目的:探讨经腹腔修补术治疗小儿复发性斜疝的安全性和疗效。方法:总结分析了我院2005年4月至2009年3月30例经腹腔修补小儿复发性斜疝手术的临床资料。30例患儿均为男性,年龄(3.10±1.36)岁,全部证实为小儿腹股沟斜疝行疝囊高位结扎术后1年内复发仍为腹股沟斜疝者,其中包括嵌顿型斜疝4例。结果:30例患儿手术均获成功,平均手术时间(31.0±5.28)分,术中失血(10.85±4.56)mL,术后平均住院天数(6.5±1.38),术中均无精索及膀胱损伤,术后均无阴囊血肿及远端疝囊积液,术后随访至今,无一例复发。结论:经腹腔修补术治疗小儿复发性斜疝术具有术中出血少,损伤小,并发症少,术后复发率低等优点,是一种安全有效的治疗方式,值得基层医院推广。
目的 探讨局部麻醉下行自体疝囊植入法修补腹股沟疝的方法和治疗体会。方法 对36例腹股沟疝患者的临床资料进行回顾性分析，单一采用利多卡因作腹股沟区域阻滞麻醉，并改进利用自体疝囊植入充填封闭内环部及腹股沟管后壁的缺损与裂隙，然后进行常规方法修补缝合。结果 本组36例患者麻醉与手术效果皆满意，平均麻醉时间5min，平均手术时间40min，术中均未再注射止痛药物。患者术后早期切口有饱满、夯实感，疼痛症状较传统手术轻。无伤口瘀血、感染、阴囊血肿或尿潴留等并发症发生。术后6h即可进食，2～5d可下床活动，平均住院时间7d，住院费用较硬膜外麻醉减少20%～30%。经随访1～5年，平均随访3年，无再复发。结论 局部区域阻滞麻醉安全性高，并完全能满足手术需要；而自体疝囊组织为“天然补片”，植入后可充分加强内环部及腹股沟管后壁的强度，愈合后形成较为坚固的纤维组织壁，最大程度地防止疝的形成与复发。麻醉与手术操作相对简单，费用低廉，便于基层医院开展。
ObjectiveTo survey the feasibility of laparoscopic high ligation for pediatric inguinal hernias by performing the surgery on rabbit models. MethodsLaparoscopic high ligation was operated on 32 healthy New-Zealand male rabbits. Eight random rabbits were observed under laparoscope on the 7th, 15th, 30th, and 60th days after operation, and the anti-tension strength at the instant when hernial inner ring cracked was measured. Repair regions were resected. After HE-staining, the syzygial status of the repair regions were checked. ResultsNone of the rabbits died during the research with no such complications as ankylenteron intestinal obstruction or hernia relapses after surgery. The anti-tension strength by the inguinal regions of the experimental rabbits after surgery on the 7th, 15th, 30th, and 60th days was respectively (42.69±6.98), (69.31±6.52), (102.64±7.91), and (106.53±7.54) mm Hg (1 mm Hg=0.133 kPa). As for the pathological section observation, the agglutination of the repair region was consistent with reparative process of chronic nonbacterial inflammation. ConclusionThe operation of laparoscopic high ligation for repairing inguinal hernia on rabbits is safe and reliable.
目的探讨腹股沟直疝突入阴囊的可能原因及其手术修补方法。 方法回顾性分析笔者所在医院2005年6月至2013年6月期间收治的353例次腹股沟直疝患者的临床资料。 结果353例次腹股沟直疝患者，发生疝囊突入阴囊12例次，发生率为3.4%。与未突入阴囊组比较，突入阴囊组患者的年龄大、病程长、疝环口及疝囊大，且多伴有慢性支气管炎、便秘等导致慢性腹内压增高的疾患。12例次中采用“疝环充填+平片”修补术1例次，其余11例次均采用腹膜前修补术。术后随访6～60个月，平均37个月，无复发病例。 结论腹股沟直疝在少数情况下可以突入阴囊，宜选择腹膜前间隙疝无张力修补术。
ObjectiveTo compare the effects of medical glue and stapling in the prevention of postoperative seroma for patients undergoing laparoscopic direct hernia repair. MethodsNinty-four patients were randomly by computer generated randomization number divided into two groups: medical glue group (medical glue was used to fix pseudo-direct hernia sac) and stapling group (staple was used to fix pseudo-direct hernia sac).The time of follow-up was two years.The operative time, length of hospital stay, the pain level on first day and 7th day after operation, postoperative complications (seroma, wound infection, wound bleeding), hospital costs, and hernia recurrence rate within 2 years were observed. ResultsThe medical glue group compared with the stapling group, the operative time was shorter〔(35±5.1) min vs.(41±7.5) min〕, hospitalization time was shorter〔(4±0.51) d vs.(5±0.83) d〕, lower postoperative pain score〔the first day: (5±0.52) scores vs.(6±0.33)scores; the 7th day: (3±0.67) scores vs.(4±0.53) scores〕, and lower cost in hospital〔(5 731±560.50) yuan vs.(8 715±534.33) yuan〕, there were significant difference (P < 0.05).The incidence of seroma and other complications after operation and postoperative 1-year and 2-year hernia recurrence rate showed no significant differences (P > 0.05). ConclusionsThe medical glue has good prevention effects on postoperative seroma for patients undergoing laparoscopic direct hernia surgery, with shorter operative time and lower cost.This method is suitable for all levels of hospitals
Objective To investigate the clinical value of laparoscopic high ligation of hernia sac with constructed veress needle in the treatment of indirect inguinal hernia in children. Methods Ninety-one cases of pediatric indirect inguinal hernia who received treatment in Suqian People’s Hospital of Nanjing Drum-Tower Hospital Group from October 2014 to December 2015 were selected and randomly divided into two groups, cases of laparoscopy group (n=41) were treated by laparoscopic high ligation of hernia sac with constructed veress needle, and cases of tradition group (n=50) were treated with traditional open high ligation of hernia sac. Comparison of clinical effect between the 2 groups was performed. Results All the operations were successfully carried out, and there was no conversion to open surgery in laparoscopy group. Three cases were diagnosed as two-side inguinal hernia in laparoscopy group, who were diagnosed as one-side inguinal hernia before operation. The operation time, length of surgical incision, blood loss, and hospital stay of the laparoscopy group were all significantly less than those of the tradition group (P<0.05). The incidence of postoperative complications such as scrotal edema and scrotal hydrocele, incidence of testicular dysplasia, and the recurrence rate in the laparoscopy group were all significantly lower than those of the tradition group (P<0.05). Conclusions Laparoscopic high ligation of hernia sac with constructed veress needle in the treatment of indirect inguinal hernia in children has good application value, which has advantages of small surgical trauma, shorter hospital stay, faster recovery, and less postope-rative complications, and we can find out contralateral recessive hernia during operation and avoid the second surgery.