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我们采用非疝囊剥离治疗新生儿腹股沟疝5例,收到良好效果。患儿年龄20天至3个月,多采用头低位、氯胺酮全麻。手术方法:经下腹部自然横纹横切口,长约3cm。依次切开皮肤、皮下脂肪、腹外斜肌腱膜,保护髂腹下和髂腹股沟神经,显露分离精索,游离精索上至内环口,下至外环口。提起精索,在内环口精索的下方缝合腹横筋膜1～2针,缩小抬高内环口。分离出精索动脉、静脉和输精管并保护。精索的其余部分(包括疝囊、提睾肌等)用两把中弯血管钳夹住,距精索近内环处的血管钳一定要达到内环口处,另一把距第一把钳约0.5cm。剪除两把血管钳之间的组织,如发现有一完整环形组织为后天性疝,反之为先天性疝。分别用4号丝线缝扎两断端。缝合腹外斜肌腱膜并妥善重建外环口。缝合皮下组织和皮肤,结束手术。 体会:本文术式有以下优点:①内环口处精索下缝合不但可缩小内环口,重要的是将内环口抬高,改善了腹部压力对内环口处的作用点。②重建外环口,即将外环口适当缩小,使重建后的外环口压低、
We used non-hernia sac dissection in 5 cases of neonatal inguinal hernia, received good results. Children aged 20 days to 3 months, use more head low, ketamine anesthesia. Surgical methods: the natural horizontal stripes through the lower abdomen incision, about 3cm. Followed by skin incision, subcutaneous fat, abdominal oblique aponeurosis, ilio-abdominal and ilioinguinal nerve protection, revealed the separation of spermatic cord, free spermatic cord to the inner ring mouth, down to the outer ring mouth. Lift the spermatic cord, suture the transverse fascia 1 ~ 2 stitches under the inner loop spermatic cord, reduce and raise the inner ring mouth. Isolated spermatic artery, vein and vas deferens and protection. The rest of the spermatic cord (including the hernia sac, cremaster muscle, etc.) with two curved vascular clamp, close to the spermatic cord between the inner forceps must reach the inner ring mouth, the other from the first Pliers about 0.5cm. Cut off the two between the vascular forceps, if found to have a complete ring of tissue for acquired hernia, conversely congenital hernia. Respectively, No. 4 silk suture two broken ends. Suture of extra-abdominal oblique aponeurosis and proper reconstruction of the outer ring mouth. Suture subcutaneous tissue and skin, the end of surgery. Experience: This technique has the following advantages: ① suture suture within the mouth not only can narrow the inner ring mouth, it is important to raise the inner ring mouth to improve the abdominal pressure on the role of the inner ring mouth. ② rebuild the outer ring mouth, the outer ring mouth is about to narrow, so that the reconstruction of the outer ring mouth down,