Liu Ming,Chi Renjie,Li Fujiang,et al.Three-dimensional laparoscopic treatment of indirect inguinal hernia in children by water injection[J].Journal of Clinical Pediatric Surgery,2019,18(08):686-691.[doi:10.3969/j.issn.1671-6353.2019.08.014]
3D腹腔镜下注水疝气针疝囊高位结扎术治疗小儿腹股沟斜疝
- Title:
- Three-dimensional laparoscopic treatment of indirect inguinal hernia in children by water injection
- Keywords:
- Hernia; Inguinal/TH; Laparoscopes
- 分类号:
- R616.5;R656.2+1
- 摘要:
- 目的 探讨3D高清腹腔镜辅助治疗小儿腹股沟斜疝的可行性及注水疝气针在小儿腹股沟斜疝疝囊高位结扎术中的应用。方法 2015年6月至2016年12月青岛大学附属医院小儿外科收治340例腹股沟斜疝或鞘膜积液患儿，其中100例接受传统腹腔镜手术（普通腹腔镜组），平均年龄为3.3岁，单侧为67例，双侧为33例；23例有嵌顿史。240例接受3D腹腔镜手术（3D腹腔镜组），平均年龄为3.5岁，单侧165例，双侧75例，其中有50例有嵌顿史。两组患儿术前一般情况无差异。结果 3D腹腔镜组和普通腹腔镜组的单侧术中诊断时间分别为（4.5±1.4）min和（6.7±3.5）min，差异有统计学意义（t=6.85，P=0.001）；3D腹腔镜组和普通腹腔镜组的单侧手术时间分别为（13.2±1.4）min和（15.5±3.4）min，差异有统计学意义（t=7.31，P=0.001）；3D腹腔镜组和普通腹腔镜组的双侧术中诊断时间分别为（5.7±2.1）min和（8.8±5.2）min，差异有统计学意义（t=4.42，P=0.001）；3D腹腔镜组和普通腹腔镜组的双侧手术时间分别为（20.4±2.1）min和（23.5±4.4）min，差异有统计学意义（t=4.97，P=0.001）；3D腹腔镜组术后有16例出现并发症，普通腹腔镜组术后9例出现并发症，差异无统计学意义（χ2=0.09，P=0.76）。术后复诊和电话随访6个月，3D腹腔镜组有4例复发，普通腹腔镜组有2例复发，差异无统计学意义（χ2=0.05，P=0.83）。术后2周患儿复诊，3D腹腔镜组患儿术后肚脐形状与普通腹腔镜组肚脐形状基本无差异。结论 3D高清腹腔镜具有三维直视、分辨率高的优点，使疝针跨过输精管变得简单易学，二者在小儿腹股沟斜疝手术治疗中有显著优势。
- Abstract:
- Objective To explore the therapeutic feasibility of three-dimensional (3D) high-definition (HD) laparoscopy and examine the application of water injection in high ligation of hernial sac in children with indirect inguinal hernia.Methods From June 2015 to December 2016,340 cases of children with indirect inguinal hernia or hydrocele were recruited.Two groups were designated as traditional laparoscopic group (n=100,A) and 3D laparoscopic group (n=240,B).In group A,the average age was 3.3 years and there was a history of incarceration in 23 cases.The involved side was unilateral (n=67) and bilateral (n=33); In group B,the average age was 3.5 years and there was a history of incarceration in 50 cases.The involved side was unilateral (n=165) and bilateral (n=75).No inter-group difference existed in preoperative general profiles.Results For groups Band A,unilateral intraoperative diagnostic time was (4.5±1.4) and (6.7±3.5)min.And the difference was statistically significant (t=6.85,P=0.001); Unilateral operative duration was (13.2±1.4) and (15.5±3.4) min.And the difference was statistically significant (t=7.31,P=0.001); Bilateral intraoperative diagnostic time was (5.7±2.1) and (8.8±5.2)min.And the difference was statistically significant (t=4.42,P=0.001); Bilateral operative duration was (20.4±2.1) and (23.5±4.4) min.And the difference was statistically significant (t=4.97,P=0.001); The number of complications was 16 versus 9.And the difference was not statistically significant (χ2=0.09,P=0.76); During postoperative re-examinations and 6-month telephone follow-ups,the number of recurrence was 4 versus 2.And the difference was not statistically significant (χ2=0.05,P=0.83); At 2-week re-examinations,umbillical morphology was basically similar.Conclusion 3D HD laparoscopy offers the advantages of three-dimensional vision and high resolution.Injection of hernia needle across vas deferens becomes simple and easy to learn.Both may be widely applied during pediatric inguinal hernia surgery.
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备注/Memo
收稿日期:2017-08-29。
基金项目:山东省医药卫生科技发展计划项目（编号：2014WS0179）
通讯作者:鹿洪亭,Email:luhongting@126.com