[1]杨周健 向波① 刘钧** 唐青松 杨健 陈曹婧 蒲永斌 宋鹏.新生儿腹股沟嵌顿疝的诊治分析[J].中国微创外科杂志,2020,01(4):345-348.
　Yang Zhoujian*,Xiang Bo,Liu Jun*,et al.Analysis of Diagnosis and Surgical Therapy of Incarcerated Inguinal Hernia in Newborns[J].Chinese Journal of Minimally Invasive Surgery,2020,01(4):345-348.
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新生儿腹股沟嵌顿疝的诊治分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年4期
页码:
345-348
栏目:
临床研究
出版日期:
2020-04-25

文章信息/Info

Title:
Analysis of Diagnosis and Surgical Therapy of Incarcerated Inguinal Hernia in Newborns
作者:
杨周健 向波① 刘钧** 唐青松 杨健 陈曹婧 蒲永斌 宋鹏
(绵阳市中心医院小儿外科，绵阳621000)
Author(s):
Yang Zhoujian*;  Xiang Bo;  Liu Jun*;  et al.
*Department of Pediatric Surgery, Mianyang Central Hospital, Mianyang 621000, China
关键词:
腹腔镜; 腹股沟斜疝; 新生儿; 嵌顿疝
Keywords:
Laparoscopy; Inguinal hernia; Newborn; Incarcerated hernia
文献标志码:
A
摘要:
目的总结新生儿腹股沟嵌顿疝的诊治经验。方法2012年7月~2019年3月我院共收治32例新生儿腹股沟斜疝嵌顿，均完善腹壁疝彩超，彩超提示疝内容物存在血供可试行手法复位(复位成功后家属选择手术时间)，复位失败安排急诊手术，彩超提示疝内容物无血流信号安排急诊手术。结果手法复位成功8例，择期完成手术。余24例手法复位失败急诊手术，其中10例采用开放手术，14例采用腹腔镜手术。24例术中见嵌顿内容物14例为小肠，2例为盲肠，2例为大网膜，6例为卵巢；睾丸坏死4例，卵巢坏死1例，肠坏死5例。术后切口感染3例，经换药处理后痊愈出院。32例随访2个月~6年10个月，中位随访时间2年11个月，无复发、鞘膜积液及睾丸萎缩发生，开放手术患儿发生医源性隐睾1例，2例对侧异时疝，均再次手术。结论新生儿腹股沟斜疝消化道症状常见，全面查体及彩超检查非常重要。一经诊断应及时手术治疗，以避免嵌顿所导致的严重并发症。术式首选腹腔镜下腹膜外疝囊高位结扎术。
Abstract:
ObjectiveTo summarize the experiences in diagnosis and treatment of incarcerated indirect inguinal hernia in newborn.MethodsThe clinical data were retrospectively analyzed for 32 newborn patients with incarcerated indirect inguinal hernia from July 2012 to March 2019. All the patients were given color Doppler ultrasound examination. If the ultrasonography showed the hernia contents presented blood flow signal, manual reduction was initially performed (After the success of the reduction, the family decided the surgical time). When reduction was ineffective, an emergency procedure was performed. If hernia contents had no blood flow signal, an emergency procedure was performed.ResultsThe manipulative reduction was successfully completed in 8 cases, who underwent selective operations. The other 24 cases underwent emergency surgical treatment, including 10 open repair and 14 laparoscopic procedures. The hernia contents included bowel in 14 cases, cecum in 2 cases, omentum in 2 cases, and ovary in 6 cases. There were 4 cases with necrosis of testes, 1 case with necrosis of ovary, and 5 cases with necrosis of bowels. There were 3 cases of postoperative wound infection, which were cured and discharged after the treatment with drug dressing. Followups lasted for two months to six years and ten months (median, 35 months) in 32 cases. No recurrence or testis atrophy or hydrocel occurred, except one suffered from iatrogenic cryptorchidism and two metachronous inguinal hernia in the open surgery group. ConclusionsGastrointestinal symptom is common in newborn with incarcerated hernia. Comprehensive physical examination and ultrasonography are essential for these patients who should be operated in time, and thereby avoiding severe complications. Laparoscopic extraperitoneal surgery is preferred.

参考文献/References:

[1]杨周健,刘钧,向波,等.开放手术与腹腔镜下手术治疗新生儿嵌顿性腹股沟斜疝的临床疗效比较.中国内镜杂志,2019,25(9):70-74.
[2]Gulack BC, Greenberg R, Clark RH, et al. A multiinstitution analysis of predictors of timing of inguinal hernia repair among premature infants. J Pediatr Surg,2018,53(4):784-788.
[3]Ozdamar MY, Karakus OZ. Testicular ischemia caused by incarcerated inguinal hernia in infants: Incidence, conservative treatment procedure, and followup.Urol J,2017,14(4):4030-4033.
[4]Koppen IJ, Bakx R, Oomen MW, et al. Inguinal hernia in children: examine thoroughly, treat rapidly. Ned Tijdschr Geneeskd,2014,158:A7130.
[5]Pini PA, Rossi V, Mosconi M, et al. Inguinal hernia in neonates and expreterm: complications, timing and need for routine contralateral exploration. Pediatr Surg Int,2015,31(2):131-136.
[6]Ezomike UO, Ekenze SO, Amah CC. Irreducible inguinal hernias in the paediatric age group. Niger J Med,2013,22(3):230-233.
[7]张金哲，陈晋杰,主编.小儿门诊外科学.第3版.北京：人民卫生出版社,2008.299-303.
[8]Erdogan D, Karaman I, Aslan MK, et al. Analysis of 3776 pediatric inguinal hernia and hydrocele cases in a tertiary center. J Pediatr Surg,2013,48(8):1767-1772.
[9]向东洲,汪羽,卢宗耀,等.腹腔镜治疗新生儿嵌顿性腹股沟疝：附8例报告.中国微创外科杂志,2018,18(5):466-468.
[10]Rafailidis V, Varelas S, Apostolopoulou F, et al. Nonobliteration of the processus vaginalis: sonography of related abnormalities in children. J Ultrasound Med,2016, 35(4):805-818.
[11]杨林,向慧娟,周佩.超声对腹股沟疝的鉴别分型诊断与其病因学关系的研究.临床超声医学杂志,2012,14(4):260-262.
[12]Youn JK, Kim HY, Huh YJ, et al. Inguinal hernia in preterms in neonatal intensive care units: Optimal timing of herniorrhaphy and necessity of contralateral exploration in unilateral presentation. J Pediatr Surg,2018,53(11):2155-2159.
[13]Duggan EM, Patel VP, Blakely ML. Inguinal hernia repair in premature infants: more questions than answers. Arch Dis Child Fetal Neonatal Ed,2015,1009(4):F286-F288.
[14]Abdulhai S, Glenn IC, Ponsky TA. Inguinal hernia. Clin Perinatol,2017,44(4):865-877.
[15]中华医学会小儿外科学分会内镜外科学组.小儿腹股沟疝腹腔镜手术操作指南(2017 版)(上篇).中华疝和腹壁外科杂志(电子版)，2018,12(1):1-5.
[16]Geiger S, Bobylev A, Schdelin S, et al. Singlecenter, retrospective study of the outcome of laparoscopic inguinal herniorrhaphy in children. Medicine (Baltimore), 2017,96(52): e9486.
[17]Koivusalo AI. A review of the incidence, manifestation, predisposing factors, and management of recurrent pediatric inguinal hernia.Eur J Pediatr Surg,2017,27(6):478-483.
[18]Verhelst J, de Goede B, van Kempen BJ, et al. Emergency repair of inguinal hernia in the premature infant is associated with high direct medical costs. Hernia,2016,20(4):571-577.
[19]Shibuya S, Miyazaki E, Miyano G, et al. Comparison of laparoscopic percutaneous extraperitoneal closure versus conventional herniotomy in extremely low birth weight infants. Pediatr Surg Int,2019, 35(1):145-150.
[20]杨周健, 刘钧, 唐青松,等.腹腔镜手术治疗新生儿腹股沟斜疝的临床疗效分析.腹腔镜外科杂志,2018,23(8):67-70.
[21]Yoshimaru K, Kinoshita Y, Shono T. The safety and efficacy of laparoscopic percutaneous extraperitoneal closure for inguinal hernia in neonates and infants younger than 1 year of age in comparison to older patients. J Laparoendosc Adv Surg Tech A,2017,27(1): 91-96.
[22]Esposito C, Escolino M, Cortese G, et al. Twentyyear experience with laparoscopic inguinal hernia repair in infants and children: considerations and results on 1833 hernia repairs. Surg Endosc,2017,31(3):1461-1468.
[23]王敏, 朱海涛, 沈淳,等.新生儿嵌顿性腹股沟斜疝肠切除高危因素分析.中华小儿外科杂志,2016,37(3):206-210.
[24]马同胜,刘丰丽,曾战东,等.腹腔镜与传统手术治疗新生儿嵌顿性腹股沟斜疝的比较.中国微创外科杂志,2018,18(2):124-126.

备注/Memo

备注/Memo:
基金项目：绵阳市中心医院院级课题项目（2019YJ15）**通讯作者，Email:yniver@yeah.net ①(四川大学华西医院小儿外科，成都610041)
更新日期/Last Update: 2020-07-14