单孔腹腔镜腹膜外结扎术治疗小儿腹股沟疝相关并发症分析  

Related complications of single-port laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia

作　　者：费川[1] 张永婷[1] 刘雪来[1] 孙驰[1] 刘林[1] 李萌[1] 李索林[1] 

机构地区：[1]河北医科大学第二医院小儿外科,河北省石家庄市050000

出　　处：《临床小儿外科杂志》2016年第4期328-331,共4页Journal of Clinical Pediatric Surgery

基　　金：国家卫生和计划生育委员会公益性行业科研专项(编号:201402007)

摘　　要：目的探讨单孔腹腔镜腹膜外结扎术治疗小儿腹股沟疝相关并发症的原因。方法收集2011年1月至2016年2月采用双钩套扎针完成单孔腹腔镜监视下腹膜外结扎术治疗小儿腹股沟疝2 258例的手术记录及术后随访资料,统计手术相关并发症予以分析。结果除35例因巨大疝、滑动疝、网膜嵌顿或粘连需要另外一个操作孔辅助完成手术外,2 223例成功实施单孔腹腔镜腹膜外内环结扎手术,出现相关并发症25例(25/2 223,1.11%,),其中4例腹壁下血管穿刺损伤、1例髂外静脉穿刺损伤、2例脐部戳孔网膜嵌顿、1例脐部切口感染、5例线结反应、2例腹股沟区牵拉疼痛不适感、疝复发4例和鞘膜积液形成6例;无肠管或膀胱损伤以及医源性隐睾或睾丸萎缩等并发症发生。结论借助双钩套扎针实施单孔腹腔镜腹膜外内环结扎术虽操作简单、创伤小、恢复快、瘢痕隐蔽美观,若术中操作不当仍可引起并发症。需要术者进一步规范操作,减少并发症的发生。Objetive To explore the causes of complications during single-port laparoscopic percutane-ous extraperitoneal closure （SPLPEC）for pediatric inguinal hernia. Methods The operative and follow-up data of 2258 children with inguinal hernia undergoing SPLPEC were retrospectively analyzed and their complica-tions collected from January 2011 to February 2016. Results Additional working port was required in 35 ca-ses due to huge hernia,sliding hernia,omental incarceration or adhesion.And 2,223 children with inguinal hernias underwent SPLPEC successfully with a two-hooked core hernia needle.Among 25 complications （1.11%）,there were the injuries of inferior epigastric vessel （n =4）,external iliac vein （n =1）,umbilical omental hernia （n =2）,umbilical infection （n =1）,suture granuloma （n =5）,discomfort in groin area （n =2）,recurrence （n =4）and hydrocele （n =6）.There was no postoperative onset of intestinal or bladder inju-ry,iatrogenic cryptorchidism or testicular atrophy. Conclusions With a dual-hooked core hernia needle, SPLPEC causes less trauma and leaves an invisible scar.However,improper handling results in the occur-rences of complications.For a lower incidence of complications,operators ought to further standardize and re-fine the technique.

关 键 词：腹腔镜 疝 腹股沟 腹膜 结扎术 治疗 儿童 

分 类 号：R726.5[医药卫生—儿科]