腹腔镜手术治疗儿童嵌顿斜疝170例中长期疗效  

Laparoscopic Surgery for the Treatment of 170 Cases of Incarcerated Indirect Inguinal Hernia in Children:Medium and Long-term Efficacy

作　　者：叶茂 陈震[1] 范世莹 许坚吉 刘雪来[1] Ye Mao;Chen Zhen;Fan Shiying(Department of General Surgery,Children’s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院普通外科,北京100020

出　　处：《中国微创外科杂志》2024年第11期726-730,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市自然科学基金(7222015);首都儿科研究所所级课题(LCYJ-2023-07);中国医学科学院小儿外科微创诊疗创新单元(2021RU015);北京市卫生健康委员会2024-2025年度“一带一路”国际卫生健康合作项目和世界卫生组织合作中心项目。

摘　　要：目的探讨腹腔镜治疗嵌顿性斜疝的中长期疗效,总结腹腔镜治疗经验和嵌顿性斜疝的发病特点。方法回顾性分析2016年1月~2024年2月腹腔镜手术治疗170例嵌顿斜疝的临床资料。男109例,女61例。年龄11天~11岁,中位数8月27天。右侧88例,左侧82例。嵌顿时间(发病至手术时间)0.5~360 h,中位时间24 h。结果手术时间11~191 min,(51.9±29.5)min。20例中转开放手术,其中14例经腹股沟中转开放手术,行嵌顿物复位及坏死物切除,6例经脐部切口中转开放手术(4例肠切除吻合,2例回肠修补)。发生嵌顿的器官以小肠(均为回肠)居多(84例),其次是卵巢-输卵管(53例),再次是回盲部(15例)和大网膜(11例)。术中148例腹腔镜监视下体外手法复位,14例腹股沟切开复位,8例自行复位。小肠坏死5例(2.9%),大网膜坏死3例(1.8%),小肠穿孔、小肠浆肌层破损、卵巢-输卵管坏死各2例(1.2%),结肠浆肌层破损1例。术中探查合并对侧隐匿疝109例(64.1%),隐睾7例(4.1%),脐疝7例(4.1%),梅克尔憩室1例(0.6%),卵巢囊肿1例(0.6%)。肠管嵌顿106例中,术前有呕吐症状32例(30.2%),其中嵌顿肠管坏死或穿孔7例均有呕吐,嵌顿肠管浆肌层破损3例中2例呕吐,嵌顿肠管青紫中41.2%(7/17)呕吐,嵌顿肠管血运可者20.3%(16/79)呕吐。住院时间1~11 d,中位数1 d。随访4个月~8年5个月,中位时间4年11个月,其中<3年51例,3~5年38例,>5年81例。斜疝复发2例(1.2%),腹股沟切口感染1例(0.6%),无肠梗阻、医源性隐睾等并发症。结论腹腔镜治疗嵌顿性斜疝中长期疗效好,术中需结合疝复位难度和嵌顿器官血运,适时中转开放手术。嵌顿斜疝患儿术前如有呕吐症状,可能提示嵌顿肠管血运差,需尽快手术处理。Objective To explore the medium and long term curative effect of laparoscopic treatment of incarcerated indirect inguinal hernia and summarize the experience of laparoscopic treatment and the characteristics of incarcerated indirect inguinal hernia.Methods A retrospective summary was made on clinical data of 170 children with incarcerated hernia who underwent laparoscopic surgery between January 2016 to February 2024,including 109 boys and 61 girls.The patient’s age ranged from 11 days to 11 years old,with a median of 8 months and 27 days.There were 88 cases of right incarcerated hernia and 82 cases of left incarcerated hernia.The incarcerating time(from onset to surgery)was 0.5-360 h,with a median time of 24 h.Results The surgical time was 11-191 min(mean,51.9±29.5 min).Conversion to open surgery was required in 20 cases,in which 14 cases were engaged through the inguinal region for reduction of incarcerated organ and removal of necrotic organ,and 6 cases were treated through umbilical incisions(4 cases of intestinal resection and anastomosis and 2 cases of ileal repair).Most of incarcerated organs among them were small intestine(ileum,84 cases),followed by the ovaries and fallopian tubes(53 cases),and ileocecal region(15 cases),as well as the greater momentum(11 cases).During the surgery,148 cases underwent manual reduction through laparoscopic surgery,14 cases underwent open inguinal region reduction,and 8 cases underwent self-reduction.There were 5 cases(2.9%)of small intestinal necrosis,3 cases(1.8%)of greater omentum necrosis,2 cases(1.2%)of small intestine perforation,2 cases(1.2%)of small intestine sarcoplasmic layer damage,2 cases(1.2%)of ovarian fallopian tube necrosis,and 1 case of colonic seromuscular layer damage.The intraoperative exploration revealed 109 cases(64.1%)of contralateral hidden hernia,7 cases(4.1%)of cryptorchidism,7 cases(4.1%)of umbilical hernia,1 case(0.6%)of Meckel’s diverticulum,and 1 case(0.6%)of ovarian cyst.Intestinal incarceration was seen in 106 cases,with 32 cases(30.2%)

关 键 词：腹腔镜 儿童 嵌顿疝 斜疝 

分 类 号：R726.5[医药卫生—儿科]