腹腔镜下经腹壁肌层至皮下环形缝扎疝环治疗儿童隐性腹股沟直疝9例  

Laparoscopic Circular Closure Through Muscle Layer to Subcutaneous Layer of Abdominal Wall Around the Hernia Ring in 9 Children With Occult Direct Inguinal Hernia

作　　者：刘雪来[1] 许坚吉 范世莹 周燕 Liu Xuelai;Xu Jianji;Fan Shiying(Department of General Surgery,Children’s Hospital,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》2025年第3期175-179,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);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：目的探讨两孔法腹腔镜直疝疝环全层环形缝扎的安全性和可行性。方法2019年9月~2024年2月,9例儿童斜疝两孔法腹腔镜内环缝扎术中发现合并右侧隐性腹股沟直疝。腹腔镜监视下完成腹股沟斜疝疝囊高位结扎术后,探查直疝疝囊底部,针持持针依次从4点方向进针,经腹膜跨越腹壁肌层至皮下,于8点方向出针至腹腔内。相同方法从8点方向进针,于12点方向出针,从12点方向进针,于16点(此前4点进针点附近)方向出针,打结,闭合直疝疝环。结果术后诊断3例Pantalon疝(右侧腹股沟斜疝+右侧直疝)和6例左侧腹股沟斜疝+右侧直疝,探查均未见疝囊腹膜外存在脂肪瘤,行两孔法腹腔镜疝囊高位结扎+经腹壁肌层至皮下环形缝扎直疝疝环。手术时间(32.5±3.5)min,出血<1 ml,无术中并发症,均在术后6 h内出院。随访5~13个月(平均8个月),其中3例随访>12个月。无切口感染、复发疝、鞘膜积液、医源性隐睾或睾丸萎缩等并发症。患侧直疝三角区域超声检查显示腹壁厚度均一,未见局限性缺损。结论腹腔镜下经腹壁肌层至皮下环形缝扎直疝疝环具有安全性和可行性。该术式在不改变脐内侧皱襞的正常解剖学位置的前提下,缝合关闭直疝缺损的腹膜和腹壁肌层,是对儿童腹股沟直疝修补术式的补充。Objective To investigate the safety and feasibility of two-port laparoscopic full layer circular closure of the hernia ring for direct inguinal hernia.Methods Between September 2019 and February 2024,9 cases of pediatric indirect inguinal hernia were found to be accompanied by an occult direct inguinal hernia on the right side during two-port laparoscopic inner ring closure.After completing the high ligation of the indirect hernia under laparoscopic monitoring,the bottom of the direct hernia sac was investigated.The needle was held and inserted sequentially from the 4 o’clock direction,crossing the abdominal wall muscle layer through the peritoneum to the subcutaneous layer,and exited at the 8 o’clock direction.The same method was conducted from the 8 o’clock direction in and at the 12 o’clock direction out,and afterwards from the 12 o’clock direction in and at the 16 o’clock direction out(near the previous 4 o’clock insertion point),followed by knotting and closure of the hernia ring.Results Postoperative diagnosis indicated 3 cases of Pantalon hernia(right indirect hernia+right direct hernia)and 6 cases of left indirect hernia+right direct hernia.No extraperitoneal lipoma was found outside the hernia sac.Two-port laparoscopic high ligation of the indirect hernia and laparoscopic circular closure through muscle layer to subcutaneous layer of abdominal wall around the hernia ring was carried out.The operation time was(32.5±3.5)min,and blood loss was less than 1 ml.No intraoperative complications were seen.All the patients were discharged within 6 h after surgery and followed up for 5-13 months(mean,8 months),with 3 cases followed up for more than 12 months.No complications such as incision infection,recurrent hernia,hydrocele,iatrogenic cryptorchidism or testicular atrophy was found.Ultrasound examination of the direct hernia triangular area showed uniform thickness of the abdominal wall and no localized defects observed.Conclusions Laparoscopic circular closure through muscle layer to subcutaneous

关 键 词：腹腔镜 腹股沟直疝 疝环 缝扎 儿童 

分 类 号：R65[医药卫生—外科学]