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作 者:翟佳琪 尚培中[1] 苗建军[1] 刘冰[1] 石德光[2] 李晓武[1] 杜欣[1] 郭宏荣 ZHAI Jia-qi;SHANG Pei-zhong;MIAO Jian-jun;LIU Bing;SHI De-guang;LI Xiao-wu;DU Xin;GUO Hong-rong(Department of General Surgery,The Hospital of PLA 81st Group Army,Zhangjiakou,Hebei075000,China;Department of General Surgery,The Air Force Hospital of PLA Central Theater,Datong,Shanxi 037006,China)
机构地区:[1]中国人民解放军陆军第八十一集团军医院普通外科,河北张家口075000 [2]中国人民解放军中部战区空军医院普通外科,山西大同037006
出 处:《河北北方学院学报(自然科学版)》2020年第6期5-10,共6页Journal of Hebei North University:Natural Science Edition
基 金:张家口市科学技术研究与发展计划项目(No.1921123H)。
摘 要:目的探讨腹腔镜下采用体内缝合疝囊高位结扎术加脐内侧襞瓣片覆盖加强内环口腹膜薄弱区治疗儿童巨大型腹股沟斜疝的安全性及临床效果。方法回顾性分析2013-01-2018-06月收治的74例身高120~166 cm、疝囊颈左右直径>15 mm的单侧巨大型腹股沟斜疝患儿临床资料,2013-01-2015-06月采用传统开放手术的32例作为开放组,2015-07-2018-06月采用腹腔镜手术的42例作为腹腔镜组,对比分析2组患儿手术治疗结果。结果开放组和腹腔镜组手术时间分别为(18.5±4.2)min和(19.4±3.3)min,术中出血量分别为(3.1±2.7)mL和(2.9±2.3)mL,组间比较差异无统计学意义(P>0.05);开放组不能判断对侧有无隐匿性疝,腹腔镜组发现对侧隐匿性疝6例(14.3%),术后疼痛评分分别为(3.1±0.5)分和(1.5±0.6)分,发生阴囊(阴唇)肿胀分别为5例(15.6%)和1例(2.4%),平均住院时间分别为(5.0±1.5)d和(2.5±1.4)d,术后1年复发分别为3例(9.4%)和0例,上述5项指标组间比较差异均有统计学意义(P<0.05)。结论腹腔镜下采用体内缝合疝囊高位结扎术加脐内侧襞瓣片覆盖加强内环口腹膜薄弱区治疗儿童巨大型腹股沟斜疝,并发症少,可避免或减少术后复发。Objective To evaluate the clinical efficacy and safety of the medial umbilical ligament as a reinforcing flap to cover the internal ring during laparoscopic high ligation for pediatric giant indirect inguinal hernia.Methods The clinical data of 74 patients(120 cm to 166 cm in height)with indirect inguinal hernia(>15 mm in diameter of hernial neck)treated from January 2013 to June 2018 were retrospectively analyzed.Among them,32 patients underwent traditional open surgery from January 2013 to June 2015(open group).And 42 patients underwent laparoscopic surgery from July 2015 to June 2018(laparoscopy group).The operation results of the two groups were comparatively analyzed.Results The duration of operation and intraoperative blood loss were(18.5±4.2)min,(3.1±2.7)mL in open group and(19.4±3.3)min,(2.9±2.3)mL in laparoscopy group,respectively.The difference between the two groups were not statistically significant(P>0.05).In the open group,it was hard to judge whether there was concealed hernia on the opposite side,but in the laparoscopic group,6 cases(14.3%)were found;the postoperative pain score,the incidence of scrotal or labial swelling,hospitalization time,and the recurrence rate one year after surgery were 0(3.1±0.5)points,5(15.6%),(5.0±1.5)d and 3(9.4%)in open group,and 6(14.3%),(1.5±0.6)points,1(2.4%),(2.5±1.4)d,0 in laparoscopy group,respectively.There were significant differences for the above five indexes(P<0.05).Conclusion Application of the medial umbilical ligament flap as a reinforcing flap to cover the internal ring during laparoscopic high ligation for pediatric giant indirect inguinal hernia may reduce complications and bring the recurrence rate close to zero.
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