腹腔镜下治疗儿童腹股沟斜疝术中所见合并问题的处理  

Coping skills for the adverse factors of laparoscopic percutaneous extraperitioneal closure of pediatric inguinal hernia

作　　者：刘洁[1] 段光琦[1] 王啸[1] 唐睿 随帮志 

机构地区：[1]皖南医学院弋矶山医院小儿外科,安徽芜湖241001

出　　处：《中华疝和腹壁外科杂志（电子版）》2017年第1期44-45,共2页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的分析总结皖南医学院弋矶山医院腹腔镜下特制疝针治疗小儿腹股沟斜疝手术遇到的一些实际问题及其处理方法。方法 2014年3月至2015年5月,皖南医学院弋矶山医院行腹腔镜下经皮穿刺腹膜外内环口结扎术小儿腹股沟斜疝患者318例。回顾性分析术中合并常见问题、解决方法及术后随访。结果手术时间5~40 min,平均13.5 min,术中出血1.5 ml,术中在其他部位增加操作通道和器械23例。腹膜皱襞遮挡33例、大网膜疝入并与疝囊粘连2例、合并隐性直疝13例、发现鞘膜积液5例、肠系膜与腹膜粘连1例、发现美克尔憩室1例、术中肠粘连1例、内脏下滑靠近内环口5例、巨大疝25例。结论单孔腹腔镜经皮穿刺腹膜外结扎术已成为治疗小儿腹股沟斜疝的首选手术方式,具有创伤小、恢复快、同时能发现对侧隐性疝及处理多种合并疾病等多种优点,但手术过程中仍会面临多种问题,随着术者的技术水平不断提高,正确的处理可以取得良好疗效,减少手术创伤。Objective To analyze and summarize the adverse factors affecting laparoscopic percutaneous extraperitioneal closure （LPEC） for pediatric inguinal hernia （PIH） , and to explore the coping skills. Methods 318 children who diagnosed as PIH were applied with LPEC from March 2014 to May 2015. The adverse factors, coping skills and outcome of follow-up were retrospective analyzed. Results 318 LPEC were completed. The operating time was 5-40 minutes. A series of adverse factors were encountered during the operation and solved properly, including 23 cases with increasing operation channel and instruments, 33 cases with radical peritoneum fold, 2 cases with epiploon adhesion to the hernial sac, 13 cases with direct hernia, 5 cases with bydrocele of tunica vaginalis, etc. Conclusion LPEC has become the first choice for the treatment of PIH, it is effective for children with minimal invasion and low recurrence rate, which can be handled at the contralateral inguinal hernia. However there are a series of adverse factors during the procedure, which should be solved with appropriate techniques and principles.

关 键 词：疝 腹股沟 腹腔镜 疝 儿童 

分 类 号：R726.5[医药卫生—儿科]