目的 探讨改良式肠造口引流装置应用于新生儿肠造瘘手术治疗中的安全性与使用价值.方法 回顾性分析南方医科大学附属东莞市妇幼保健院小儿外科2011年1月至2018年8月收治的45例需行肠造瘘新生儿的临床资料,均采用急诊或亚急诊剖腹探查术进行治疗,术中均实施了暂时性肠造瘘手术,采用随机分配的方法 将45例受试者分为传统组(n＝27)和改良组(n＝18),两组患儿一般临床资料情况对比差异无统计学意义(P＞0.05);改良组术中均在造瘘口的近端采用由包皮环和避孕套组合而成的肠造瘘引流装置,传统组近端造瘘肠管不作处理.对比两组患儿术中出血量、非计划再次手术例数、手术时间、术后住院天数和术后并发症等资料.结果 45例均顺利完成手术.改良组18 例,无一例死亡;传统组27例,其中1例因感染性休克并发多器官功能衰竭死亡;改良组术后并发症发生率低于传统组,差异有统计学意义(P＜0.05).改良组手术时间为(89.50 ±16.73)min,传统组手术时间为(86.07 ±17.27)min,差异无统计学意义(P＞0.05).改良组术后无一例并发症,传统组术后14例出现并发症,差异有统计学意义(P＜0.05).改良组术后住院时间为(19.89 ±4.54)d,传统组术后住院时间为(24.73 ±11.57)d,差异有统计学意义(P＜0.05).改良组非计划再次手术1例,传统组非计划再次手术10例,差异有统计学意义(P＜0.05).结论 改良式肠造口引流装置应用于新生儿肠造瘘手术可有效降低肠造瘘术后的并发症发生率,并且具有操作简单、术后外形美观、护理方便等优点,值得临床推广应用.

目的 观察改良式肠造口引流在新生儿中高位肛门闭锁中的应用效果.方法 23例先天性肛门闭锁患儿分别采用传统肠造口引流方式(对照组,n=12)和改良式肠造口引流方式(观察组,n=11),对比两组手术时间、术中出血量、术后并发症、术后住院时间、护理满意度等指标.结果 观察组的住院时间、术后并发症、护理满意度明显优于对照组(P＜0.05或0.01).结论 改良式肠造口引流可提高中高位肛门闭锁的疗效,缩短住院时间,提高护理满意度.

目的?探讨血液学检测在小儿睾丸扭转和急性附睾睾丸炎鉴别诊断中的应用,并探讨血液学参数在小儿睾丸扭转诊断中的预测价值.方法?本研究回顾性分析了本院2016年1月—2018年12月因阴囊疼痛住院的患儿病例资料.将病例资料分成3组,即睾丸扭转组、急性附睾睾丸炎组和对照组.其中睾丸扭转组11例,均接受手术治疗(切除睾丸或睾丸固定),急性附睾睾丸炎组25例,对照组30例健康儿童.分析比较各组患儿年龄、术前血液检测参数[包括中性粒细胞与淋巴细胞比率(NLR)、单核细胞与嗜酸性粒细胞比率(MER)、血小板与淋巴细胞比率(PLR)等]的差异性.结果?睾丸扭转组与急性附睾睾丸炎组比较中性粒细胞计数、淋巴细胞计数、嗜酸性细胞计数、NLR、MER、PLR差异具有统计学意义(P<0.05),有助于临床鉴别诊断;对照组中的中性粒细胞计数、血小板计数、白细胞计数、NLR、MER和CRP值均低于扭转组,差异具有统计学意义(P<0.05).MER在预测小儿睾丸扭转的敏感性(63.6％)和特异性上(96.7％)与多普勒超声的敏感性(63％～86％)和特异性(97％～100％)相当,且通过ROC曲线对比分析,MER的敏感性(63.6％)要优于NLR(54.5％).结论 MER在预测小儿睾丸扭转的敏感性和特异性上与多普勒超声的敏感性和特异性相当,且敏感性更优于NLR,提示MER在小儿睾丸扭转中具有预测价值.

目的 探讨改良式肠造瘘术在先天性中高位肛门闭锁患儿中的临床应用及其可行性.方法 选取2016年1月-2019年10月在广东省东莞市妇幼保健院接受治疗的11例先天性中高位肛门闭锁的患儿,其中男8例,女3例.所有患儿经查体及辅助检查并根据Krinkenbeck分类确诊为中高位肛门闭锁,一期手术均行本院改良式肠造瘘术,术后监测指标包括术后肠功能恢复、营养以及是否出现肠造瘘并发症(造瘘口回缩、造瘘口突出、伤口感染以及切口疝)等情况.结果 所有患儿均在急诊手术条件下顺利完成本院改良的肠造瘘术,所有患儿术后均未出现术后肠造瘘并发症,并分期实施肛门成型及肠关瘘手术,目前身高和体重均达到正常同龄儿水平.结论 对于先天性中高位肛门闭锁的患儿,采用本院改良的肠造瘘术是安全可行的.

目的 探讨平均血小板体积(MPV)与精索静脉曲张炎症病理过程的相关性,以研究精索静脉曲张的发病机制.方法 选取2013年1月至2019年1月在东莞市妇幼保健院诊治的83例精索静脉曲张患者作为研究对象.将这83例患者设为精索静脉曲张(VC)组.随机挑选健康男性101例设为对照组.比较两组MPV值,以受试者工作曲线(ROC)分析MPV对精索静脉曲张的诊断价值,用Spearman等级相关检验分析MPV在精索静脉曲张中炎症病理过程中的相关性.结果 精索静脉曲张组MPV值高于对照组,两组间差异具有统计学意义(P＜0.05).ROC分析MPV的最佳截断值为9.75 fL.MPV与精索静脉曲张分级以及静脉曲张直径呈正相关.结论 MPV在精索静脉曲张组中的水平高于对照组,并且与曲张静脉的直径以及曲张的分级程度呈正相关趋势,MPV对于精索静脉曲张炎症病理机制的研究具有重要的意义.

小儿胃重复畸形在临床罕见,该文对1例新生儿胃重复畸形进行报道并对相关文献进行复习,加强小儿外科医生对该病的认识,以提高诊治水平,最大程度挽救患儿的生命,提高预后.

目的 探讨复方玄驹胶囊联合腹腔镜精索静脉高位结扎术治疗精索静脉曲张的疗效.方法 选取2013年1月～2017年1月收治的精索静脉曲张不育患者40例,采取随机数字表法分为对照组和观察组各20例,对照组采取单纯腹腔镜精索静脉高位结扎术治疗,观察组在对照组基础上加用复方玄驹胶囊治疗,比较分析两组的疗效.结果 观察组总有效率比对照组更高(P<0.05);治疗后观察组A级精子率、精子密度、精子总活率均比对照组更高,精子畸形率显著低于对照组(P<0.05);治疗后观察组促卵泡激素(FSH)、促黄体素生成激素(LH)及睾酮(T)改善比对照组更明显(P<0.05).结论 临床治疗精索静脉曲张采用复方玄驹胶囊联合腹腔镜精索静脉高危结扎术能有效提高临床治疗效果,促进精子质量明显提升,改善性激素水平,值得推广.

目的 分析腹腔镜睾丸下降固定术在小儿高位隐睾临床治疗中的应用效果及价值.方法 选取本院2014年1月～2018年1月我院收治的小儿高位隐睾患儿30例.将其按照入院顺序进行奇偶排序分为观察组和对照组各15例.观察组接受腹腔镜睾丸下降固定术治疗,对照组接受开放手术睾丸下降固定术治疗.对比两组患儿治疗效果,观察两组患儿手术基本情况、术后并发症发生情况及术前术后疼痛评分(VAS)变化情况.结果 观察组患儿治疗总有效率稍低于对照组,差异无统计学意义(P>0.05).两组患儿术前VAS评分比较,差异无统计学意义(P>0.05),术后VAS评分显著低于术前(P<0.05).观察组患儿手术时间、术中出血量、住院时间均低于对照组,差异有统计学意义(P<0.05);观察组术后总并发症发生率显著低于对照组(P<0.05).结论 小儿高位隐睾患者接受腹腔镜睾丸下降固定术治疗效果显著,在降低患儿疼痛感、缩短患者手术时间的基础上,达到了与传统开放手术同等的效果,并且安全性较高,值得在临床中推广使用.

目的 探讨使用单孔腹腔镜治疗小儿鞘状突畸形的临床效果.方法 124例鞘状突畸形患儿,均使用单孔腹腔镜进行治疗,观察其治疗效果.结果 124例患儿顺利完成手术,1例中转为双孔辅助钳操作下完成,术中发现59例隐匿疝,术中无输精管、精索血管损伤,术后无阴囊血肿、切口感染等并发症发生.麻醉清醒后根据具体情况指导饮食,次日恢复活动.124例均获随访,随访时间3～22个月,平均随访时间14个月,术后无一例睾丸萎缩、医源性隐睾、切口疝、疝复发等发生,3例腹股沟线结炎症反应,经局部处理,6个月后清除线结愈合.结论 单孔腹腔镜在治疗小儿鞘状突畸形临床效果优势明显,值得逐步在临床上推广.

目的 对比瘘口后移肛门成形术及后矢状入路直肠肛门成形术治疗无肛前庭瘘的疗效.方法 回顾总结性分析2010~2016年我院分别采用瘘口后移肛门成形术(26例)和完成23例后矢状入路直肠肛门成形术的临床治疗,通过搜集比较两组术中出血、手术时间、住院天数及术后出现便秘,伤口感染、裂口,直肠黏膜回缩,污粪、瘘口复发等情况.结果 比较后矢状入路肛门成形术组,瘘口后移肛门成形组的并发症发生率、瘘口复发率明显低于对比组,差异具有统计学意义(P<0.05),且手术时间及住院天数明显短于前者,在术中出血量方面,二者之间差异无统计学意义(P>0.05).结论 瘘口后移肛门成形术无需大范围解剖肛门会阴区,对于无肛前庭瘘是一种经济、创伤小且行之有效的手术方式,还能够提高患者预后效果,提高生活质量,值得临床进一步应用以及推广.

目的 探讨空气灌肠在治疗病程>48 h肠套叠患儿的价值及临床经验.方法 回顾性分析52例病程>48 h肠套叠患儿临床资料,均给予空气灌肠,配合腹部手法按摩复位.观察治疗效果.结果 52例患儿中38例复位成功,成功率73.1%,复位后给予禁食补液等对症支持治疗,无患儿出现继发性肠坏死及复套情况,住院2 d后均治愈出院;14例失败后转手术复位成功,术中证实2例套叠类型为回回结型、6例为回盲结型、6例回结型,6例仅单纯行手法复位,2例术中发现套头部存在美克尔憩室,给予切除.6例术中证实肠坏死,给予热敷、肠系膜根部注射利多卡因后肠血运蠕动无改善,给予肠切除吻合或肠造瘘术,其中1例由于降结肠全层撕裂,给予修补后行回肠造瘘术.其中另1例手术过程顺利,但术后出现高热不退,感染性休克,给予全力治疗后患儿出现反应意识迟钝,行磁共振(MR)提示脑萎缩,后转入康复科治疗后逐步恢复.结论 对于病程>48 h肠套叠患儿,空气灌肠是比较安全有效的治疗方法,能避免手术,便于了解套叠的范围及部分复位,降低手术难度.

Objective:To summarize the perioperatie high-quality nursing method of treatment of pediatric inguinal hernia under laparoscope.Methods:Selected 68 child patients receiving inguinal hernia under laparoscope in our hospital from March 2014 to March 2016 as the research objects, and they received high-quality nursing service in perioperative period, and the complications of child patients were observed after treatment.Results:All the child patients in this group had the laparoscopic surgery completed successfully, with a length of stay of (4.5±1.1)d, and after operation, there were no complications such as scrotum hematoma and incision affection.Conclusion:The high-quality nursing in perioperative period of treatment of pediatric inguinal hernia under laparoscope could effectively reduce the discomfort of operation to the child patients and their parents, shorten the length of stay of child patients and reduce the occurring of complications, with a significant clinical application effect.

Objective To evaluate the clinical value of laparoscopic techniques for giant incarcerated hernia in children.Methods The clinical data of 52 children with giant incarcerated hernia between February 2012 and February 2016 undergoing emergency modified laparoscopy was retrospectively analyzed.Operations were performed under general anesthesia with tracheal intubation.After laparoscopic assisted manual reduction,laparoscopic double purse-string plus suture with medical umbilical flap high-ligation of internal ring (modified) was performed.If reduction was unsuccessful,a small incision 1.5 cm in length was made in groin outer surface projection for releasing the lesion.Results Modified laparoscopy was successfully performed in al1 52 cases.And laparoscopic assisted reduction was completed in 36 cases with an operative duration of (35.4 ± 9.16) min and a mean postoperative hospitalization stay of (4.5 ± 1.5) days.Laparoscopic embedded Bolton loosening was performed in 16 cases with an operative duration of (54.9 ± 13.6) min and a mean postoperative hospitalization stay of(5.5 ± 1.7)days.There was no injury of seminiferous duct or spermatic vessel.No postoperative scrotal hematoma,incision infection or other complications occurred.The mean follow-up period was 14 (3-24) months.No testicular atrophy,iatrogenic cryptorchidism or incisional hernia was noted.Conclusions Modified laparoscopy is both safe and effective for giant incarcerated hernia.

Objective To explore the effect and value of laparoscopic double purse-string plus suture with medical umbilical flap high ligation of internal ring in treatment of giant inguinal hernia in children. Methods 167 cases of children admitted to our hospital in April 2010 to August 2013 with giant inguinal her-nia as the observation object of this study were selected;from April 2010 to January 2012,72 cases of children with giant inguinal hernia were treated with laparoscopic double high ligation of internal ring(group A);from February 2012 to August 2013,95 cases of children with giant inguinal hernia were treated with laparoscopic double purse-string plus suture plus medical umbilical flap high ligation of internal ring(group B);The postop-erative complication and recidivation of follow-up were compared between the two groups.Results Two groups of children were successfully completed surgery.In the hemorrhage of incisional wound,infection of incisional wound,reaction of silk thread after surgery,there was no statistically significant difference (P >0.05).But af-ter surgery and 1 ~3 years follow-up,5 relapse cases were foundoccurred in group A and no relapse occurred in group B.In recurrence rate of two groups of children,there were differences and there was statistical signifi-cance (P <0.05). Conclusions Laparoscopic double purse -string plus suture with medical umbilical flap high ligation of internal ring in treatment of giant inguinal hernia in children can reduce the recurrence rate and improve the cure rate.

目的 探讨婴幼儿急性阑尾炎的临床特征.方法 对我院2008年1月至2012年12月我院收治的婴幼儿急性阑尾炎病例95例进行回顾性分析,总结婴幼儿急性阑尾炎的临床特点,并对其诊疗方法进行探讨.结果 95例婴幼儿急性阑尾炎中,临床症状表现为不典型腹痛的患儿有51例,占比53.68％,B超未提示异常的急性阑尾炎有22例,占比23.16％,B超确诊阑尾脓肿23例,占比24.21％,术中发现阑尾穿孔16例,占比16.84％.结论 婴幼儿急性阑尾炎临床表现不典型,临床容易延误诊断,穿孔率高,对怀疑急性阑尾炎的患儿应反复仔细检查,一旦确诊应紧急手术.

目的探讨止血海绵外涂红霉素软膏加压包扎在隐匿性阴茎手术后应用的临床效果。方法将120例隐匿性阴茎需行手术的患儿随机分成两组，对照组术后采取纱块外涂红霉素软膏加压包扎，观察组使用止血海绵外涂红霉素软膏加压包扎。分别观察患儿术后第5天伤口渗出、伤口粘连、包皮水肿、伤口感染等情况。结果观察组无一例发生伤口与敷料粘连，伤口渗出及包皮水肿、伤口感染等的发生率较对照组明显减少，差异有统计学意义（P ＜0．05）。结论止血海绵外涂红霉素软膏加压包扎应用在隐匿性阴茎手术后，对减少伤口渗液，减轻伤口粘连，减轻包皮水肿、降低伤口感染的发生率等，明显优于纱块外涂红霉素软膏加压包扎的患儿，差异有统计学意义，止血海绵外涂红霉素软膏加压包扎对降低隐匿性阴茎术后并发症有明显优势，可在临床推广使用。

Objective To evaluate the clinical value of laparoscopic techniques in the treatment of incarcerated inguinal hernia in infants . Methods The clinical data of 62 infants with incarcerated inguinal hernia between February 2011 and February 2014 treated by emergent laparoscopic surgery was retrospectively analyzed .The operations were performed under general anesthesia with tracheal intubation .After laparoscopic assisted manual reduction , laparoscopic high ligation was carried out .If the reduction failed, a small incision 1.5 cm in length was made in the groin outer surface projection to release the lesion . Results The laparoscopic surgery was successfully performed in all the 62 cases.Laparoscopic assisted reduction was completed in 49 cases, with an operation time of 32.4 ±11.9 min and a mean postoperative hospital stay of 4.3 ±1.1 days.Laparoscopic embedded Bolton loose solution was performed in 13 cases, with an operation time of 52.1 ±15.4 min and a mean postoperative hospital stay of 5.1 ±1.7 days.No seminiferous duct or spermatic vessels injuries were noted .No postoperative scrotal hematoma , incision infections , or other complications happened.All the patients were followed up for 2-24 months (average, 14 months).No testicular atrophy, iatrogenic cryptorchidism, or incisional hernia was observed .Postoperative recurrence was recorded in 1 case, with a recurrence rate of 1.6%(1/62). Conclusions Laparoscopic surgery in the treatment of infantile inguinal strangulated hernia is safe and effective .The procedure is helpful for detecting and dealing with concealed hernia .

目的对婴幼儿的腹股沟斜疝使用腹腔镜治疗时的效果及具体方法进行研究。方法对我院2010年5月～2012年3月500例婴幼儿(1岁内)腹股沟斜疝(其中嵌顿疝5例)进行随机分组,一组为治疗组,行腹腔镜下疝囊高位结扎术。另一组为对照组,进行常规的手术治疗。结果治疗组中手术都取得成功,手术平均时间为18min。其中62例为隐性疝,3例发生了切口线结反应,2例出现复发现象。结论对婴幼儿腹股沟斜疝运用腹腔镜进行治疗的优点为,手术的创口较小、住院时间很短而且安全、术后效果也很好,在治疗嵌顿疝方面也有很好的疗效。

目的:探讨超声引导Mammotome微创旋切系统对乳腺良性肿块切除术的方法、并发症的防治及治疗价值。方法:回顾性分析162例374个乳腺良性肿块进行超声引导下Mammotome微创旋切手术的临床资料。结果:374个病灶均被B超引导下使用Mammotome旋切系统完全切除,每个肿块平均旋切次数为6次(3～31次),平均手术时间为12 min(5～25 min),术后仅留下0.3 cm的微小切口。手术无1例失败,成功率为100%。术后出现并发症10例(6.17%),保守治疗后均痊愈。病理结果:乳腺纤维腺瘤292个(78.07%),乳腺腺瘤6个(1.61%),乳腺腺病64个(17.11%),乳腺囊肿12个(3.21%)。结论:应用Mammotome旋切系统治疗乳腺良性肿块既能切除病灶得到组织学诊断,又能达到美学效果,可为治疗乳腺良性肿块(直径≤3.0 cm)的首选方法。