Bian Jun,Wei Qiang,Shi Weidong,et al.Operative techniques of laparoscopic hernia sac high-ligation for pediatric inguinal hernia: a report of 1411 cases[J].Journal of Clinical Pediatric Surgery,2018,17(09):707-711.
腹腔镜下疝气针无损伤腹膜疝囊高位结扎术治疗小儿腹股沟斜疝1 411例手术技巧探讨
- Title:
- Operative techniques of laparoscopic hernia sac high-ligation for pediatric inguinal hernia: a report of 1411 cases
- Keywords:
- Pediatric indirect inguinal hernia; Hernia needle; Non-invasive peritoneum; Operative technique
- 文献标志码:
- A
- 摘要:
- 目的 探讨腹腔镜下疝气针单通道无损伤腹膜疝囊高位结扎术治疗小儿腹股沟斜疝的手术技巧。方法 回顾性分析2014年8月30日至2015年8月29日我科室收治的腹股沟斜疝患儿1 411例（男1 233例，女178例），平均年龄3岁2个月（6个月至15岁2个月）；左侧505例，右侧779例，双侧127例；术中采用腹腔镜下疝气针单通道无损伤腹膜疝囊高位结扎术（手术中疝气针通过输精管或者精索时穿破腹膜的发生率为10% ~ 15%，此种情况下先退针，重新选择潜行位置顺利通过输精管和精索）。 结果 单侧女童手术平均耗时约3 min，双患侧约5 min；单侧男童手术平均耗时约5 min，双侧约8 min；患儿手术当日进食流质饮食，次日出院，门诊复查1个月，电话随访1年，复发2例，其余患儿均未出现术后不良反应。 结论 腹腔镜下疝气针单通道无损伤腹膜疝囊高位结扎术治疗小儿腹股沟斜疝是一种操作简单、手术时间短、微创安全的方式，值得临床推广。
- Abstract:
- Objective To explore the operative techniques of laparoscopic hernia sac high-ligation for pediatric inguinal hernia. Methods Retrospective statistical analyses were performed for a total of 1411 hospitalized cases of pediatric oblique inguinal hernia from August 30, 2014 to August 29, 2015. The involved side was left (n=505), right (n=779) and bilateral (n=127). The operative approach was laparoscopic hernia sac high-ligation. During surgery, hernia needle had an incidence of 10-15% guiding through spermatic cord or vas deferens piercing peritoneum. Such an event required re-selecting stealth position and passing smoothly through vas deferens and spermatic cord. Results For girls, the average operative duration was 3 min in unifeteral hernia and 5 min in bilateral hernia; For boys, the average time was 5 min in unifeteral hernia and 8 min in bilateral hernia. They resumed a liquid diet the same day and were discharged the next day. Follow-ups were conducted by clinic visits at 1 month and telephone at 1 year. Two cases recurred and the remainder showed no major postoperative discomforts. Conclusion Laparoscopic hernia sac high-ligation offers the advantages of simple handling, short operative duration and minimal trauma. It is quite worthy of clinical popularization.
参考文献/References:
1 费川，张永婷，刘雪来等.单孔腹腔镜腹膜外结扎术治疗小儿腹股沟斜疝相关并发症分析[J].临床小儿外科杂志，2016，15（4）:328-331. DOI:10.3969/j.issn.1671-6353.2016.04.005. Fei C, Zhang YT, Liu XL, et al. Related complications of single-port laparoscopic percutaneous extraperitoneal closure for pediatric in-guinal hernia[J].Journal of Clinical Pediatric Surgery,2016，15（4）:328-331. DOI:10.3969/j.issn.1671-6353.2016.04.005. 2 刘洁，段光琦，王啸等.单孔腹腔镜下特制疝气针治疗儿童腹股沟斜疝的问题及处理[J].临床小儿外科杂志， 2015，14（3）:226-228.DOI：10.3969/j.issn.1671-6353.2015.03.018. Liu J, Duan GQ, Wang X, Tang R, et al. Adverse factors and coping skills of laparoscopic percutaneous extraperitoneal closure for 196 cases of pediatric inguinal hernia[J].Journal of Clinical Pediatric Surgery, 2015，14（3）:226-228.DOI：10.3969/j.issn.1671-6353.2015.03.018. 3 段光琦，张敏，管肖浩.单孔腹腔镜治疗小儿腹股沟斜疝55例分析[J].中华疝和腹壁外科杂志， 2014，7（3）:255-257.DOI:10.3877/cma.j.issn.1674-392X.2013.03.016. Duan GQ, Zhang M, Guan XH. Pediatric patients with inguinal hernia via single-port laparoscopic (report of 55 cases)[J].Chinese Journal of Hernia and Abdominal Wall Surgery (Electronic Version), 2014，7(3):255-257.DOI:10.3877/cma.j.issn.1674-392X.2013.03.016. 4 侯崇智，卞军，施伟栋等.腹腔镜下单通道自制疝气针完全腹膜外疝囊高位结扎术治疗小儿腹股沟斜疝163例[J]. 中国微创外科杂志，2014，14（6）:519-521.DOI:10.3969/j.issn.1009-6604.2014.06.012. Hou CZ, Bian J,Shi WD, Wang J, et al.Single-port Laparoscopic Total Extraperitoneal High Ligation of Hernia Sac in Children: an Analysis of 163 Cases[J].Chinese Journal of Minimally Invasive Surgery,2014，14（6）:519-521.DOI:10.3969/j.issn.1009-6604.2014.06.012. 5 夏东亮，张丽华，李庆浩等.单孔腹腔镜和雪橇针治疗小儿腹股沟斜疝手术经验和技巧[J].中华疝和腹壁外科杂志，2014，8（3）265-270.DOI:10.3969/cma.j.issn.1674-392X.2014.03.022. Xia DL, Zhang LH, Li QH, et al.Adverse factors of laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia[J].Chinese Journal of Hernia and Abdominal Wall Surgery (Electronic Version),2014，8（3）265-270.DOI:10.3969/cma.j.issn.1674-392X.2014.03.022. 6 刘琳，李索林.腹腔镜技术诊疗小儿腹股沟斜疝的演化[J].中华小儿外科杂志，2016，37(10):796-800.DOI:10.3760/cma.j.issn.0253-3006.2016.10.019. Liu L, Li SL.Evolving role of laparoscopy in the management of pediatric inguinal hernia[J].Chinese Journal of Pediatric Surgery,2016，37(10):796-800.DOI:10.3760/cma.j.issn.0253-3006.2016.10.019. 7 王根本，刘里侯. 医用局部解剖学[M].第4版，人民卫生出版社2001. Wang J, Liu LH. Medical Topical Anatomy [M]. 4th edition, People’s Medical Publishing House, 2001. 8 Bruzoni M, Jaramillo JD, Kastenberg ZJ, et al. Long-term follow-up of laparoscopic transcutaneous inguinal herniorraphy with high transfixation suture ligature of the hernia sac[J]. Journal of Pediatric Surgery, 2015, 50(10):1767-1771. DOI: 10.1016/j.jpedsurg.2015.06.006. 9 Helal AE. Laparoscopic single instrument closure of inguinal hernia in female children: A novel technique[J]. Journal of Pediatric Surgery, 2015, 50(9):1613-1616. DOI: 10.1016/j.jpedsurg.2015.05.003. 10 Baird R, Guilbault MP, Tessier R, et al. A systematic review and meta-analysis of caudal blockade versus alternative analgesic strategies for pediatric inguinal hernia repair[J]. Journal of Pediatric Surgery, 2013, 48(5):1077-1085. DOI: 10.1016/j.jpedsurg.2013.02.030. 11 牛志尚,郝春生,叶辉等.经脐单一部位单通道与双通道腹腔镜手术治疗小儿腹股沟斜疝对比研究[J].中国微创外科杂志，2013，13(12):1112-1119. Niu ZS, Hao CS, Ye H, et al. Comparative Study between Transumbilical Single Site One-port and Double-port Laparoscopic High Ligation of Hernia Sac for the Treatment of Indirect Inguinal Hernia in Children[J].Chinese Journal of Minimally Invasive Surgery,2013，13(12):1112-1119. 12 王怀经.局部解剖学[M]. 北京：人民卫生出版社， 2001 :165. Wang HJ.Regional anatomy[M].Beijing:Beijing,2001:165. 13 曹献延.手术解剖学[M].人民卫生出版社，1996:646. Cao XY.SurgicamL anatomy[M].Beijing:Beijing,1996:646. 14 吴阶平，裘法祖.黄家驷外科学[M]. 北京：人民卫生出版社， 1988：899. Wu JP, Qiu FZ.Huang Jia Si Surgury[M].Beijing:Beijing,1988:899. 15 张世伟, 张浩然, 马计超,等. 改良单孔疝针经皮腹膜外结扎术治疗小儿腹股沟疝[J]. 中华小儿外科杂志, 2016, 37(10):754-757. DOI:10.3760/cma.j.issn.0253-3006.2016.10.009. Zhang SW, Zhang HR, Ma JC, et al.Modified single-site laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia[J].Chinese Journal of Pediatric Surgery,2016,37(10):754-757.DOI:10.3760/cma.j.issn.0253-3006.2016.10.009. 16 陈易, 赵军锋, 林杰,等. 应用腹腔镜治疗小儿对侧未闭隐匿性鞘状突[J]. 中华小儿外科杂志, 2016, 37(10):750-753. DOI:10.3760/cma.j.issn.0253-3006.2016.10.007. Chen Y, Zhao JF, Lin J, et al.Laparoscopy of contralateral patent processus vaginalis in children with unilateral inguinal hernia[J].Chinese Journal of Pediatric Surgery, 2016, 37(10):750-753. DOI:10.3760/cma.j.issn.0253-3006.2016.10.007. 17 蔡威，孙宁，魏光辉.小儿外科学[M]. 第五版.北京：人民卫生出版社， 2015 :276. Cai W, Sun N, Wei GH. Pediatric Surgery 5th .Beijing:Beijing,2015:276. 18 郑向欣, 管小青, 吴骥,等. 腹腔镜下带线气腹针治疗小儿腹股沟斜疝的应用价值[J]. 中国普外基础与临床杂志, 2015,22(4):468-471. Zheng XX, Guan XQ, Wu J, et al. Clinical Value of Laparoscopy Via Veress Needle with Th read in Children with Inguinal Hernia[J].Chin J Bases Clin General Surg,2015,22(4):468-471. 19 王新星，李帅，汤绍涛，等.单纯经腹腔镜下疝囊高位结扎术治疗小儿腹股沟斜疝[J].临床小儿外科杂志， 2016，15(4):348-350.DOI：10.3969/j.issn.1671-6353.2016.04.011. Wang X, Li S, Tang ST, et al. Transumbilical laparaoscopy for high inguinal hernias in children [J].Journal of Clinical Pediatric Surgery, 2016，15(4):348-350.DOI：10.3969/j.issn.1671-6353.2016.04.011. 20 莫崖冰，谢俐，肖新辉等.单孔腹腔镜双沟疝针完全腹膜外疝囊高位结扎术治疗小儿腹股沟斜疝的疗效分析[J].临床小儿外科杂志， 2017，16(5):491-494.DOI：10.3969/j.issn.1671-6353.2017.05.017. Mo YB, Xie L, Xiao XH, et al. Single-incision laparoscopic hernia needle two -hooked core totally extraperitoneal hernia sac high-liga-tion for pediatric inguinal [J]. J Clin Ped Sur, 2017，16(5):491-494.DOI：10.3969/j.issn.1671-6353.2017.05.017.
相似文献/References:
[1]杨虎,王鹏,何立鹏,等.小切口疝囊高位结扎术514例报道[J].临床小儿外科杂志,2007,6(01):36.