改良疝针在腹腔镜下小儿疝高位结扎术的应用体会

目的 通过对硬膜外导管针加以改进,自制成疝修补针应用于腹腔镜下小儿疝高位结扎术,对比小切口小儿疝高位结扎术,探讨其临床疗效,以明确腹腔镜技术应用于治疗小儿腹股沟疝的可行性、有效性、安全性。 方法 回顾性分析阜阳市人民医院普外科2014年4月—2016年4月收治的56例小儿腹股沟疝病例临床资料,并根据实施的手术方法分为2组,腹腔镜组28例运用改良疝修补针行腹腔镜下疝囊高位结扎术,小切口组28例行小切口疝囊高位结扎手术治疗,记录所有患儿术中及术后情况,比较2组手术时间、手术切口、术后并发症、术后复发率、住院时间等情况。数据采用SPSS 19.0统计软件进行分析处理,P<0.05为差异有统计学意义。 结果 自制硬膜外导管针腹腔镜下疝囊高位结扎手术较小切口疝囊高位结扎术手术时间明显缩短(t=5.441、P<0.001),腹腔镜下疝囊高位结扎手术切口小(t=5.403、P<0.001),腹腔镜下疝囊高位结扎术组患儿较小切口组患儿术后并发症明显减少(χ2=4.082、P=0.043),差异有统计学意义(P<0.05),术后复发率(χ2=1.018、P=0.313)及住院天数(t=0.928、P=0.357)差异无统计学意义(P>0.05)。 结论 通过改进硬膜外导管针、自制成疝修补针应用于腹腔镜下小儿疝囊高位结扎术,具有手术时间短、手术切口小、术后并发症少等特点,术中视野清晰开阔,并可发现对侧隐匿性疝,同时可进行腹腔探查,且安全可靠,为儿童腹股沟斜疝治疗提供新的思路与方法,同时得到了患儿家长的认同,值得临床推广。 

Application of a self-made epidural catheter needle in laparoscopic high ligation of hernial sac in children

Objective To explore the feasibility, effectiveness and safety of laparoscopic high ligation of hernial sac with a self-made suture needle (remade from epidural catheter needle) by comparing with minithoracotomy high ligation of hernial sac for children's hernia. Methods The clinical data of 56 children with inguinal hernia in our hospital between April, 2014 and April, 2016 were analyzed retrospectively.The patients were divided into two groups according to the operation methods.Twenty-eight cases of the laparoscopy group were treated with laparoscopic high ligation of hernial sac with a self-made epidural catheter needle, while other 28 cases of the open surgery group were treated with minithoracotomy high ligation of hernial sac.The intraoperative and postoperative conditions of patients in the two groups were recorded.The operation time, surgical incision, postoperative complication, postoperative recurrence rate and hospitalization time between the two groups were compared.The data was analyzed by SPSS 19.0 statistical software, setting P < 0.05 for statistically significant. Results Compared with minithoracotomy high ligation method, laparoscopic high ligation of hernial sac was with advantage in the operation time (t=5.441, 5.403, all P < 0.001) and postoperative complications (χ2=4.082, P=0.043), the difference was statistically significant (P < 0.05).The difference in recurrence rate and hospitalization time was not significant. Conclusion The laparoscopic high ligation of hernial sac with a self-made suture needle is a simple, effective and minimally invasive procedure with a shorter operative time, smaller incision, less postoperative complications, clearer intraoperative vision.The contralateral occult hernia can be found.At the same time, the abdominal cavity detection can be performed, which can provide with a new method for children's inguinal hernia treatment and get the approbation of the parents.Therefore it was worthy of clinical promotion.