水分离双钩套扎针辅助单孔腹腔镜腹股沟疝腹膜外结扎术  

Single-port Laparoscopic Percutaneous Extraperitoneal Closure of Inguinal Hernia by Using an Inner Two-hooked Cannula with Hydrodissection

作　　者：李索林[1] 费川[1] 张永婷[1] 刘琳[1] 李萌[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：《中国微创外科杂志》2017年第1期42-45,50,共5页Chinese Journal of Minimally Invasive Surgery

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

摘　　要：目的探讨使用双钩套扎针腹膜外注水分离技术辅助单孔腹腔镜腹股沟疝内环结扎术的可行性与安全性。方法 2013年7月~2015年6月582例763侧小儿腹股沟疝经脐单孔腹腔镜监视下,将双钩套扎针钩挂结扎线经内环体表穿刺,一次穿刺腹壁保持进出线在同一路径,借助水分离技术环绕疝缺损腹膜外套扎内环。结果全部患儿均顺利完成单孔腹腔镜经皮穿刺腹膜外内环结扎术,其中401例行单侧内环结扎术,181例行双侧内环结扎术。48侧巨大疝钩挂同侧脐内侧韧带遮盖修补术,15例网膜粘连或滑动疝在脐旁置入另一操作钳辅助完成。单侧和双侧腹股沟疝手术时间分别为(10.6±2.2)min和(13.8±2.4)min。无切口感染、医源性隐睾或睾丸萎缩等并发症发生。574例随访6~30个月,平均9.6月,1例复发,2例鞘膜积液,3例线结肉芽肿形成。结论采用双钩套扎针注水分离技术辅助单孔腹腔镜腹膜外疝环结扎术是一种安全有效的简便方法,脐窝瘢痕隐蔽、美观,是治疗小儿腹股沟疝值得选择的技术。Objective To explore the feasibility and safety of single-port laparoscopic hernia ring ligation by using an inner two-hooked cannula with extraperitoneal hydrodissection. Methods A total of 582 children with 763 inguinal hernias were treated with single-port laparoscopic percutaneous extraperitoneal closure（ SPLPEC）. Under laparoscopic visualization through a single umbilical port,an inner two-hooked cannula with a nonabsorbable suture was inserted at the corresponding point of the internal ring,which was readily kept in an identical subcutaneous path. The orifice of the hernia defect was lassoed extraperitoneally by the suture that was introduced into the abdomen on one side and withdrawn on the opposite side by using the cannula around the internal ring with the hydrodissection technique. Results All the hernia repairs were successfully performed by SPLPEC,including 401 cases of unilateral inguinal hernia repairs and 181 cases of bilateral inguinal hernia repairs. Of them,additional medial umbilical flap reinforcement was required in 48 huge hernias and an assisted grasping instrument was needed in 15 cases due to omental adhesion or sliding hernia. The operating time for unilateral and bilateral inguinal hernia repairs was（ 10. 6 ± 2. 2） min and（ 13. 8 ± 2. 4） min,respectively. There were no intra-operative complications,such as wound infection,iatrogenic cryptorchidism or testicular atrophy.Postoperative follow-up for 6- 30 months（ mean,9. 6 months） in 574 children found 1 case of recurrence,2 cases of hydroceles and3 cases of suture granuloma formations. Conclusions SPLPEC by using an inner two-hooked cannula with preperitoneal hydrodissection has proved to be a safe and effective technique in the treatment of inguinal hernia in children. It has advantages of invisible scars and good cosmetic results,being worthy for pediatric inguinal hernia.

关 键 词：腹股沟疝 单孔 腹腔镜 双钩套扎针 腹膜外结扎 

分 类 号：R656.2[医药卫生—外科学]