自制水分离疝针在腹腔镜鞘状突高位结扎术中的应用

Application of Self-made Water Separation Hernia Needle in Laparoscopic High Ligation of Processus Vaginalis

目的探讨自制水分离疝针腹腔镜鞘状突高位结扎术的疗效。方法2018年4月~2019年4月我院行腹腔镜鞘状突高位结扎术121例,其中59例行腹腔镜一步穿刺法自制疝针鞘状突结扎术(观察组),62例行腹腔镜传统两步穿刺法鞘状突结扎术(对照组),对比2组患者手术时间、术中出血量、术后住院时间、复发及并发症发生情况。结果所有手术均获成功。与对照组相比,观察组中位手术时间更短[8(6,9)min vs.12(11,13)min,Z=-7.319,P=0.000],中位术中出血量更少[1(1,2)ml vs.2(1,2)ml,Z=-4.656,P=0.000]。2组中位术后住院时间分别为1(1,1)、1(1,1)d,差异无统计学意义(Z=-0.436,P=0.663)。2组并发症分别为1、3例,差异无统计学意义(χ^2=0.210,P=0.647)。除观察组1例(术后第1天B超复查鞘膜囊仍有明显积液)随访12个月外,余120例患儿术后随访6个月,所有患儿均无复发。结论自制水分离疝针腹腔镜鞘状突高位结扎术具有单次腹壁穿刺、注水分离腹膜的优点,安全有效,基层医院均可开展,值得推广。

Objective To explore the therapeutic effect of laparoscopic high ligation of processus vaginalis with self-made water separation hernia needle.Methods From April 2018 to April 2019,121 cases of laparoscopic high ligation of processus vaginalis were performed in our hospital.Among them,59 cases underwent laparoscopic ligation of processus vaginalis by a single step puncture with self-made hernia needle(observation group),and 62 cases underwent traditional laparoscopic ligation of processus vaginalis by two-step puncture(control group).The operative time,intraoperative blood loss,postoperative hospital stay,recurrence and complications were compared between the two groups.Results All operations were successful.Compared with the control group,the median operative time in the observation group was shorter[8(6,9)min vs.12(11,13)min,Z=-7.319,P=0.000],and the median intraoperative blood loss was less[1(1,2)ml vs.2(1,2)ml,Z=-4.656,P=0.000].The median postoperative hospital stay in the two groups was 1(1,1)and 1(1,1)d,respectively,with no significant difference(Z=-0.436,P=0.663).There was 1 complication in each group,and the difference was not significant(χ^2=0.210,P=0.647).In the observation group,1 case was followed up for 12 months,and the remaining 120 cases were followed up for 6 months after surgery.None of the children had recurrence.Conclusions Laparoscopic high ligation of processus vaginalis with self-made water separation hernia needle has features of single abdominal wall puncture and separation of peritoneum by water injection.It is safe and effective,and can be carried out in primary hospitals.It is worthy of promotion.