经脐单一部位腹腔镜应用大圆针治疗小儿嵌顿性斜疝的疗效分析  

Analysis of Curative Effect of Laparoendoscopic Single-site Use Large Circular Taper Needle Treatment of Children with Incarcerated Hernia

作　　者：龚独辉 李炳根 莫宇轩 谢志华 彭永辉 聂向阳 李达强 

机构地区：[1]广东省广州市番禺区何贤纪念医院普外科,511400

出　　处：《医学理论与实践》2018年第5期640-643,共4页The Journal of Medical Theory and Practice

基　　金：广东省医学科研基金资助项目(A2013577)

摘　　要：目的:探讨经脐单一部位腹腔镜应用大圆针行疝囊高位结扎治疗小儿嵌顿性斜疝的疗效。方法:2015年3月—2017年3月,我科经脐单一部位腹腔镜应用大圆针治疗小儿腹股沟嵌顿斜疝36例。术前诊断右侧腹股沟嵌顿疝24例,左侧腹股沟嵌顿疝12例。经脐下缘做小切口置入5mm Trocar,导入5mm 30°腹腔镜,于操作孔位于脐上缘偏向患侧置入3mm Trocar做操作孔,置入3mm操作钳,探查明确嵌顿的疝内容物、嵌顿程度。腹腔镜监视下采用嵌顿疝手法复位的方法将疝内容物复位,观察嵌顿过的脏器是否损伤,有无血运障碍。如无脏器损伤,在腹腔镜监视下,采用大圆针行疝囊高位结扎术。如存在对侧腹股沟隐匿疝则同时处理。结果:36例均顺利完成经脐单一部位腹腔镜手术。术中发现对侧隐匿疝共14例。嵌顿的疝内容物为肠管28例,大网膜2例,卵巢及输卵管6例。手法复位及在3mm钳辅助下均能顺利还纳,镜下观察大约10min,36例嵌顿疝嵌顿的疝内容物均无坏死。单侧疝(22例)手术时间12~25min,平均手术时间18min;双侧疝(14例)手术时间18~36min,平均手术时间24min。麻醉清醒2h后即可进食,均可耐受伤口疼痛。术后12~24h(平均18h)出院。随访3~16个月,无伤口感染、阴囊血肿、反复疼痛、睾丸萎缩等并发症,36例均无复发。结论:经脐单一部位腹腔镜治疗小儿腹股沟嵌顿斜疝,无需破坏腹股沟管各层的解剖结构,直视下观察嵌顿的疝内容物损伤程度,探查对侧有无隐匿性疝,以大圆针行疝囊高位结扎,操作简单、方便。该技术微创、安全、有效,具有一定的推广价值。Objective:To explore the curative effect of laparoendoscopic single-site use large circular taper needle treatment of children with incarcerated hernia.Methods:36 patients with incarcerated hernia who were hospitalized in our hospital from March 2015 to March 2017 underwent laparoendoscopic single-site treatment.Preoperative diagnosis of hernia was right sided in 24 cases,and left sided in 12 cases.Via an umbilical incision placing 5 mm trocar establishment of pneumoperitoneum,and placing a 30°5 mm laparoscope;3 mm Trocar is placed in the upper edge of the umbilical cord as the operation hole.To explore hernial content type and incarcerated degree.If the incarcerated organs were not necrosed,application of large circular taper needle for high ligation of hernial sac.Contralateral side was explored for finding concealed hernia;if have hernia,treatment in the same tome.Results:The laparoendoscopic single-site surgery was successfully completed in all cases.14 cases of concealed hernia were found in the operation.Incarcerated hernia contents included bowel in 28 cases,omentum in 2 cases,ovaries in 6 cases.All the incarcerated organs were successfully restored by manual reduction and 3 mm forcep assistance.After observation for 10 minutes,the incarcerated organs were not necrosed in all the 36 cases.Unilateral hernia(22 cases)operation time of 12~25 minutes(mean 18 minutes);bilateral hernia(14 cases)operation time 18~36 minutes(mean 24 minutes),all the children began to diet after awake from anesthesia,can withstand the pain.The patients were discharged from hospital at 12~24 hpostopative hours(mean 18 h).Follow up for 3~16 months,there were no postoperative wound infection,no hematoma,no testicular atrophy,no recurrent pain and other complications,no recurrence cases.Conclusion:The Laparoendoscopic single-site treatment of children with incarcerated hernia,does not destroy the anatomical structure of the inguinal canal,to explorate the damage of the contents of the hernia under the direct vision,and can find concea

关 键 词：小儿 嵌顿疝 腹股沟斜疝 大圆针 经脐单一部位腹腔镜 

分 类 号：R656.2[医药卫生—外科学]