单孔腹腔镜导丝定位法经皮腹膜外结扎术治疗小儿腹股沟疝  

Single-port laparoscopic percutaneous extra-peritoneal closure using positioning guide wire for inguinal hernia in children

作　　者：刘扬 邱云[1] 王春燕 李贵斌[1] Liu Yang;Qiu Yun;Wang Chunyan;Li Guibin(Department of Pediatric Surgery,Fifth Central Municipal Hospital,Tianjin 300450,China)

机构地区：[1]天津市第五中心医院小儿外科,300450

出　　处：《中华小儿外科杂志》2020年第9期800-805,共6页Chinese Journal of Pediatric Surgery

基　　金：天津市滨海新区卫计委科技资金青年项目(2018BWKQ033);天津市卫计委科技基金项目(2015KZ017)。

摘　　要：目的探讨单孔腹腔镜导丝定位法经皮腹膜外结扎术治疗小儿腹股沟疝的价值。方法回顾性分析2013年2月至2019年6月行单孔腹腔镜经皮腹膜外结扎术的146例腹股沟斜疝患儿的临床资料。其中,采用改良双钩疝钩针实施手术78例(疝钩针组),采用导丝定位法使用硬膜外穿刺针实施手术68例(导丝定位组)。对比两种术式的操作要领、手术时间及术中、术后并发症。结果所有146例患儿均顺利完成手术,无术中并发症发生。导丝定位组和疝钩针组手术时间在单侧疝分别为(23.57±5.49)min和(22.86±4.29)min,在双侧疝分别为(32.65±6.96)min和(30.98±5.67)min,虽前者均较后者延长,但组间比较,差异均无统计学意义(P=0.624和0.198)。所有患儿均于术后1~4 d恢复正常饮食和活动后出院,其中导丝定位组和疝钩针组术后住院时间分别为(3.50±0.56)d和(3.33±0.72)d,组间比较,差异无统计学意义(P>0.05)。导丝定位组术后未出现并发症或复发病例,疝钩针组术后出现皮下线结反应1例。结论单孔腹腔镜导丝定位经皮腹膜外结扎术安全、可行、有效,无须使用特殊器械即可完成单穿刺道腹膜外结扎,手术取材方便经济,更适合中国国情。Objective To explore the applicable efficacies of single-port laparoscopic percutaneous extraperitoneal closure(SPLPEC)using positioning guide wire for indirect inguinal hernia in children.Methods Retrospective review was conducted for 146 children who underwent SPLPEC procedure using different techniques from February 2013 to June 2019.The procedures included modified two-hooked core needle(two-hooked group,n=78)and a positioning guide wire plus an epidural needle(guide wire group,n=68).Operative techniques,operative duration and peri-operative complications were compared between two groups.Results All operations were completed successfully.There were no intraoperative complications.Operative duration was slightly longer in guide wire group than that of two-hooked group[unilateral hernia:(23.57±5.49)vs.(22.86±4.29)min,P=0.624;bilateral hernia:(32.65±6.96)vs.(30.98±5.67)min,P=0.198].However,inter-group difference was not statistically significant.All children had normal feedings and activities and were discharged at 1-4 days postoperatively[guide wire group vs.two-hooked group:(3.50±0.56)vs.(3.33±0.72)days,P>0.05].No complication or any evidence of recurrence was found in guide wire group.One case of subcutaneous ligature abscess occurred in two-hooked group.Conclusions SPLPEC using positioning guide wire is both safe and feasible.And internal ring orifice is securely lassoed in an identical subcutaneous extraperitoneal path without any special equipment.Because of both inexpensive and convenient,surgical instruments are applicable in China's Mainland.

关 键 词：疝 腹股沟 单孔腹腔镜手术 结扎术 

分 类 号：R726.5[医药卫生—儿科]