Zhou Chengxiao,Tang Ran,Bian Jian,et al.Treatment of special types of hernias in children using single-port transumbilical laparoscopic 9-gauge needle suture technique[J].Journal of Clinical Pediatric Surgery,2024,(11):1088-1092.[doi:10.3760/cma.j.cn101785-202402031-016]
经脐单部位腹腔镜下9号针头带线缝合法治疗儿童特殊类型疝
- Title:
- Treatment of special types of hernias in children using single-port transumbilical laparoscopic 9-gauge needle suture technique
- Keywords:
- Laparoscopy; Surgical Procedures; Operative; Child
- 摘要:
- 目的 初步总结经脐单部位腹腔镜下9号针头带线缝合法治疗儿童特殊类型疝的临床经验。方法 回顾性分析2019年8月至2023年9月安徽省儿童医院普外科采用经脐单部位腹腔镜下9号针头带线缝合法治疗的18例特殊类型疝患儿临床资料,其中6例Amyand’s疝、2例Littre疝、2例直疝、7例白线疝、1例Morgagni疝,对手术方式、手术时间、手术出血量、住院时间、术后并发症及疝复发率等指标进行分析。结果 18例均经脐单部位腹腔镜下9号针头带线缝合法顺利手术,均痊愈出院。6例Amyand’s疝均发生在右侧,1例阑尾正常,仅行阑尾还纳复位+疝囊高位结扎术;5例为阑尾炎症,予以悬吊法切除阑尾,再予疝囊高位结扎术。2例Littre疝发生在右侧,分离粘连内容物Meckel憩室,扩大脐部切口后将Meckel憩室提出腹外,予以Meckel憩室切除,行肠吻合+疝囊高位结扎术。1例Pantaloon疝和1例直疝发生在左侧,予疝囊高位结扎+脐内侧壁加强修补术。7例白线疝的疝环位于上腹部,5例疝内容物为肝圆韧带,2例疝内容物为脐正中韧带,采用U型间断缝合两侧白线及腹膜,修补缺损。1例胸骨后疝,还纳部分结肠入腹腔后完成膈肌缺损修补术。手术时间20~90 min;术中出血量1~8 mL;术后2~14 d出院,随访2~45个月;无一例疝复发、睾丸萎缩、医源性隐睾、阴囊感染,下肢运动及感觉均正常。结论 采用经脐单部位腹腔镜下9号针头带线缝合法治疗儿童特殊类型疝安全有效,值得临床推广。
- Abstract:
- Objective To preliminarily summarize the clinical experience of treating special types of hernias in children using a single-port transumbilical laparoscopic 9-gauge needle suture. Methods A retrospective analysis was conducted on 18 pediatric cases with special types of hernias treated using this technique in the Department of Pediatric Surgery at Anhui Provincial Children’s Hospital from August 2019 to September 2023.The cases included 6 Amyand’s hernias,2 Littre hernias,2 direct hernias,7 linea alba hernias,and 1 Morgagni hernia.The surgical approach,duration,blood loss,hospital stay,postoperative complications,and hernia recurrence rate were analyzed. Results All 18 cases underwent successful surgery using the single-port transumbilical laparoscopic 9-gauge needle suture technique,and all were discharged in good health.Among the 6 Amyand’s hernia cases,5 involved cecal content with inflamed or suppurative appendices and underwent appendectomy with high-ligation of the hernial sac; the remaining case with normal appendix underwent simple reduction and high-ligation of the sac.For 2 Littre hernia cases,Meckel’s diverticulum was resected after widening the umbilical incision.The single Pantaloon and direct hernia cases involved high-ligation of the sac and medial umbilical wall reinforcement.For the 7 linea alba hernia cases,a U-shaped interrupted suture was used to repair defects in the linea alba and peritoneum.One retrosternal hernia case involved reduction of colonic contents followed by diaphragm defect repair.The operation time ranged from 20 to 90 minutes,blood loss was 1-8 mL,and hospital discharge occurred within 2-14 days post-surgery.Follow-up (2-45 months) showed no hernia recurrence,testicular atrophy,iatrogenic cryptorchidism,scrotal infection,or abnormal movement and sensation in the lower limbs. Conclusions The single-port transumbilical laparoscopic 9-gauge needle suture technique is safe,effective,and cosmetically favorable approach for treating special types of hernias in children.This method has valuable applications and merits wider clinical adoption.
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备注/Memo
收稿日期:2024-2-29。
通讯作者:戚士芹,Email:qishiqin@163.com