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目的:探讨腹腔镜下鞘状突环扎治疗小儿鞘膜积液的临床疗效。方法:总结我院2009年12月—2012年12月429例腹腔镜下鞘状突环扎术后的鞘膜积液患儿,年龄(2~12)岁,平均(2.8±0.3)岁。其中左侧191例,右侧220例,双侧18例。腹腔镜直视下用硬膜外穿刺针,带7号丝线穿刺入腹膜外,沿着腹膜外从鞘状突的内侧,跨过输精管及精索血管,环绕半圈穿出腹腔,再从腹壁原穿刺孔带7号双丝线从鞘状突的外侧环绕半圈,从环绕的内侧孔穿出,用双线将尾线带出皮肤外,环扎鞘状突,线结埋于皮下,对侧鞘状突未闭同法环扎。结果:手术时间平均(13±2.9)min,住院时间(2~5)日。随访(6~24)个月,复发2例,无腹腔内脏损伤、出血、感染、阴囊血肿、输精管损伤以及精索血管损伤所引起的睾丸萎缩等并发症。结论:腹腔镜下小儿鞘膜积液腹膜外环扎治疗,具有微创、安全、美容等优点,值得临床推广。
Objective: To investigate the clinical efficacy of laparoscopic sheath ring cerclage treatment of pediatric hydrocele. Methods: From December 2009 to December 2012, 429 children with hydrocele after laparoscopic sheath cerclage surgery were enrolled in this study. Patients (2 to 12 years) with an average of (2.8 ± 0.3) years old were enrolled in this study. There were 191 cases on the left, 220 cases on the right and 18 cases on both sides. Laparoscopic direct use of epidural puncture needle, with No. 7 thread punctured into the peritoneum, along the peritoneal sheath from the medial side of the sheath, across the vas deferens and spermatic vessels, perforated half circle around the abdominal cavity, and then from the abdominal wall The original puncture with double No. 7 double silk line from the sheath around the outer half circle, pierced from the inside of the hole around with a two-wire to the tail out of the skin, loop the sheath-like process, the knot buried in the subcutaneous, right Side sheath herniation with the same method of cerclage. Results: The average operation time (13 ± 2.9) min, hospital stay (2 ~ 5) days. Follow-up (6-24 months), relapse in 2 cases, no complications of abdominal visceral injury, hemorrhage, infection, scrotal hematoma, vas deferens injury and testicular atrophy caused by spermatic vascular injury. Conclusion: Laparoscopic pediatric hydrocele outside the peritoneal cerclage treatment, with the advantages of minimally invasive, safe, cosmetic, worthy of clinical promotion.