单纯经脐腹腔镜下疝囊高位结扎术治疗小儿腹股沟斜疝  

Transumbilical laparoscopy for high ligating inguinal hernias in children

作　　者：王新星[1,2] 李帅[1,2] 汤绍涛[1] 曹国庆[1] 普佳睿[1] 余铖[1] 史雯嘉[1] 李时望[1] 毛永忠[1] 王勇[1] 童强松[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院小儿外科,湖北省武汉市430022 [2]华中科技大学同济医学院附属协和医院超声影像科,湖北省武汉市430022

出　　处：《临床小儿外科杂志》2016年第4期348-350,共3页Journal of Clinical Pediatric Surgery

基　　金：卫计委行业基金项目,小儿腔镜诊断治疗先天性畸形技术规范标准及新技术评价研究,项目号201402007

摘　　要：目的：探讨采用单纯经脐切口及腹腔内打结技术行疝囊高位结扎术的安全性及手术效果。方法2013年10月至2014年6月，我们采用单纯经脐切口及腹腔内打结技术行腹股沟斜疝手术86例，其中双侧30例，单纯左侧15例，单纯右侧41例。具体方法为：经脐5 mm Trocar 置镜，脐环免Trocar 置入3 mm 针持。内环口上外3 cm 腹壁外以2－0不可吸收带针缝线自腹壁穿入腹腔，线尾留置在腹壁外侧，环形缝合内环口一周，避开精索血管及输精管。采用腹腔内绕线、腹腔外牵拉尾线辅助打结，腹壁外剪线。皮肤胶粘合伤口。结果单侧病例平均手术时间18．7 min，双侧病例平均手术时间23．5 min。无精索血肿、腹腔脏器损伤、腹壁气肿及术后阴囊水肿的发生。术后第1天自由活动率为99％。随访时间7～15个月，目前无复发病例，无一例出现腹股沟区异物感或异物反应；术后1个月腹壁基本无可视疤痕。结论采取单纯经脐腹腔镜技术、常规器械腹腔内打结方法进行疝囊高位结扎术治疗小儿腹股沟斜疝，安全有效，腹壁皮肤外观好，无皮下异物感或异物反应。Objetive To evaluate the feasibility and safety of transumbilical laparoscopy for high ligating inguinal hernias in children using one para-umbilical microincision and intraperitoneal knot-ty-ing. Methods Between October 2013 and June 2014,a total of 102 children with inguinal hernias were re-cruited for the above technique.There were 86 boys and 16 girls with a mean age range of 2.4 years （25 days to 13.6 years）.Their clinical data were retrospectively analyzed.The detailed approaches were as follows：One 5 mm trocar was inserted into abdomen through umbilicus.A needle holder was punctured into abdomen through 3 mm incisions on umbilical ring without trocars.And 2 -0 non-absorbable suture was introduced into peritoneal cavity through anterior abdominal wall near internal inguinal ring.The orifice of hernial sac was closed extraperitoneally with a purse-string suture around internal inguinal ring and intraperitoneal knot-tying performed. Results All operations were completed successfully.The mean operative duration was 18.7 min for single side and 23.5 min for two sides.There was no onset of postoperative hemorrhage,abdominal wall emphysema,abdominal viscera injury,scrotal edema,postoperative testicular atrophy or hypertrophy or hernia recurrence.And 99% of patients resumed appropriate activities on the first postsurgical day.The mean follow-up period was 11 （7 ~15）months.There was no recurrence,visible scars on abdominal wall or foreign body feelings on inguinal portion. Conclusions Transumbilical laparoscopy is both safe and efficient for inguinal hernia in children.And the cosmetic outcomes are excellent.

关 键 词：腹腔镜 疝 腹股沟 结扎术 治疗 儿童 

分 类 号：R726.5[医药卫生—儿科]