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目的:比较经脐单通道腹腔镜结合改良双钩疝针与传统开放手术治疗小儿鞘膜积液的临床疗效。方法:回顾性分析2014年1月至2015年1月采用经脐单通道腹腔镜结合改良双钩疝针治疗小儿鞘膜积液35例(54侧),并与同期行开放手术的46例(58侧)患儿临床资料进行比较。记录患者的手术时间、出血量、住院时间、阴囊水肿情况、有无术后并发症等指标。结果:腔镜组在手术时间、术中出血量、阴囊水肿情况及住院时间方面均优于开放组,差异均有统计学意义(5.7%vs 6.5%,P均<0.05)。而术后并发症两者相比差异无统计学意义(P>0.05)。腔镜组有2例出现皮下气肿,给予吸氧等对症处理后于1~3 d逐渐吸收,无其他不良反应,无远期并发症出现。开放组3例出现并发症,其中1例为阴囊血肿,予以清创缝合后愈合良好,2例为术后3 d切口感染脂肪液化,予以每日换药后愈合良好。术后随访6个月以上,腔镜组无复发、睾丸萎缩等远期并发症发生。开放组有3例复发,其中1例术后1个月单侧复发,改行腹腔镜内环口结扎后治愈;另有2例对侧再次出现鞘膜积液,予以腹腔镜内环口结扎后治愈,无其他远期并发症发生。结论:经脐单通道腹腔镜结合改良双钩疝针治疗小儿鞘膜积液临床疗效明显优于传统开放手术。
Objective: To compare the clinical efficacy of transsphenoidal laparoscopy combined with modified double hook hernia needle and traditional open surgery for pediatric hydrocele. Methods: From January 2014 to January 2015, 35 cases (54 sides) of pediatric hydrocele were treated with single-channel transabdominal laparoscopy combined with modified double-hook hernia needle and 46 cases (58 cases) with open surgery Side) in children with clinical data were compared. Record the patient’s operation time, bleeding, hospital stay, scrotal edema, with or without postoperative complications and other indicators. Results: The operation time, intraoperative blood loss, scrotal edema and hospital stay in the endoscopic group were better than that in the open group (5.7% vs 6.5%, P <0.05). There was no significant difference in postoperative complications between the two groups (P> 0.05). There were 2 cases of subcutaneous emphysema in the endoscopic group, which gradually absorbed after 1 ~ 3 days of symptomatic treatment such as oxygen inhalation. There were no other adverse reactions and no long-term complications occurred. In the open group, complications occurred in 3 cases. Among them, 1 had scrotal hematoma and healed well after debridement. Two cases were infected with fat liquefaction 3 days after operation and healed well after daily dressing change. All the patients were followed up for more than 6 months. No recurrence was found in the endoscopic group and atrophy of the testicle and other long-term complications occurred. In the open group, there were 3 cases of recurrence, of which 1 case had one-sided recurrence 1 month after operation and was cured after ligation of the laparoscopic endopexy; another 2 cases had hydrocephalus again on the contralateral side, and laparoscopic ligation Cure, no other long-term complications. Conclusion: The single-channel laparoscopic combined with improved double hook hernia needle treatment of pediatric hydrocele clinical efficacy was significantly better than the traditional open surgery.