高频超声诊断女婴腹股沟斜疝内容物为卵巢1例

目的探讨高频超声在诊断女婴腹股沟斜疝,内容物为卵巢的临床应用价值。方法回顾性分析我院收治并手术确诊的1例腹股沟斜疝,内容物为卵巢的女婴的超声声像图特点及临床资料。结果超声检查诊断此例女婴腹股沟斜疝,疝内容物为卵巢,与手术结果相符。结论高频超声可作为女婴腹股沟斜疝,疝内容物为卵巢的首选检查方法,为早期临床诊断治疗提供可靠依据。     

Perioperative management of infant inguinal hernia surgery; a review of the recent literature

Inguinal hernia surgery is one of the most common electively performed surgeries in infants. The common nature of inguinal hernia combined with the high-risk population involving a predominance of preterm infants makes this a particular area of interest for those concerned with their perioperative care. Despite a large volume of literature in the area of infant inguinal hernia surgery, there remains much debate amongst anesthetists, surgeons and neonatologists regarding the optimal perioperative management of these patients. The questions asked by clinicians include; when should the surgery occur, how should the surgery be performed (open or laparoscopic), how should the anesthesia be conducted, including regional versus general anesthesia and airway devices used, and what impact does anesthesia choice have on the developing brain? There is a paucity of evidence in the literature on the concerns, priorities or goals of the parents or caregivers but clearly their opinions do and should matter. In this article we review the current clinical surgical and anesthesia practice and evidence for infants undergoing inguinal hernia surgery to help clinicians answer these questions.     

婴儿腹股沟斜疝单孔腹腔镜手术的临床体会

目的:总结反复嵌顿的腹股沟斜疝婴儿行单孔腹腔镜疝囊高位结扎术的手术经验与临床体会。方法:回顾分析为55例腹股沟斜疝婴儿行单孔腹腔镜疝囊高位结扎术的临床资料,其中男53例,女2例,2～8个月;单侧41例(74.5%),双侧14例(25.5%)。结果:55例手术均顺利完成,无需另做切口。术后婴儿顺利恢复,第2天出院,并正常进食。术后1个月复查,脐部切口愈合良好,腹部无疤痕,治疗效果与美容效果均满意。随访1个月～3年,均无复发。结论:单孔腹腔镜疝囊高位结扎术治疗婴儿腹股沟斜疝快速、安全、疗效明显可靠、创伤小、康复快、美容效果好。因婴儿腹腔容量小,腹壁较薄,穿刺Trocar时应轻柔、稳妥。可在具备相应麻醉及手术条件的医院广泛开展。     

Inguinal herniotomy in young infants.

Ninety-two consecutive infants aged up to 12 months underwent primary inguinal herniotomy over a 5-year period. All were treated in a district hospital paediatric surgical unit according to recommendations of the British Association of Paediatric Surgeons. After a mean follow-up of 45.8 months, one patient had a failed repair and four (4 per cent) a hernia recurrence. One infant developed a wound infection. Infantile hernia can be managed safely and efficiently in a district hospital.     

Spinal anaesthesia in the neonate

Postoperative apnoea in ex-premature infants is inversely proportional to gestational age at birth and postmenstrual age (PMA). Spinal anaesthesia is an important technique in ex-premature infants as it reduces the risk of postoperative apnoea, provided intra-operative sedation is avoided. Recent studies have provided more data on recommended doses of local anaesthetics for infant spinal anaesthesia as well as adjuvants used to prolong the duration of surgical anaesthesia. Spinal anaesthesia is also used for surgical procedures other than inguinal hernia repair. There are a variety of reasons why awake regional is not the preferred technique for ex-premature infants undergoing lower abdominal surgery in many centres, and there is also controversy over the appropriate anaesthetic technique for outpatient surgery in infants <60 weeks PMA. A pragmatic decision analysis on the selection of anaesthetic techniques for inguinal hernia repair in infants is presented.     

Bladder injury during herniorrhaphy. Manifested by ascites and azotemia

A case of inadvertent injury to the bladder during repair of an inguinal hernia in a three-month-old male infant is reported. This injury was manifested by urinary ascites and severe azotemia. Awareness of the anatomic relation of the bladder to the internal inguinal ring in infants will prevent this injury or allow recognition of it at surgery. Proper repair can then be undertaken before serious complications ensue.     

Emergency repair of inguinal hernia in the premature infant is associated with high direct medical costs

Purpose

Inguinal hernia repair is frequently performed in premature infants. Evidence on optimal management and timing of repair, as well as related medical costs is still lacking. The objective of this study was to determine the direct medical costs of inguinal hernia, distinguishing between premature infants who had to undergo an emergency procedure and those who underwent elective inguinal hernia repair.

Methods

This cohort study based on medical records concerned premature infants with inguinal hernia who underwent surgical repair within 3 months after birth in a tertiary academic children’s hospital between January 2010 and December 2013. Two groups were distinguished: patients with incarcerated inguinal hernia requiring emergency repair and patients who underwent elective repair. Real medical costs were calculated by multiplying the volumes of healthcare use with corresponding unit prices. Nonparametric bootstrap techniques were used to derive a 95 % confidence interval (CI) for the difference in mean costs.

Results

A total of 132 premature infants were included in the analysis. Emergency surgery was performed in 29 %. Costs of hospitalization comprised 65 % of all costs. The total direct medical costs amounted to €7418 per premature infant in the emergency repair group versus €4693 in the elective repair group. Multivariate analysis showed a difference in costs of €1183 (95 % CI ?1196; 3044) in favor of elective repair after correction for potential risk factors.

Conclusion

Emergency repair of inguinal hernia in premature infants is more expensive than elective repair, even after correction for multiple confounders. This deserves to be taken into account in the debate on timing of inguinal hernia repair in premature infants.

     

Spinal anaesthesia for inguinal hernia repair in high-risk neonates

To avoid the high incidence of respiratory complications associated with general anaesthesia in premature neonates, 44 spinal anaesthetics for inguinal hernia repair in very low birthweight infants were administered in 47 attempts. Hyperbaric tetracaine with epinephrine 1:200,000 was administered in a dose range of 0.27-1.10 mg.kg-1. Attempted lumbar puncture failed in three infants. In 24 procedures, spinal anaesthesia alone provided satisfactory operating conditions; in 20, supplementary inhalational general anaesthesia or iv ketamine was necessary. Perioperative apnoeic episodes requiring bag/mask assisted ventilation occurred in six infants. In five infants, apnoeic spells occurred in the postoperative period. No infant required tracheal intubation; there was no haemodynamic instability. Twenty-four infants required no postoperative analgesia. Our experience suggests that spinal anaesthesia for inguinal hernia repair in very low birth weight infants reduces but does not eliminate the risk of respiratory instability, and that supplementary anaesthesia is often necessary to provide satisfactory operating conditions.     

Impact of paediatric surgery training on the attitudes and experience of frontline general surgeons in common paediatric surgical emergencies

Aim: The present study is a survey of the attitudes and experience of frontline general surgeons in common paediatric surgical emergencies, and their exposure to paediatric surgery (PS) during training. Methods: Questionnaires were sent to higher trainees and junior specialists in general surgery. Their experience in the management of common paediatric emergency conditions including acute scrotum, toddler appendicitis, infant incarcerated inguinal hernia and intussusception was asked. Results: Of the surgeons, 60.8% and 41.2% had no exposure to PS in their internship and basic surgical training, respectively. The majority of them managed less than five cases of intussusception (82.4%) and incarcerated inguinal hernia (66.7%); 19.6% and 37.3% indicated that they were competent in managing intussusception and incarcerated inguinal hernia, respectively. The majority believed that general surgeons should know how to manage these common paediatric emergency conditions. However, 56.9% and 78.4% opined that infants with incarcerated inguinal hernia and intussusception, respectively, should be managed in paediatric surgical centres. Conclusions: Although most frontline general surgeons opined that they should know how to manage common paediatric surgical emergencies, the majority of them did not feel competent to manage infantile intussusception and incarcerated inguinal hernia due to inadequate clinical exposure. They believed that intussusception and incarcerated inguinal hernia should be managed in a paediatric surgical centre.     

基层医院开展局麻开放腹股沟疝日间手术可行性分析

目的探讨基层医院开展局麻开放腹股沟疝日间手术的可行性。 方法收集2018年4月至2019年4月，大同市第五人民医院接受腹股沟疝日间手术患者143例，明确患者接受腹股沟疝日间手术的效果，总结和分享腹股沟疝日间手术经验。 结果所有患者均顺利完成手术并出院，术后发现血清肿5例，其中自行恢复4例，进行穿刺后痊愈1例，无复发、出血、感染及长期慢性疼痛患者。 结论通过严格把握手术指征和遵守手术操作规程，基层医院开展腹股沟疝日间手术是安全可行的。     

隐匿小切口疝囊高位结扎术治疗儿童腹股沟斜疝

目的：研究隐匿小切口疝囊高位结扎术治疗儿童腹股沟斜疝的临床效果。方法回顾性分析2013年2∽8月,赤峰学院附属医院新城院区应用隐匿小切口疝囊高位结扎术治疗儿童腹股沟斜疝32例患儿的临床资料。结果手术时间10∽25 min,平均14 min;住院时间2．0∽4．5 d,平均3d;皮肤切口小且隐匿,无需缝合,医用胶水粘合即可。全组患儿均随访6个月,术后切口均一期愈合。随访期间无复发,无并发症发生。结论隐匿小切口疝囊高位结扎术治疗儿童腹股沟斜疝具有创伤小,切口隐匿,术后恢复快的优点,便于临床广泛推广。     

A case of incarcerated femoral hernia in an infant

The authors describe the case of an incarcerated femoral hernia in an infant. A 4-month-old female infant was hospitalized with an incarcerated right groin hernia. Attempts to reduce the mass were unsuccessful, so an emergency surgery was performed. During surgery, the hernial sac seemed to protrude under the inguinal ligament. The authors opened the hernial sac and observed a dark red small intestine. The authors did not resect the intestine because its color gradually improved after the constriction was released. The hernial sac passed under the inguinal ligament, and the infant was diagnosed with incarcerated femoral hernia.     

腹腔镜手术治疗婴幼儿腹股沟嵌顿性斜疝62例

目的：探讨腹腔镜手术在婴幼儿腹股沟嵌顿性斜疝中的临床应用价值。方法2011年2月-2014年2月采用腹腔镜急诊手术治疗婴幼儿腹股沟嵌顿疝62例,气管插管全麻后腹腔镜辅助手法复位,复位失败于腹股沟外环体表投影1．5 cm小切口,松解嵌顿,均行腹腔镜下内环口高位结扎。结果62例均顺利完成腹腔镜手术：腹腔镜辅助复位49例,手术时间（32．4±11．9）min,住院时间（4．3±1．1）d;腹腔镜嵌顿松解13例,手术时间（52．1±15．4）min,住院时间（5．1±1．7）d。无输精管、精索血管损伤,无阴囊血肿、切口感染等并发症。62例随访2-24个月,平均14个月,术后无睾丸萎缩、医源性隐睾、切口疝等并发症,术后复发1例,复发率1．6％（1/62）。结论腹腔镜下可同时发现和处理对侧隐性内环口未闭,腹腔镜手术治疗婴幼儿腹股沟嵌顿性斜疝安全可行,疗效确切。     

腹腔镜手术治疗小儿腹股沟斜疝138例

目的探讨腹腔镜手术应用于小儿腹股沟斜疝的临床效果及其价值。方法回顾性分析2009年1月至2011年1月经腹腔镜手术治疗小儿腹股沟斜疝的138例患儿的临床资料,其中男131例,女7例,平均年龄（4．9±0．2）岁。单侧腹股沟斜疝114例,双侧腹股沟斜疝24例;术中发现对侧隐匿疝8例,对侧鞘状突未闭6例。全部患儿均采用腹腔镜手术治疗,均经过术后随访5—8个月,复发患儿再行腹腔镜手术。结果全部患儿均顺利完成手术,手术时间平均21min,住院时间3～5d。随访结果发现术后1个月2例出现复发,再次腹腔镜手术后治愈。结论经腹腔镜下手术治疗小儿膀股沟斜疝是一种专伞有效的手术方式,具有手术时间锕、创伤小、恢每懊的优点。     

腹腔镜手术治疗婴儿肥厚性幽门狭窄合并腹股沟斜疝

目的总结婴儿肥厚性幽门狭窄腹腔镜下幽门环肌切开术,同时探查双侧内环口,若合并腹股沟斜疝则同时行腹腔镜下疝囊高位结扎术的经验。方法腹腔镜下先行幽门环肌切开术,然后腹腔镜转向盆腔探查双侧内环口,若未闭合（直径≥0.3 cm）则行疝囊高位缝扎术。结果86例中合并腹股沟斜疝32例（37.2%）,其中单侧13例,双侧19例。手术时间较单纯行幽门环肌切开术增加5~20 min,平均15 min。均于术后6 h开始喂养,术后2~6 d,平均3.5 d出院。86例术后随访3~24个月,平均13个月,无并发症发生。结论腹腔镜下幽门环肌切开术同时行疝囊高位结扎术避免了二次行嵌顿疝复位或疝囊高位结扎手术的可能性,同时因疝囊小,没有因疝内容反复进出或嵌顿形成的瘢痕而易于操作,较传统手术更不易损伤精索。     

社区医院全科医师对小儿腹股沟疝的检出率及术式探讨

目的探讨社区医院全科医师对小儿腹股沟疝的检出率及手术方式。 方法选择2015年2月至2017年1月就诊于太阳宫社区卫生服务中心77例患儿的临床资料,由全科医师行问诊及相关的体格检查得出初步诊断,进一步行超声检查后转诊至上级医院行腹腔镜腹股沟疝疝囊高位结扎术,根据术中诊断回顾性评估社区医院全科医师对小儿腹股沟疝的检出率及社区医院超声诊断准确率,随访术后复发等情况。 结果77例患儿中,全科医师对小儿腹股沟疝检出率为42.9%,超声诊断准确率为70.1%,并且超声诊断单侧腹股沟疝的54例患儿中,对侧隐匿疝的发生率为35.2%。患儿行腹腔镜腹股沟疝疝囊高位结扎术后均随访6个月,术后阴囊短期内稍水肿,无血肿,无1例复发。 结论社区医院全科医师对小儿腹股沟疝检出率低,有必要对全科医师行儿童疝和腹壁外科专业培训降低漏诊率。腹腔镜治疗小儿腹股沟疝手术安全可行且可以同时发现对侧病变,降低了漏诊率,避免了二次手术的风险。     

经脐单孔腹腔镜手术治疗儿童腹股沟斜疝的临床研究

目的:探讨经脐单孔腹腔镜手术治疗儿童腹股沟斜疝的应用价值.方法:采用脐部单孔腹腔镜手术治疗腹股沟斜疝患儿27例,其中单侧23例,双侧4例,均行内环口环形缝扎术.结果:单侧腹股沟斜疝手术时间平均(33.13±5.44)min,双侧手术时间平均(52.25±1.71)min,术后平均住院(3.52±1.09)d,无阴囊积液...     

'One-stop' inguinal hernia surgery--day-case referral, diagnosis and treatment

BACKGROUND: Patients with unilateral inguinal hernias are conventionally seen at an out-patient appointment before being placed on a waiting list for surgery. Many patients are also required to attend a pre-assessment clinic prior to admission. AIM: To establish whether patients fit for day surgery inguinal hernia repair could be assessed and treated at a single hospital appointment. PATIENTS AND METHODS: Patients referred with unilateral inguinal hernias were sent an information sheet and health questionnaire by post. General practitioners were asked to help patients complete the medical details. Patients suitable for day surgery were sent a single appointment for assessment and treatment by an open, tension-free Lichtenstein mesh repair. RESULTS: Ninety-eight patients were sent an appointment for 'one-stop' inguinal hernia treatment. Ninety-two patients (93.5%) underwent inguinal hernia repair and were discharged on the same day without complication. CONCLUSIONS: Patients with unilateral primary inguinal hernias who are under 70 years old and ASA grade I or II can been seen, assessed and treated on the same day. 'One-stop' inguinal hernia surgery reduces the number of patient visits to the hospital and could be expanded to incorporate many more hernia repairs and other day case procedures.     

Postoperative outcome in high-risk infants undergoing herniorrhaphy: comparison between spinal and general anaesthesia

The incidence of inguinal hernia is higher in premature infants, particularly in low birth weight neonates. This latter group may also incur increased postoperative respiratory complications and inpatient admissions. The purpose of this study was to compare the effects of general and spinal anaesthesia on postoperative respiratory morbidity and on the length of hospital stay in high-risk infants undergoing inguinal herniorrhaphy. Forty patients, all high-risk infants who underwent unilateral or bilateral herniorrhaphies, were randomly assigned to receive general anaesthesia ( n  = 20) or spinal anaesthesia ( n  = 20). There was a significant difference in respiratory morbidity between the two groups, as well as a significant difference in the inpatient hospital stay. The present study suggests that spinal anaesthesia can be used safely for high-risk infants, preterm or formerly preterm, undergoing inguinal hernia repair.     

Irreducible inguinal hernia due to crossed testicular ectopia in an infant

The usual presentation of crossed testicular ectopia (CTE) is that of inguinal hernia with contralateral absent testis. We report on a 10-month-old infant with CTE, which presented as irreducible inguinal hernia. Diagnosis was made during surgery, as the child underwent an emergency operation for repair of his irreducible right inguinal hernia. A normal-sized and normal-shaped testis was found in the hernial sac with its blood vessels and vas deferens. A herniotomy with fixation of the ectopic gonad to the opposite hemiscrotum was done. The child remained asymptomatic 1 year postoperatively. Crossed testicular ectopia in infancy may present as irreducible hernia, requiring urgent surgery.