单孔腹腔镜双钩疝针内环结扎并脐内侧襞遮盖术  

Single-port laparoscopic internal ring closure with medial umbilical fold flap reinforcement using a two-hooked core hernia needle

作　　者：费川[1] 张永婷[1] 李索林[1] 刘雪来[1] 孙驰[1] Fei Chuan Zhang Yongting Li Suolin Liu Xuelai Sun Chi.(Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Chin)

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：《中华腔镜外科杂志（电子版）》2016年第5期277-280,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：国家卫生与计划生育委员会公益性行业科研专项(201402007)

摘　　要：目的介绍一种使用双钩疝针辅助单孔腹腔镜内环结扎并脐内侧襞遮盖加强修补术。方法 59例小儿腹股沟巨大疝在脐单孔腹腔镜监视下,将双钩疝针钩挂结扎线经腹横纹内环体表投影处穿刺至内环前壁腹膜外,借助水分离技术于腹膜外套扎内环;疝针带线再次进针入腹,穿过同侧脐内侧襞后预置结扎线,疝针再返回内环外侧间隙至精索血管前穿透后腹膜、进入腹腔钩挂预置线牵出体外结扎,使脐内侧襞遮盖已结扎内环区域加强修补。结果 59例患儿的65侧巨大疝成功实施内环结扎并脐内侧襞遮盖术(包括3例复发疝和1例复合疝),其中16例对侧隐性疝给予同时单纯内环结扎。单侧和双侧腹股沟疝的手术时间分别为(11.2±2.2)min和(15.8±2.7)min。其中术后1例鞘膜积液和2例线结反应,无复发疝、医源性隐睾或睾丸萎缩等并发症发生。结论双钩疝针腹膜外注水分离技术辅助单孔腹腔镜内环结扎并脐内侧襞加强修补术是一种安全有效的简便方法。瘢痕隐蔽、美观,是治疗小儿巨大腹股沟疝的可靠技术。Objective To describe single-port laparoscopic internal ring closure combined with the ipsilateral medial umbilical fold flap（ MUFF） cover using a two-hooked core needle. Methods Fifty-nine children with huge inguinal hernias were encountered MUFF reinforcement after laparoscopic percutaneous extraperitoneal closure（ LPEC）. Under single-port laparoscopic vision,an inner two-hooked needle with a non-absorbable suture was inserted at abdominal transverse striation closed to hernia ring and was readily kept in an identical subcutaneous path. The hernia ring was ligated using the hydrodissection technique.Afterwards,the needle with another non-absorbable suture was inserted at identical subcutaneous path and the suture was left after penetrating the ipsilateral medial umbilical fold,then the needle was re-introduced into abdomen through lateral extraperitoneal space and the suture at bottom of medial umbilical fold was grabbed and extracorporeal ligated. The closed orifice area was additionally reinforced due to MUFF cover.Results In Fifty-nine children,A total of 65 huge inguinal hernias（ including three previous recurrences and one complex hernia） were successfully completed LPEC with additional MUFF reinforcement. In which,16 cases were found contralateral patent processus vaginalis needed to have LPEC. Mean operating time for unilateral and bilateral repairs were（ 11. 2 ± 2. 2） min and（ 15. 8 ± 2. 7） min respectively. There were no recurrence,iatrogenic cryptorchidism or testicular atrophy postoperative except for one hydrocele formation and two suture granulomas. Conclusions Single-port LPEC with MUFF reinforcement using a two-hooked core needle is safe and feasible,as a handy technique with invisible scar has proved to be a safe and effective approach and is therefore a worthy option in treatment of pediatric huge inguinal hernia.

关 键 词：腹股沟巨大疝 单孔腹腔镜 双钩疝针 内环结扎 脐内侧襞 

分 类 号：R726.5[医药卫生—儿科]