[1]莫智峰,何汉忠,张焯荣,等.腹腔镜下个体化处置疝囊治疗小儿腹股沟斜疝的应用体会[J].临床小儿外科杂志,2020,19(12):1130-1134.[doi:10.3969/j.issn.1671-6353.2020.12.013]
　Mo Zhifeng,He Hanzhong,Zhang Zhuorong,et al.Application of individualized laparoscopy for oblique inguinal hernia based upon the classification of internal ring in children[J].Journal of Clinical Pediatric Surgery,2020,19(12):1130-1134.[doi:10.3969/j.issn.1671-6353.2020.12.013]
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腹腔镜下个体化处置疝囊治疗小儿腹股沟斜疝的应用体会

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第19卷 期数: 2020年12期 页码: 1130-1134 栏目: 论著 出版日期: 2020-12-15
Title:
Application of individualized laparoscopy for oblique inguinal hernia based upon the classification of internal ring in children
作者:
莫智峰1; 2;  何汉忠3;  张焯荣3;  余家康1; 3
1. 广州医科大学(广东省广州市, 510000);
2. 中山大学附属第七医院急诊与灾难医学中心(广东省深圳市, 518000);
3. 广州市妇女儿童医疗中心小儿外科(广东省广州市, 510000)
Author(s):
Mo Zhifeng1; 2;  He Hanzhong3;  Zhang Zhuorong3;  Yu Jiakang1; 3
1. Guangzhou Medical University, Guangzhou 510000, China;
2. Emergency and Disaster Medical Center, Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen 518000, China;
3. Department of Pediatric Surgery, Municipal Women & Children’s Medical
关键词:
疝; 腹股沟/外科学; 疝; 腹股沟/先天性; 腹腔镜检查; 治疗结果
Keywords:
Hernia;  Inguinal/SU; Hernia;  Inguinal/CN; Laparoscopy; Treatment Outcome
分类号:
R615;R656.2+1
DOI:
10.3969/j.issn.1671-6353.2020.12.013
摘要:
目的 探讨在腹腔镜下根据疝内环口的分型个体化处置疝囊治疗小儿腹股沟斜疝的临床应用价值。方法 回顾分析2015年4月至2018年4月由中山大学附属第七医院收治的1 021例腹股沟斜疝患者临床资料，其中641例根据疝内环口分型在腹腔镜下选择不同手术方式（单纯内环结扎术、双重内环结扎术、双重高位结扎加缝脐内侧韧带）进行手术的患者为研究组，其余380例行腹腔镜下内环口双重结扎术的患者为对照组；对比两组患者手术时间、术后并发症和术后复发情况。结果 两组患者均顺利完成手术。两组患者手术时间、术后并发症发生率差异无统计学意义（P>0.05）；但是经过术后1年随访观察，发现对照组有6例复发，而研究组只有1例复发。两组复发率有统计学差异（P<0.05）。结论 腹腔镜下根据患者内环口的分型个体化处置疝囊治疗小儿腹股沟斜疝，可以提高治疗效果，降低复发率。
Abstract:
Objective To explore the clinical value of laparoscopy of indirect inguinal hernia based upon the classification of internal ring in children.Methods For this retrospective and observational study,1021 children of indirect inguinal hernia in treatment group underwent pediatric surgery from April 2015 to April 2018 while another 380 children in control group had double laparoscopic high ligation of inguinal hernia sac.And 641 children in study group underwent laparoscopy (simple internal ring ligation,double internal ring ligation & double high ligation plus medial umbilical ligament) based upon the classification of internal ring.Operative duration,postoperative complications and recurrence rate were compared between two groups.Results Results All procedures were completed successfully.No significant inter-group difference existed in operative duration or postoperative complications (P>0.05).However,after 1-year follow-up,recurrence occurred in control group (n=6) and study group(n=1).Recurrent rate had inter-group statistical significance (P<0.05).Conclusion Based upon the classification of internal ring,laparoscopy of indirect inguinal hernia improves the operative outcomes and lowers the recurrent rate in children.

参考文献/References:

1 费川,张永婷,刘雪来,等.单孔腹腔镜腹膜外结扎术治疗小儿腹股沟疝相关并发症分析[J].临床小儿外科杂志,2016,15(4):328-331.DOI:10.3969/j.issn.1671-6353.2016.04.005. Fei C,Zhang YT,Liu XL,et al.Related complications of single-port laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia[J].J Clin Ped Sur,2016,15(4):328-331.DOI:10.3969/j.issn.1671-6353.2016.04.005.
2 刘洁,段光琦,王啸,等.单孔腹腔镜下特制疝针治疗儿童腹股沟斜疝的问题及处理[J].临床小儿外科杂志,2015,14(3):226-228.DOI:10.3969/j.issn.1671-6353.2015.03.018. Liu J,Duan GQ,Wang X,et al.Adverse factors and coping skills of laparoscopic percutaneous extraperitoneal closure for 196 cases of pediatric inguinal hernia[J].J Clin Ped Sur,2015,14(3):226-228.DOI:10.3969/j.issn.1671-6353.2015.03.018.
3 中华医学会小儿外科学分会内镜外科学组.小儿腹股沟疝腹腔镜手术操作指南(2017版)(上篇)[J].中华疝和腹壁外科杂志(电子版),2018,12(1):1-5.DOI:10.3877/cma.j.issn.1674-392X.2018.01.001. Endoscopic Surgery Group,Pediatric Surgery Branch,Chinese Medical Association.Guidelines of Laparoscopic Handling for Inguinal Hernia in Children (2017 Edition) (Section I)[J].Chin J Hernia Abdominal Wall Surg (Electronic Edition),2018,12(1):1-5.DOI:10.3877/cma.j.issn.1674-392X.2018.01.001.
4 中华医学会小儿外科学分会内镜外科学组.小儿腹股沟疝腹腔镜手术操作指南(2017版)(下篇)[J].中华疝和腹壁外科杂志(电子版),2018,12(2):81-85.DOI:10.3877/cma.j.issn.1674-392X.2018.02.001. Endoscopic Surgery Group,Pediatric Surgery Branch,Chinese Medical Association.Guidelines for Laparoscopic Handling for Inguinal Hernia in Children (2017 Edition) (Section II)[J].Chin J Hernia Abdominal Wall Surg (Electronic Edition),2018,12(2):81-85.DOI:10.3877/cma.j.issn.1674-392X.2018.02.001.
5 Shalaby R,Elsaied A,Shehata S,et al.Needlescopic assisted internal ring suturing;a novel application of low-cost home-made instruments for pediatric inguinal hernia repair[J].Hernia,2019,23(6):1279-1289.DOI:10.1007/s10029-019-01982-0.
6 Shalaby R,Ismail M,Gouda S,et al.Laparoscopic management of recurrent inguinal hernia in childhood[J].J Pediatr Surg,2015,50(11):1903-1908.DOI:10.1016/j.jpedsurg.2015.07.015.
7 Shalaby R,Ismail M,Samaha A,et al.Laparoscopic inguinal hernia repair;experience with 874 children[J].J Pediatr Surg,2014,49(3):460-464.DOI.10.1016/j.jpedsurg.2013.10.019.
8 Esposito C,Escolino M,Cortese G,et al.Twenty-year experience with laparoscopic inguinal hernia repair in infants and children:considerations and results on [1833] hernia repairs[J].Surg Endosc,2017,31(3):1461-1468.DOI:10.1007/s00464-016-5139-8.
9 Esposito C,Alicchio F,Giurin I,et al.Technical Standardization of Laparoscopic Direct Hernia Repair in Pediatric Patients[J].J Laparoendosc Adv Surg Tech A,2012,22(1):113-116.DOI.10.1089/lap.2011.0324.
10 Chan IH,Tam PK.Laparoscopic inguinal hernia repair in infants and children:state-of-the-art technique[J].Eur J Pediatr Surg,2017,27(6):465-471.DOI:10.1055/s-0037-1608685.
11 Dunckley M,Mahomed A.Re:Choi et al.(2012) Ped Surg Int 28:1165-1169:outcomes following laparoscopic inguinal hernia repair in infants compared with older children[J].Pediatr Surg Int,2013,29(7):761.DOI:10.1007/s00383-013-3300-1.
12 陈开运,向国安,王汉宁,等.腹腔镜疝囊高位结扎联合脐正中襞覆盖内环治疗小儿腹股沟斜疝[J].中华外科杂志,2007,45(3):207-209.DOI:10.3760/j:issn:0529-5815.2007.03.021. Chen KY,Xiang GA,Wang HN,et al.Laparoscopic high ligation of hernia sac plus median umbilical fold covering internal ring for indirect inguinal hernia in children[J].Chin J Surg,2007,45(3):207-209.DOI:10.3760/j:issn:0529-5815.2007.03.021.
13 王保国,黄河.腹腔镜疝囊高位结扎联合脐内侧襞覆盖内环口治疗小儿腹股沟疝172例[J].中国医刊,2012,47(8):77-78.DOI:10.3969/j.issn.1008-1070.2012.08.034. Wang BG,Huang H.Laparoscopic high ligation of hernial sac plus medial umbilical fold covering internal ring opening for inguinal hernia:a report of 172 children[J].Chinese Journal of Medicine,2012,47(8):77-78.DOI:10.3969/j.issn.1008-1070.2012.08.034.
14 Shalaby R,Elsaied A,Shehata S,et al.Needlescopic assisted internal ring suturing;a novel application of low-cost home-made instruments for pediatric inguinal hernia repair[J].Hernia,2019,23(6):1279-1289.DOI:10.1007/s10029-019-01982-0.
15 Mo ZF,Yan LB,Zhang W,et al.Effects of early enteral nutrition on gastrointestinal function recovery and nutritional status after gastrointestinal surgery in children[J].Dig Med Res,2019,2:14.DOI:10.21037/dmr.2019.07.04.

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备注/Memo

收稿日期:2019-08-08。
通讯作者:余家康,Email:853594394@qq.com

更新日期/Last Update: 1900-01-01