单孔腹腔镜自制疝针经皮完全腹膜外内环结扎术治疗小儿腹股沟斜疝715例  

Single-port laparoscopic percutaneous extraperitoneal closure using self-made hernia needle for pediatric inguinal hernia

作　　者：胡伟泽 戴育坚[1] 郑辉明[1] 刘震[1] 叶彤[1] 王英俊[1] Hu Weize;Dai Yujian;Zheng Huiming;Liu Zhen;Ye Tong;Wang Yingjun(Department of Pediatric Surgery,First Municipal Affiliated Hospital,Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院小儿外科,泉州362000

出　　处：《临床小儿外科杂志》2023年第3期278-282,共5页Journal of Clinical Pediatric Surgery

基　　金：福建省自然科学基金(2020J011285)

摘　　要：目的探讨单孔腹腔镜自制疝针经皮完全腹膜外内环结扎术治疗小儿腹股沟斜疝的方法与疗效。方法回顾性分析2018年9月至2020年6月福建医科大学附属泉州第一医院小儿外科收治的715例小儿腹股沟斜疝患者临床资料。男580例,女135例;单侧687例,双侧28例;男性患儿中右侧325例、左侧240例、双侧15例,女性患儿中右侧62例、左侧60例、双侧13例。分析男女比例、侧别占比情况、手术时间、术中出血量及术中发现对侧鞘状突未闭或隐性疝占比情况。结果715例均于腹腔镜下完成手术,无一例中转开放手术。术中发现对侧鞘状突未闭或隐性疝320例(46.5%,320/687),其中男性右侧140例(43.1%,140/325)、男性左侧115例(47.9%,115/240),女性右侧33例(53.2%,33/62)、女性左侧32例(53.3%,32/60)。术中因内环口内侧腹膜褶皱多导致疝针不能顺利通过35例(4.9%,35/715),均为男性,于脐下3 cm左右或脐旁置入一辅助抓钳辅助操作。手术时间:单侧10~15 min,平均12 min;双侧15~21 min,平均17 min。术中出血量0~1 mL。麻醉清醒后即进食。715例均于入院后24 h内出院。无一例损伤精索血管、输精管、腹壁下动脉,术后无一例阴囊肿胀。随访12~33个月(平均18.3个月),2例复发,1例出现线结反应,无一例出现睾丸萎缩、医源性隐睾、术后鞘膜积液。结论单孔腹腔镜自制疝针经皮完全腹膜外内环结扎术治疗小儿腹股沟斜疝创伤小、恢复快、复发率低、切口美观,可发现并同期治疗对侧鞘状突未闭或隐性疝,值得临床推广。Objective To explore the method and efficacy of single-port laparoscopic percutaneous extraperitoneal closure using self-made hernia needle for pediatric inguinal hernia.Methods From September 2018 to June 2020,clinical data were retrospectively reviewed for 715 children of pediatric inguinal hernia undergoing single-port laparoscopic percutaneous extraperitoneal closure using self-made hernia needle.There were 580 boys and 135 girls.The involved side was unilateral(n=687)and bilateral(n=28).Among 580 boys,the involved side was right(n=325),left(n=240)and bilateral(n=15);Among 135 girls,the involved side was right(n=62),left(n=60)and bilateral(n=13).Proportion of gender,proportion of sideness,operative duration,intraoperative volume of hemorrhage and proportion of children with patent processus vaginalis or recessive hernia detected intraoperatively were analyzed.Results All children underwent laparoscopy without any conversion into open surgery.A total of 320 cases of contralateral non-closure of processus vaginalis or latent hernia were detected intraoperatively,accounting for about 46.5%of all children,including 140 boys(43.1%,140/325)at right side,115 boys(47.9%,115/240)at left side,33 girls(53.2%,33/62)at right side and 32 girls(53.3%,32/60)at left side.During operation,35 boys(approximately 4.9%,35/715)failed to pass hernia needle due to inner peritoneal folds of inner ring orifice.An auxiliary grasping forceps was placed about 3 cm below umbilicus or beside umbilicus to assist operation.Operative duration:unilateral(10-15)min,average 12 min,bilateral(15-21)min,average 17 min.The intraoperative blood loss was(0-1)ml.After operation,children could resume a liquid diet after anesthesia.After day surgery,they were discharged within 24h after admission.Without injury to spermatic cord,vas deferens or inferior abdominal artery,there was no postoperative swelling of scrotum.During a follow-up period of 18.3(12-33)months,there were recurrence(n=2)and suture node reaction(n=1).No testicular atrophy,iatrogenic crypt

关 键 词：腹腔镜 疝 腹部 结扎术 腹股沟 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]