单孔腹腔镜下使用水分离微抓钳治疗小儿腹股沟斜疝512例经验总结  

Treatment of Indirect Inguinal Hernia With Single-port Laparoscopic Hydrodissection Mini-grasping Forceps:Experience Summary of 512 Children

作　　者：唐睿 段光琦[1] 刘洁[1] 朱庆华 马鸿龙 王啸[1] 随帮志 徐旭东 陈进[1] 晋志远 Tang Rui;Duan Guangqi;Liu Jie(Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China)

机构地区：[1]皖南医学院弋矶山医院小儿外科,芜湖241001

出　　处：《中国微创外科杂志》2021年第9期782-786,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨单孔腹腔镜下使用水分离微抓钳腹膜外穿刺高位结扎疝囊治疗小儿腹股沟斜疝的安全性、有效性及可操作性。方法2019年6月~2020年5月对512例患儿756侧小儿腹股沟斜疝在经脐单孔腹腔镜监视下,将水分离微抓钳钳夹结扎线经内环体表穿刺,一次穿刺腹壁保持进出线在同一路径,借助水分离技术环绕疝缺损腹膜外套扎内环。结果术中发现对侧隐性鞘状突未闭202例,同期一并处理,共结扎756侧。单侧和双侧手术时间分别为(8.3±1.5)、(13.6±2.3)min;巨大疝(内环直径>1.5 cm)85例,加强修补45例;合并精索鞘膜积液2例,圆韧带囊肿2例,内脏下移5例,增加1把水分离微抓钳辅助处理。486例术后随访3~12个月,平均4.2月,2例巨大疝复发,2例脐部感染,无睾丸高位、睾丸萎缩、鞘膜囊积液、皮下血肿及线结肉芽肿形成等并发症发生。结论单孔腹腔镜监视下使用水分离微抓钳腹膜外穿刺,借助水分离技术辅助经皮内环结扎是一种安全有效的术式。Objective To investigate the safety,effectiveness and operability of the use of hydrodissection mini-grasping forceps for extraperitoneal puncture and high ligation of hernia sac in children with indirect inguinal hernia under single-port laparoscopic monitoring.Methods From June 2019 to May 2020,the data of 512 children(756 sides)with indirect inguinal hernia treated in our hospital were analyzed retrospectively.Under the monitoring of transumbilical single-port laparoscopy,the hydrodissection mini-grasping forceps were used to clamp the ligation line and puncture through the surface of the inner ring,and the inlet and outlet line should be kept in the same path.The internal ring orifice was absolutely lassoed extraperitoneally by suture under the assistance of hydrodissection.Results During the operation,202 cases of the contralateral occult sheath process were found and treated at the same time with 756 sides ligated.The average operation time of unilateral and bilateral was(8.3±1.5)min and(13.6±2.3)min,respectively.There were 85 cases of giant hernia(internal diameter>1.5 cm)and 45 cases was enhanced repaired.There were 2 cases of hydrocele of spermatic cord,2 cases of cyst of round ligament,and 5 cases of internal organs moving down.All these cases were treated with an additional use of hydrodissection mini-grasping forceps.A total of 486 cases were followed up for 3-12 months,with an average of 4.2 months.There were 2 cases of giant hernia recurrence and 2 cases of umbilical infection.No complications such as testicular high position,testicular atrophy,hydrocele,subcutaneous hematoma or linear granuloma were noted.Conclusion Under the monitoring of single-port laparoscopy,it is a safe and effective operation method to use hydrodissection technology by mini-grasping forceps to perform percutaneous internal ring ligation.

关 键 词：腹股沟斜疝 单孔腹腔镜 水分离 

分 类 号：R65[医药卫生—外科学]