单孔腹腔镜完全腹膜外腹股沟疝环结扎术的临床应用  

Clinical application for single-port laparoscopic percutaneous extraperitoneal closure in the treatment of inguinal hernia in children

作　　者：刘雪来[1] 张创 张永婷[1] 刘林[1] 李索林[1] LIU Xue-lai;ZHANG Chuang;ZHANG Yong-ting;LIU Lin;LI Suo-lin(Department of Pediatric Surgery,The Second Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院小儿外科,河北石家庄050000

出　　处：《发育医学电子杂志》2018年第2期77-81,共5页Journal of Developmental Medicine (Electronic Version)

基　　金：国家卫生与计划生育委员会重大公益性项目(201402007);河北省医学适用技术跟踪项目(G201720)

摘　　要：目的对双钩套扎针辅助单孔腹腔镜完全腹膜外腹股沟疝环结扎术的临床应用进行总结,并探讨其安全性和有效性。方法 2017年7月至10月,在河北医科大学第二医院小儿外科住院的患儿中,17例腹股沟疝患儿接受了单孔腹腔镜下的完全腹膜外疝环结扎关闭术。经脐单孔腹腔镜监视下,将双钩套扎针钩挂结扎线经腹股沟内环体表穿刺,一次穿刺腹壁保持进出线在同一路径,完全在腹膜外间隙内实现置线和钩线带出体外。采用或不采用水分离技术环绕疝缺损腹膜外套扎内环。结果 17例患儿中,11例为单侧疝,6例为双侧疝。单侧疝的平均手术时间为(10.5±2.3)分钟,双侧疝的平均手术时间为(16.6±1.5)分钟。无术中并发症发生。术后随访2~5个月,无一例出现伤口感染、医源性隐睾或睾丸萎缩等并发症,无复发疝、鞘膜积液和皮肤结肉芽肿形成。结论采用双钩套扎针辅助单孔腹腔镜完全腹膜外腹股沟疝环结扎术是一种安全有效的简便方法,避免了在腹膜上戳孔,双钩套扎针与丝线不再进入腹腔内置线和钩挂带出,实现了完全腹膜外结扎内环。Objective To conclude the clinical application of inner two-hooked cannula assisted singleport laparoscopic percutaneous extraperitoneal closure(SPLPEC)in the treatment of inguinal hernia in children and to explore its feasibility and safety.Methods From July to October 2017,17 children with inguinal hernia in Department of Pediatric Surgery of The Second Hospital of Hebei Medical University underwent SPLPEC.Under the visualization of single port laparoscopic,an inner two-hooked cannula with a suture was introduced into extraperitoneal space at the corresponding point of the internal inguinal ring,that could be readily kept in an identical subcutaneous path.The internal ring orifice was absolutely lassoed extraperitoneally by the suture without peritoneal punctures and withdrawn on the opposite side using the cannula around the internal ring with or without the hydrodissection technique.Results Among the 17 cases of children,11 cases were unilateral inguinal hernia and 6 cases were bilateral inguinal hernia.The mean operating time of unilateral was(10.5±2.3)minutes and that of bilateral inguinal hernia was(16.6±1.5)minutes.There were no intra-operative complications.Following up for 2-5 months after operation,there were no wound infection,iatrogenic cryptorchidism or testicular atrophy and other complications.And no recurrence,hydroceles and suture granuloma formations were found.Conclusion Inner two-hooked cannula assisted SPLPEC is a simple,safe and effective method.It avoids puncture on the peritoneal.Inner two-hooked cannula and suture do not put and withdraw via intraperitoneal,achieving extraperitoneal ligation of inner ring completely.

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：R726.5[医药卫生—儿科]