腹腔镜手术治疗小儿腹股沟疝的并发症分析

Analysis of complications and its prevention of laparoscopic treatment of inguinal hernia in children

目的探讨腹腔镜手术治疗小儿腹股沟疝的术后并发症及防治对策。方法回顾性分析2015年1月至2019年1月于武汉科技大学附属孝感医院收治的1040例小儿腹股沟疝患者资料。所有患儿均在全身麻醉下采用疝钩针行腹腔镜下疝囊高位结扎术,术后门诊及电话随访患儿术后并发症,总结分析并提出防治策略。结果所有患儿腹腔镜手术均成功完成。术后腹股沟区皮下硬结23例,予以观察后好转。5例并发鞘膜积液,其中3例行穿刺抽吸观察后吸收,2例穿刺抽吸无效后再次手术;3例术后复发,再次手术。线头反应3例,其中2例线头排出后恢复,1例线头排出后复发,再次手术。脐部出血2例,其中1例压迫后缓解,1例压迫无效行切口缝合止血。脐部网膜脱出2例,行脱出网膜切除脐部缝合。手术并发症多发生在早期开展病例中,通过改进手术方式及细节,后期并发症减少。结论腹腔镜治疗小儿腹股沟疝的术后并发症以皮下硬结、术后鞘膜积液及脐部穿刺处并发症较多,通过改进手术方式及细节,均可避免。

Objective To investigate the complications and its prevention of laparoscopic surgery in the treatment of inguinal hernia in children.Methods From January 2015 to January 2019,1040 children with inguinal hernia were admitted to Xiaogan Hospital,which is affiliated with Wuhan University of Science and Technology.All children underwent laparoscopic high ligation of the hernia sac under general anesthesia with a hernia hook needle.Postoperative outpatient and telephone follow-up of the children were followed up for postoperative complications,and the prevention and treatment strategies were summarized and analyzed.Results Laparoscopic surgery was successfully completed in all children.Among the complications,23 cases were indurated under the skin of the inguinal region;5 cases were complicated with hydrocele after operation,3 cases were absorbed after pumping the liquid,2 cases were operated again after ineffective pumping;3 cases had recurrence and reoperation again;3 cases were treated with line head reaction,2 cases recovered after line head excretion,1 case was reoperation again;2 cases were treated with umbilical hemorrhage,1 case was relieved after compression,1 case was sutured with incision suture to stop bleeding;2 cases were treated with prolapse of omentum in the umbilical,and 2 cases were sutured with removal of omentum.Surgical complications mostly occur in early-stage cases,and later complications can be reduced by improving surgical methods and details.Conclusion Subcutaneous induration,postoperative hydrocele,and umbilical puncture are more common postoperative complications of laparoscopic treatment of inguinal hernia in children,which can be avoided by improving surgical methods and details.