腹膜闭合器改良钩针在小儿腹股沟疝手术中的应用  

Application for extraperitoneal closure of using an inner grappler in the operation of inguinal hernia in children

作　　者：刘雪来[1] 李龙[1] 李索林[2] 曹学会 张永婷[2] 刘林[2] 李亮星 LIU Xue-lai;LI Long;LI Suo-lin;CAO Xue-hui;ZHANG Yong-ting;LIU Lin;LI Liang-xing(Department of Surgery, Children's Hospital Capital Institute of Pediatric, Beijing 100020, China;Department of Pediagric Surgery, The Second Hospital of Hebei Medical University, Hebei, Shijiazhuang050000, China)

机构地区：[1]首都儿科研究所附属儿童医院外科,北京100020 [2]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》2019年第3期203-207,共5页Journal of Developmental Medicine (Electronic Version)

基　　金：公益性行业科研专项(201402007);2018年度儿科学科协同发展中心“儿科专项”(子课题XTZD20180301)

摘　　要：目的 介绍采用一次性腹膜闭合器套装内的改良钩针实施完全腹膜外疝环结扎术的方法,并评价该方法的可行性与近期疗效。方法 2017年11月至2018年1月,在河北医科大学第二医院小儿外科就诊的腹股沟疝患儿中,26例患儿采用腹膜闭合器改良钩针辅助单孔腹腔镜完全腹膜外腹股沟疝环结扎术。经脐单孔腹腔镜监视下,将改良钩针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,采用水分离技术环绕疝缺损腹膜外套扎内环。回顾性分析患儿的基本情况、单侧或双侧疝、手术时间、术后复发率和并发症,评价该手术方法的可行性与安全性。结果 26例患儿的年龄为11个月~3岁,男性23例,女性3例。术前诊断单侧腹股沟疝20例,双侧6例;术中证实单侧疝17例,双侧疝9例,共35侧疝。单侧和双侧腹股沟疝的平均手术时间分别为(10.5±1.8)和(19.6±2.1)min。无术中并发症发生,所有患儿均在术后24h内出院。随访9~12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 采用改良钩针辅助单孔腹腔镜完全腹膜外腹股沟疝环结扎术安全、有效、简便,脐窝瘢痕隐蔽,可用于临床治疗小儿腹股沟疝。Objective To introduce the way for using disposable extraperitoneal closure of using an inner grappler in hernia ring ligation and evaluate its feasibility and recent efficacy. Methods From November 2017 to January 2018, 26 children with inguinal hernias were underwent single-port laparoscopic percutaneous extraperitoneal closure(SPLPEC)using an inner grappler with hernia ring ligation in Department of Pediatric Surgery of The Second Hospital of Hebei Medical University. Under laparoscopic visualization through a single umbilical port, an inner grappler with a nonabsorbable suture was introduced into extraperitoneal space at the corresponding point of the internal inguinal ring, which 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 The internal ring orifice was absolutely lassoed extraperitoneally by the suture without peritoneal punctures and withdrawn on the opposite side using the cannula around the internal ring with the hydrodissection technique. The basic information of the infants, operating time, recurrent rate of post-operative and complications were analyzed retrospectively for evaluation the feasibility and safety by the procedure. Results A total of 26 cases(ranging from 11 months to 3 years old, male 23 and female 3), 20 cases were diagnosed as unilateral inguinal hernia, 6 cases were diagnosed as bilateral inguinal hernias at pre-operation;while 17 cases were diagnosed as unilateral inguinal hernia, 9 cases were diagnosed as bilateral inguinal hernias during operation. There were 35 side hernias totally. Mean operating time for unilateral and bilateral inguinal hernia was (10.5±1.8) min and (19.6±2.1) min respectively. There were no complications intra-operative and all of the cases were discharged within 24 hours at post-operation. Follow-up for 9-12 months, there were no wound infection, iatrogenic cryptorchidism or testicular atrophy and other complications, as well as recurrence hernia, hydrocele, suture granuloma formations. Conclusion It is safe, effective and convenient to apply th

关 键 词：腹股沟疝 单孔 腹腔镜 腹膜外 结扎 

分 类 号：R726.5[医药卫生—儿科]