評(píng)價(jià)傳統(tǒng)手術(shù)與微創(chuàng)手術(shù)治療小兒疝氣的臨床價(jià)值

魏勇551500貴州省黔西育才醫(yī)院

評(píng)價(jià)傳統(tǒng)手術(shù)與微創(chuàng)手術(shù)治療小兒疝氣的臨床價(jià)值

魏勇
551500貴州省黔西育才醫(yī)院

目的：評(píng)價(jià)傳統(tǒng)手術(shù)與微創(chuàng)手術(shù)治療小兒疝氣的臨床價(jià)值。方法：2013年1-12月收治小兒疝氣患者50例，將其隨機(jī)分為觀察組與對(duì)照組，各25例。觀察組給予微創(chuàng)手術(shù)法治療；對(duì)照組給予傳統(tǒng)手術(shù)法治療，比較兩組患者的臨床效果。結(jié)果：兩組患者均得到有效的治療，并順利出院。但相比而言，觀察組具有手術(shù)時(shí)間短、術(shù)中出血量小、術(shù)后恢復(fù)快等臨床特點(diǎn)，與對(duì)照組比較差異顯著，結(jié)果具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論：微創(chuàng)手術(shù)法治療小兒疝氣安全性較高，創(chuàng)傷較小，術(shù)后易恢復(fù)，值得在臨床上廣泛推廣，以幫助更多患者受益。

傳統(tǒng)手術(shù)；微創(chuàng)手術(shù)；小兒疝氣；臨床價(jià)值

小兒疝氣是普外科最為常見(jiàn)的一類疾病，疝氣可影響患者的生殖器官發(fā)育及其他臟器功能。但隨著醫(yī)學(xué)技術(shù)的不斷發(fā)展，小兒疝氣的治療技術(shù)已發(fā)展得相當(dāng)成熟。以往，臨床上主要以平行腹股溝韌帶斜切口術(shù)對(duì)患者進(jìn)行治療，該種手術(shù)法雖具有較好的治療效果，但其因創(chuàng)口較大，術(shù)中出血量較多等特點(diǎn)，使得患者術(shù)后恢復(fù)較慢。近年來(lái)，微創(chuàng)手術(shù)法治療小兒疝氣在臨床上獲得了較為廣泛的應(yīng)用，微創(chuàng)手術(shù)法不僅降低了手術(shù)的創(chuàng)傷，同時(shí)可促進(jìn)患者康復(fù)[1]。在此次調(diào)查中，我院對(duì)傳統(tǒng)手術(shù)與微創(chuàng)手術(shù)治療小兒疝氣的臨床效果進(jìn)行比較，具體情況如下。

資料與方法

2013年1-12月收治小兒疝氣患者50例，將其隨機(jī)分為觀察組與對(duì)照組，各25例。觀察組男22例，女3例，年齡3～8歲，平均(6.0±1.2)歲；對(duì)照組男21例，女4例，年齡2～10歲，平均(7.3±1.3)歲。兩組患者中，斜疝34例，直疝16例。兩組患者在一般臨床資料上差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)，具有可比性。

方法：①觀察組以微創(chuàng)手術(shù)法進(jìn)行治療。具體步驟：患者取仰臥位，以氯胺酮進(jìn)行處理。使患者雙腿微曲并分開(kāi)。于恥骨結(jié)節(jié)外側(cè)、外環(huán)口體表投影處作1 cm左右的手術(shù)切口，切開(kāi)皮膚時(shí)需注意不要切至皮下組織，避免增加出血量。顯露腹外斜肌腱膜，牽拉皮下組織，并顯露腹股溝管外環(huán)。手術(shù)刀順著纖維走向作切口，至顯露精索。因幼兒腹膜溝管較短，因此可不打開(kāi)外環(huán)，同時(shí)注意避免傷及髂腹下與髂腹股溝神經(jīng)。鈍性分離提睪肌，通過(guò)剪刀將精索前內(nèi)方的白色膜狀物剪開(kāi)，提起疝囊后將其切開(kāi)，并可見(jiàn)少量清亮液體流出。若小疝囊未進(jìn)入陰囊，將其提起后可直接將其鈍性剝離。若疝囊進(jìn)入陰囊，可在外環(huán)口處將其離斷。因疝環(huán)較狹窄，因此可在內(nèi)環(huán)處對(duì)其進(jìn)行高位貫穿縫合結(jié)扎。將多余的疝囊剪除，結(jié)扎端自動(dòng)縮入內(nèi)環(huán)深處。以3-0絲線逐層縫合內(nèi)部切口，將睪丸重新復(fù)位至陰囊底部，在止血后對(duì)其皮下及皮膚切口進(jìn)行縫合[2]。②對(duì)照組以傳統(tǒng)手術(shù)法進(jìn)行治療，于患側(cè)腹直肌外緣下腹皮橫紋處作＞2.5 cm的手術(shù)切口，其他操作基本同觀察組。

觀察指標(biāo)：對(duì)兩組患者的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后住院時(shí)間及并發(fā)癥發(fā)生率等指標(biāo)進(jìn)行觀察比較。

統(tǒng)計(jì)學(xué)處理：以SPSS 18.0統(tǒng)計(jì)學(xué)軟件對(duì)所得數(shù)據(jù)進(jìn)行分析處理，組間以t檢驗(yàn)作為計(jì)數(shù)資料，以χ2檢驗(yàn)作為計(jì)量資料，P＜0.05時(shí)差異具有統(tǒng)計(jì)意義。

結(jié)果

手術(shù)觀察指標(biāo)比較：觀察組的手術(shù)時(shí)間、術(shù)中出血量及住院時(shí)間3項(xiàng)觀察指標(biāo)均明顯短于(少于)對(duì)照組，組間差異具有統(tǒng)計(jì)意義(P＜0.05)，見(jiàn)表1。

術(shù)后并發(fā)癥發(fā)生情況比較：觀察組陰囊腫脹2例，并發(fā)癥發(fā)生率8%；對(duì)照組陰囊腫脹5例，腹脹2例，復(fù)發(fā)2例，并發(fā)癥發(fā)生率36%。兩組數(shù)據(jù)差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。

Evaluation on the clinical value of traditional operation and minimally invasive operation in the treatment of infantile hernia

Wei Yong
Yucai Hospital of Qianxi County,Guizhou Province 551500

Objective:To evaluate the clinical value of traditional operation and minimally invasive operation in the treatment of infantile hernia.Methods:50 patients with infantile hernia were selected from Jaunary to December of 2013,they were randomly divided into the observation group and the control group with 25 cases in each.Patients in the observation group were received the minimally invasive operation;while in the control group were received traditional operation therapy,then we compared the clinical effect of patients between the two groups.Results:Patients in the two were treated effectively and discharged smoothly.However, compared with the control group,operation time of the patients in the observation group were shorter,and the intraoperative bleeding volume was smaller,in addation,the postoperative recovery was faster and other clinical features significantly different, and the differences were statistically significant between two groups(P＜0.05).Conclusion:Minimally invasive operation has high safety in the treatment of infantile colic,and also less trauma,postoperative recovery is easy,so it is worthy of widely spread in the clinical,in order to benefit for more patients.

Traditional operation;Minimally invasive operation;Infantile hernia;Clinical value

10.3969/j.issn.1007-614x.2015.8.29