单部位单手操作腹腔镜内环口缝扎术治疗小儿腹股沟疝  

Single-site laparoscopic closure of inner inguinal ring with single hand for pediatric inguinal hernias

作　　者：席红卫[1] 张鹏[1] 崔强强[1] 游志恒[1] 赵正[1] 段文强[1] 杨治[1] 

机构地区：[1]山西省儿童医院普外科,山西省太原市030013

出　　处：《临床小儿外科杂志》2015年第5期375-376,382,共3页Journal of Clinical Pediatric Surgery

基　　金：国家十一五科技支撑计划课题,项目号：2006BA105A06.

摘　　要：目的：探讨单部位腹腔镜下内环口缝扎术治疗小儿腹股沟疝的手术技巧。方法2011年1月至2015年3月作者采用单部位腹腔镜下内环口缝扎术治疗小儿腹股沟斜疝1536例，其中男性1074例，女性462例。经脐窝左、右侧缘分别做3 mm 或5 mm 切口，放置 Trocar，内置腹腔镜和持针器。由腹股沟区刺入2—0带线缝合针，持针器钳夹后，直接缝合内环口处关闭腹膜，再由腹股沟区刺出缝合针，剪除。结果所有患儿均顺利完成腹腔镜下手术，手术时间6～25 min，术后第1天出院。术中无出血，无肠管、输精管及精索损伤，无中转传统腹膜镜和开放手术。术后无阴囊血肿、水肿发生。1例术后出现鞘膜积液，再次手术时发现为线结未结扎牢固，中央有小孔；5例复发，再次手术时发现内环口开放，线结在内环口内下方，未脱落，考虑可能为线结过紧，拉豁内环口处腹膜，使之再次开放所致。结论单部位单手操作腹腔镜下内环缝扎术治疗小儿腹股沟疝是一种有效可行的治疗方法，掌握一定手术技巧可以使手术简单化。术后腹壁无可见手术瘢痕，切口美观。Objetive To explore the techniques of single-site laparoscopic closure of inner inguinal ring for pediatric inguinal hernias.Methods From Jan,2011 to Mar.2015,1 536 cases with inguinal hernia were performed with single-site laparoscopic closure of inner inguinal ring,aged from 6 months to 16 years.Of them,1074 cases were male and 462 cases were female.The 3 mm or 5 mm trocars were respectively inserted in the left and right edges of umbilicus.Then laparoscope and needle holders were placed.After 2-0 suture piercing into the abdominal cavity from the groin area,the inguinal ring was closed with encircled extraperitone-al suture.At last,the needle was pierced out and cut off. Results All patients were conducted with laparo-scopic surgery successfully.The operational time ranged from 6 to 25 minutes.All patients were discharged the day after operation.There was no conversion to conventional laparoscopy or open surgery,no bowel,vas defer-ens and spermatic cord injury and no postoperative scrotal hematoma or edema.The reoperation was found loos-en ligation in one case with postoperative hydrocele.5 cases of recurrence were discovered with unclosed ingui-nal ring in the second operation.It was too tight knots that may be accout for cut of peritonea and patency of in-ner inguinal ring.Conclusions Single-site laparoscopic closure of inner inguinal ring is an effective and cos-metic treatment for inguinal hernia in children.With certain surgical skills,the operation would be simplified.

关 键 词：疝 腹股沟 腹腔镜 外科手术 儿童 

分 类 号：R726.562.1[医药卫生—儿科]