克氏针辅助双钩注水疝针在儿童复杂性腹股沟斜疝中的临床应用  

Clinical application of a Kirschner wire assisted double-hook water-injection hernia needle in complicated pediatric oblique inguinal hernia

作　　者：刘赛赛 董隽 郭云飞[1] 黄立渠 王利霞 蒋银珠 Liu Saisai;Dong Jun;Guo Yunfei;Huang Liqu;Wang Lixia;Jiang Yinzhu(Department of Urology Surgery,Jiangsu Provincial Children′s Medical Center,Children′s Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院泌尿外科,江苏省儿童医学中心,南京210008

出　　处：《中华实用儿科临床杂志》2022年第20期1554-1558,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(82000643);江苏省自然科学基金青年项目(BK20200152)。

摘　　要：目的探讨借助克氏针辅助双钩注水疝针行单孔腹腔镜经皮腹膜外闭合术在儿童复杂性腹股沟斜疝中的临床应用价值。方法回顾性分析2020年12月至2021年10月南京医科大学附属儿童医院泌尿外科收治的366例腹股沟斜疝患儿临床资料,按照手术方式分为普通钩针组(309例,行单孔腹腔镜下双钩注水疝针术)与克氏针辅助组(57例,行克氏针辅助单孔腹腔镜下双钩注水疝针术),采用独立样本t检验及秩合检验比较2组患儿相关临床指标。结果与普通钩针组相比,克氏针辅助组患儿手术年龄更小[(2.87±1.88)岁比(4.91±2.39)岁],疝囊体积更大[17303.89(8622.49,37295.42)mm^(3)比9650.97(3849.24,17539.51)mm^(3)],差异均有统计学意义(t=-5.407、Z=-4.218,均P<0.001);2组患儿体质量指数比较,差异无统计学意义(P>0.05);以疝囊体积>10000 mm^(3)为巨大疝标准,克氏针辅助组中巨大疝占比70.18%(40/57例),普通钩针组中巨大疝占比47.25%(146/309例)。克氏针辅助组总体手术时间较普通钩针组长[20(15,20)min比15(15,20)min](Z=-2.842,P<0.05),但对于疝囊体积>10000 mm^(3)的巨大斜疝,2组手术时间比较差异无统计学意义(P>0.05)。术后随访6~16个月,2组均无复发病例。结论对于儿童巨大疝或内环处后腹膜皱襞明显,疝囊和腹壁之间瘢痕黏连较重的复杂性腹股沟斜疝,置入克氏针辅助有利于疝钩针顺利跨越输精管和精索血管,且作为单孔腹腔镜手术,无需增加Trocar孔数目,手术瘢痕较小。具有较好的可行性与安全性,适合临床推广。Objective To explore the clinical value of single-hole laparoscopic percutaneous extraperitoneal closure operation using a Kirschner wire assisted double-hook water-injection hernia needle in treating complicated pediatric oblique inguinal hernia.Methods The clinical data of 366 children with oblique inguinal hernia treated in the Department of Urology Surgery,Children′s Hospital of Nanjing Medical University from December 2020 to October 2021 were retrospectively analyzed.According to the surgical methods,the children were divided into the ordinary crochet needle group and the Kirschner wire assisted group.Children treated by a single-port laparoscopic double hook water-injection hernia crochet needle(309 cases)were classified into the ordinary crochet needle group.Children treated by a single-port laparoscopic Kirschner wire assisted double hook water-injection hernia crochet needle(57 cases)were included in the Kirschner wire assisted group.The independent sample t-test and rank sum test was used to compare the relevant clinical indicators between the two groups.Results Compared with the ordinary crochet needle group,children in the Kirschner wire assisted group were younger at surgery[(2.87±1.88)years vs.(4.91±2.39)years]and had larger hernia sacs[17303.89(8622.49,37295.42)mm^(3)vs.9650.97(3849.24,17539.51)mm^(3)].The differences in the age at surgery and hernia sac volume were statistically significant(t=-5.407,Z=-4.218;all P<0.001).There was no significant difference in body mass index between the 2 groups(P>0.05).Taking hernias with sac volume>10000 mm^(3) as huge hernias,there were 70.18%(40/57 cases)and 47.25%(146/309 cases)of huge hernias in the Kirschner wire assisted group and the ordinary crochet needle group,respectively.The overall operation time of the Kirschner wire assisted group was significantly longer than that of the ordinary crochet needle group[(20(15,20)min vs.15(15,20)min](Z=-2.842,P<0.05).However,the operation time for huge oblique hernias with sac volume>10000 mm^(3) was not statis

关 键 词：儿童 复杂性腹股沟斜疝 巨大疝 克氏针 单孔腹腔镜经皮腹膜外闭合术 

分 类 号：R726.5[医药卫生—儿科]