg Tech A,2013,23(4):392-396.
[5]张斌,马国卫,胡利民,等.单孔腹腔镜辅助双钩疝针治疗小儿腹股沟疝的临床体会[J/CD].中华疝和腹壁外科杂志(电子版),2017,11(4):310-311.
[6]吴瑞萍,胡亚美,江载芳.诸福棠实用儿科学[M].6版.北京:人民卫生出版社,1996:1165.
[7]李正,王慧兰,吉士俊.实用小儿外科学[M].北京:人民卫生出版社,2001:531-535.
[8]马亚贞,李索林,于增文,等.单孔腹腔镜监视下经阴囊入路睾丸固定术[J].中华小儿外科杂志,2013,34(2):116-118.
[9] Rossignol F,Mespoulhes-Rivière C,Vitte A,et al.Standing laparoscopic inguinal hernioplasty using cyanoacrylate for preventing recurrence of acquired strangulated inguinal herniation in 10 stallions[J].Vet Surg,2014,43(1):6-11.
[10]费川,张永婷,刘雪来,等.单孔腹腔镜腹膜外结扎术治疗小儿腹股沟疝相关并发症分析[J].临床小儿外科杂志,2016,15(4):328-331.
[11]张荣斌,李祥世.自制带线硬膜外穿刺针在单孔腹腔镜小儿疝高位结扎术中的应用[J].微创医学,2015,10(6):840-841.
[12]刘雪来,费川,张永婷,等.小儿腹腔镜单部位腹内缝扎与单孔腹膜外结扎关闭腹股沟内环的疗效对比[J].中华普通外科杂志,2017,32(4):328-331.
[13]郭伟,王佾,李铁军,等.单孔腹腔镜下双通道深静脉穿刺针治疗小儿斜疝[J].中华小儿外科杂志,2013,34(3):233-234.
[14]阿布都赛米·阿布都热依木,玉苏甫·阿克木,李凯,等.单孔腹腔镜治疗女儿童腹股沟疝的体会[J/CD].中华疝和腹壁外科杂志(电子版),2016,10(5):349-351.
[15]张世伟,张浩然,马计超,等.改良单孔疝针经皮腹膜外结扎术治疗小儿腹股沟疝[J].中华小儿外科杂志,2016,37(10):754-757.
[16] Zhao J,Chen Y,Lin J,et al.Potential value of routine contralateral patent processus vaginalis repair in children with unilateral inguinal hernia[J].Br J Surg,2017,104(1):148-151.
[17] Weaver KL,Poola AS,Gould JL,et al.The risk of developing a symptomatic inguinal hernia in children with an asymptomatic patent processus vaginalis[J].J Pediatr Surg,2017,52(1):60-64.
[18] Shalaby R,Ismail M,Shehata S,et al.Shalaby technique for efficient single incision laparoscopic pediatric inguinal hernia repair[J].J Pediatr Surg,2015,50(11):1995-2000.
[19] Shalaby R,Elsayaad I,Alsamahy O,et al.One trocar needlescopic assisted inguinal hernia repair in children:a novel technique[J].J Pediatr Surg,2017,pii:S0022-3468(17)30516-X.
[20] Li S,Li M,Wong KK,et al.Laparoscopically assisted simple suturing obliteration(LASSO)of the internal ring using an epidural needle:a handy single-port laparoscopic herniorrhaphy in children[J].J Pediatr Surg,2014,49(12):1818-1820.
[21] Li S,Liu L,Li M.Single-port laparoscopic percutaneous extraperitoneal closure using an innovative apparatus for pediatric inguinal hernia[J].J Laparoendosc Adv Surg Tech A,2014,24(3):188-193.
[22] Pelizzo G,Bernardi L,Carlini V,et al.Laparoscopy in children and its impact on brain oxygenation during routine inguinal hernia repair[J].J Minim Access Surg,2017,13(1):51-56.
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