新生儿腹股沟嵌顿疝的诊治分析

目的总结新生儿腹股沟嵌顿疝的诊治经验。方法2012年7月~2019年3月我院共收治32例新生儿腹股沟斜疝嵌顿,均完善腹壁疝彩超,彩超提示疝内容物存在血供可试行手法复位(复位成功后家属选择手术时间),复位失败安排急诊手术,彩超提示疝内容物无血流信号安排急诊手术。结果手法复位成功8例,择期完成手术。余24例手法复位失败急诊手术,其中10例采用开放手术,14例采用腹腔镜手术。24例术中见嵌顿内容物14例为小肠,2例为盲肠,2例为大网膜,6例为卵巢;睾丸坏死4例,卵巢坏死1例,肠坏死5例。术后切口感染3例,经换药处理后痊愈出院。32例随访2个月~6年10个月,中位随访时间2年11个月,无复发、鞘膜积液及睾丸萎缩发生,开放手术患儿发生医源性隐睾1例,2例对侧异时疝,均再次手术。结论新生儿腹股沟斜疝消化道症状常见,全面查体及彩超检查非常重要。一经诊断应及时手术治疗,以避免嵌顿所导致的严重并发症。术式首选腹腔镜下腹膜外疝囊高位结扎术。

Analysis of Diagnosis and Surgical Therapy of Incarcerated Inguinal Hernia in Newborns

Objective To summarize the experiences in diagnosis and treatment of incarcerated indirect inguinal hernia in newborn.Methods The clinical data were retrospectively analyzed for 32 newborn patients with incarcerated indirect inguinal hernia from July 2012 to March 2019.All the patients were given color Doppler ultrasound examination.If the ultrasonography showed the hernia contents presented blood flow signal,manual reduction was initially performed(After the success of the reduction,the family decided the surgical time).When reduction was ineffective,an emergency procedure was performed.If hernia contents had no blood flow signal,an emergency procedure was performed.Results The manipulative reduction was successfully completed in 8 cases,who underwent selective operations.The other 24 cases underwent emergency surgical treatment,including 10 open repair and 14 laparoscopic procedures.The hernia contents included bowel in 14 cases,cecum in 2 cases,omentum in 2 cases,and ovary in 6 cases.There were 4 cases with necrosis of testes,1 case with necrosis of ovary,and 5 cases with necrosis of bowels.There were 3 cases of postoperative wound infection,which were cured and discharged after the treatment with drug dressing.Follow-ups lasted for two months to six years and ten months(median,35 months)in 32 cases.No recurrence or testis atrophy or hydrocel occurred,except one suffered from iatrogenic cryptorchidism and two metachronous inguinal hernia in the open surgery group.Conclusions Gastrointestinal symptom is common in newborn with incarcerated hernia.Comprehensive physical examination and ultrasonography are essential for these patients who should be operated in time,and thereby avoiding severe complications.Laparoscopic extraperitoneal surgery is preferred.