小儿腹股沟嵌顿疝手法复位后的并发症及处理

Complications and treatment of children's incarcerated inguinal hernia after manual reduction

目的总结小儿腹股沟嵌顿疝手法复位后并发症的诊治经验。方法回顾性分析2012-01—2013-12间收治的15例手法复位后出现并发症的腹股沟嵌顿疝患儿的临床资料。结果 15例均住院接受了开腹手术治疗。术中发现:3例为假性复位,切开疝囊松解并复位肠管。12例为消化道穿孔,其中5例腹腔污染重而行肠造瘘术,术后3～6个月行闭瘘术,1例闭瘘术后1个月因粘连性肠梗阻再一次手术松解肠粘连;7例腹腔污染较轻,家长拒绝造瘘,一期行肠穿孔修补术。1例穿孔修补术后2周因发现嵌顿疝对侧腹股沟出现斜疝,而行疝囊高位结扎术。其余患儿均恢复顺利。术后随访1～23个月,未再出现其他不适。结论严格掌握小儿腹股沟嵌顿疝手法复位的适应证、禁忌证,选取正确的操作手法。手法复位后需密切观察病情变化,以便能及时发现并发症并选取适当的治疗方法,最大限度降低患儿不必要的痛苦。

Objective To summarize the clinical experience of complications and treatment of children with incarcerated inguinal hernia after manual reduction. Methods A retrospective analysis of 16 cases of incarcerated inguinal hernia with complications after manual reduction admitted was treated from 2012 to 2013. The corresponding literature was reviewed. Results All of 15 cases were cured by surgical treatment after admission. 3 cases were pseudo reset and 12 cases were gastrointestinal perforation by intraoperative findings. 3 cases of the pseudo reset were released intestinal reattachment surgery. 5 cases of the gastrointestinal perforation were accepted enterostomy due to abdominal heavy pollution,but 7 cases of them were implemented intestinal perforation repair because of peritoneal lighter contamination and parents refused fistula. Do intestinal fistula closure surgery from 3 to 6 months after enterostomy. One case who accepted intestinal fistula closure after one month was implemented enterolysis due to intestinal obstruction, the other case who done intestinal perforation repair after two weeks was accepted sac ligation because of occurred contralateral inguinal hernia. The remaining patients were successfully restored after operation. By followed up 1 to 23 months, did not recur other abnormal discomfort. Conclusion Should strictly controlled the indications, contraindications, and correct way of manual reduction of children with incarcerated inguinal hernia. Close observation of changes after reset,in order to detect complications and take appropriate treatment to minimize children unwanted pain.