单孔腹腔镜下改良双钩疝针经皮腹膜外结扎术治疗小儿腹股沟疝  

Modified single-port laparoscopic percutaneous extra-peritoneal closure for inguinal hernia in children

作　　者：李萌[1] 李索林[1] 于增文[1] 徐伟立[1] 李英超[1] 孙驰[1] 

机构地区：[1]河北医科大学第二医院小儿外科,石家庄050000

出　　处：《中华小儿外科杂志》2012年第12期916-919,共4页Chinese Journal of Pediatric Surgery

基　　金：河北省医学适用技术跟踪项目（编号：GL2010-14）

摘　　要：目的探讨单孔腹腔镜下改良双钩疝针经皮腹膜外结扎术治疗小儿腹股沟斜疝的价值。方法回顾性分析2008年6月至2011年10月行单孔腹腔镜辅助经皮穿刺腹膜外结扎关闭内环135例腹股沟疝的临床资料。其中，采用自制单钩疝针（单钩疝针组）63例和采用改良双钩疝针（双钩疝针组）72例。对比两种术式的操作要领、手术时间及术中、术后并发症。结果双钩疝针组较单钩疝针组的手术时间在单侧疝[（13．21±3．86）min vs（17．92±4．37）min]和双侧疝[17．18±4．69）minvs（25．36±7．38）min]均明显缩短，且差异有统计学意义（P〈0．05，P〈0．01）。所有病儿均于术后1-3d恢复正常饮食和活动出院，术后住院时间（2．14±0．67）d和（2．22±0．68）d，两组比较差异没有统计学意义（P〉0．05）。双钩疝针组未有出现并发症或早期复发，单钩疝针组术后出现1例复发和1例皮下线结反应。结论单孔腹腔镜下改良双钩疝针经皮腹膜外结扎术不用辅助操作戳孔，经腹壁穿刺导入和牵出结扎线可保持在同一路径，不遗留腹膜缝隙及牵涉皮下组织，能够确保腹膜外间隙紧密结扎疝缺损。Objective To explore the applicable effects of single-port laparoscopic percutaneous extraperitoneal closure （SPLPEC） using a homemade two-hooked core needle for indirect inguinal her- nia in children. Methods Retrospective review was conducted to 135 children undertaking SPLPEC procedure using differential techniques between June 2008 and October 2011, in which 63 cases were performed with a homemade one-hooked core needle （one-hooked group）, and 72 cases were done with a modified two-hooked core needle （two-hooked group）. The operative techniques, operation time, intra- and post-operative complications in two groups were targeted to compare. Results The operation time in two-hooked group was shorter than one-hooked group [unilateral hernia.. （13. 21 - 3. 86）rain vs. （17. 92 ±4. 37）rain, P（0. 05; bilateral hernia.. （17.18 ± 4. 69）rain vs. （25.36± 7. 38）rain, P（ 0. 01]. All the children had normal feedings and activities, and were discharged at 1-3 days after sur- gery [Two-hooked group vs. one-hooked group = （2. 14 ± 0. 67）days vs. （2. 22 ±0. 68）days, P〉 0. 05]. There were no complications or evidence of early recurrence in the two-hooked group. Hernia recurrence was found in 1 case and subcutaneous ligature abscess was seen in 1 case in one-hooked group. Conclusions Without assistant working port, The SPLPEC using a two-hooked needle can help to preserve steadily an identical subcutaneous path in introducing and withdrawing the suture, the ex- tra-peritoneal knot-tying could tautly closed at the hernia defect without residual peritoneal gaps and upper subcutaneous tissues.

关 键 词：疝 腹股沟 腹腔镜 结扎术 外科器械 

分 类 号：R726[医药卫生—儿科]