硬膜外穿刺针套管联合腹腔镜治疗小儿斜疝嵌顿25例
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摘要
目的:探讨基层医院使用硬膜外穿刺针套管配合腹腔镜下复位加疝囊高位结扎术在小儿腹股沟斜疝嵌顿中的应用价值。方法:25例腹股沟斜疝嵌顿患儿用硬膜外穿刺针外套管联合腹腔镜实施腔镜下疝复位、疝囊高位结扎术。结果:25例手术均获得成功,疝嵌顿时间为2 h～2 d,平均时间(3±1)h。手术时间15～50 min,平均(30±15)min,术后无1例阴囊水肿及睾丸缺血坏死。住院时间均为2 d。术中发现伴有对侧隐匿疝5例,同期施行疝囊高位结扎术。术后随访,复发1例,内环口对应切口局部硬结2例。结论:硬膜外穿刺针套管联合腹腔镜下疝囊高位结扎术治疗小儿腹股沟斜疝嵌顿,具有创伤小、探查彻底、安全经济等优点,并且有同时发现并处理对侧隐匿性疝的优势,适合临床推广,尤其适合广大基层医院应用。
Objective: To explore the application value of epidural puncture needle tube combined with laparoscopic high ligation of hernia sac in children's inguinal hernia incarceration. Methods: 25 children with inguinal hernia incarcerated in our hospital were treated with extradural puncture needle combined with laparoscope to implement endoscopic reposition of incarcerated hernia and high ligation of hernia sac. Results: all 25 operations were successful. The longest time of hernia incarceration was 2 D. The shortest time was 2 H and the average time was 4 H. The operation time was 15～50 min, with an average of 30 min. There were no scrotal edema and testicular necrosis after operation in 1 cases. The time of hospitalization was 2 D. 5 cases of contralateral concealed hernia were found during operation, and high ligation of hernia sac was performed at the same time. Follow up was 6～12 months in 25 cases, 12～24 months in 18 cases, 24～36 months in 16 cases, recurrence in 1 cases, and internal loop corresponding to local induration in 2 cases. Conclusion: epidural puncture needle cannula combined with laparoscopic high ligation of hernia sac for the treatment of incarceration of indirect inguinal hernia in children has the advantages of small trauma, thorough exploration, safe and economical, and it has the advantages of detecting and dealing with lateral herniation at the same time, suitable for clinical application, especially for the general hospital.
Objective: To explore the application value of epidural puncture needle tube combined with laparoscopic high ligation of hernia sac in children's inguinal hernia incarceration. Methods: 25 children with inguinal hernia incarcerated in our hospital were treated with extradural puncture needle combined with laparoscope to implement endoscopic reposition of incarcerated hernia and high ligation of hernia sac. Results: all 25 operations were successful. The longest time of hernia incarceration was 2 D. The shortest time was 2 H and the average time was 4 H. The operation time was 15～50 min, with an average of 30 min. There were no scrotal edema and testicular necrosis after operation in 1 cases. The time of hospitalization was 2 D. 5 cases of contralateral concealed hernia were found during operation, and high ligation of hernia sac was performed at the same time. Follow up was 6～12 months in 25 cases, 12～24 months in 18 cases, 24～36 months in 16 cases, recurrence in 1 cases, and internal loop corresponding to local induration in 2 cases. Conclusion: epidural puncture needle cannula combined with laparoscopic high ligation of hernia sac for the treatment of incarceration of indirect inguinal hernia in children has the advantages of small trauma, thorough exploration, safe and economical, and it has the advantages of detecting and dealing with lateral herniation at the same time, suitable for clinical application, especially for the general hospital.
引文
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[2]伍岗泉,李小卫,卢应酬,等.腹腔镜手术治疗婴幼儿腹股沟嵌顿性斜疝62例[J].中国微创外科杂志,2014,14(9):772~774.
[3]赵普,黄国增,莫耀良,等.硬膜外穿刺针外套管在腹腔镜小儿斜疝高位结扎术中的应用[J].中国微创外科杂志,2007,7(10):999~1000.
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[5]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.
[6]刘传荣,骆福裕,李伟俊,等.腹腔镜下手法复位+内环结扎术治疗小儿嵌顿疝临床分析[J].江西医药,2016,51(8):738~739.
[7]胡梦平,沈俊.腹腔镜下小儿腹股沟疝疝囊高位结扎术与常规手术的临床效果比较[J].实用临床医药杂志,2018,22(5):68~70.
[2]伍岗泉,李小卫,卢应酬,等.腹腔镜手术治疗婴幼儿腹股沟嵌顿性斜疝62例[J].中国微创外科杂志,2014,14(9):772~774.
[3]赵普,黄国增,莫耀良,等.硬膜外穿刺针外套管在腹腔镜小儿斜疝高位结扎术中的应用[J].中国微创外科杂志,2007,7(10):999~1000.
[4]中华医学会小儿外科学分会内镜外科学组.小儿腹股沟疝腹腔镜手术操作指南(2017版)(上篇)[J].中华疝和腹壁外科杂志(电子版),2018,12(1):1~5.
[5]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.
[6]刘传荣,骆福裕,李伟俊,等.腹腔镜下手法复位+内环结扎术治疗小儿嵌顿疝临床分析[J].江西医药,2016,51(8):738~739.
[7]胡梦平,沈俊.腹腔镜下小儿腹股沟疝疝囊高位结扎术与常规手术的临床效果比较[J].实用临床医药杂志,2018,22(5):68~70.