CAJ | 학술논문

目的探讨单孔腹腔镜下改良双钩疝针经皮腹膜外结扎术治疗小儿腹股沟斜疝的价值.方法回顾性分析2008年6月至2011年10月行单孔腹腔镜辅助经皮穿刺腹膜外结扎关闭内环135例腹股沟疝的临床资料.其中,采用自制单钩疝针(单钩疝针组)63例和采用改良双钩疝针(双钩疝针组)72例.对比两种术式的操作要领、手术时间及术中、术后并发症.结果双钩疝针组较单钩疝针组的手术时间在单侧疝[(13.21±3.86) min vs(17.92±4.37) min]和双侧疝[17.18±4.69)min vs(25.36±7.38)min]均明显缩短,且差异有统计学意义(P＜0.05,P＜0.01).所有病儿均于术后1～3 d恢复正常饮食和活动出院,术后住院时间(2.14±0.67)d和(2.22±0.68)d,两组比较差异没有统计学意义(P＞0.05).双钩疝针组未有出现并发症或早期复发,单钩疝针组术后出现1例复发和1例皮下线结反应.结论单孔腹腔镜下改良双钩疝针经皮腹膜外结扎术不用辅助操作戳孔,经腹壁穿刺导入和牵出结扎线可保持在同一路径,不遗留腹膜缝隙及牵涉皮下组织,能够确保腹膜外间隙紧密结扎疝缺损.
목적 탐토단공복강경하개량쌍구산침경피복막외결찰술치료소인복고구사산적개치.방법 회고성분석2008년6월지2011년10월행단공복강경보조경피천자복막외결찰관폐내배135례복고구산적림상자료.기중,채용자제단구산침(단구산침조)63례화채용개량쌍구산침(쌍구산침조)72례.대비량충술식적조작요령、수술시간급술중、술후병발증.결과 쌍구산침조교단구산침조적수술시간재단측산[(13.21±3.86) min vs(17.92±4.37) min]화쌍측산[17.18±4.69)min vs(25.36±7.38)min]균명현축단,차차이유통계학의의(P＜0.05,P＜0.01).소유병인균우술후1～3 d회복정상음식화활동출원,술후주원시간(2.14±0.67)d화(2.22±0.68)d,량조비교차이몰유통계학의의(P＞0.05).쌍구산침조미유출현병발증혹조기복발,단구산침조술후출현1례복발화1례피하선결반응.결론 단공복강경하개량쌍구산침경피복막외결찰술불용보조조작착공,경복벽천자도입화견출결찰선가보지재동일로경,불유류복막봉극급견섭피하조직,능구학보복막외간극긴밀결찰산결손.
Objective To explore the applicable effects of single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC) using a homemade two-hooked core needle for indirect inguinal hernia in children.Methods Retrospective review was conducted to 135 children undertaking SPLPEC procedure using differential techniques between June 2008 and October 2011,in which 63 cases were performed with a homemade one-hooked core needle (one-hooked group),and 72 cases were done with a modified two-hooked core needle (two-hooked group).The operative techniques,operation time,intra-and post-operative complications in two groups were targeted to compare.Results The operation time in two-hooked group was shorter than one-hooked group [unilateral hernia:(13.21 ± 3.86) min vs.(17.92 ± 4.37)min,P＜0.05 ;bilateral hernia:(17.18 ± 4.69) min vs.(25.36 ± 7.38) min,P＜0.01].All the children had normal feedings and activities,and were discharged at 1-3 days after surgery [Two-hooked group vs.one-hooked group =(2.14 ± 0.67) days vs.(2.22 ± 0.68) days,P＞0.05].There were no complications or evidence of early recurrence in the two-hooked group.Hernia recurrence was found in 1 case and subcutaneous ligature abscess was seen in 1 case in one-hooked group.Conclusions Without assistant working port,The SPLPEC using a two hooked needle can help to preserve steadily an identical subcutaneous path in introducing and withdrawing the suture,the extra-peritoneal knot-tying could tautly closed at the hernia defect without residual peritoneal gaps and upper subcutaneous tissues.