目的 探讨单孔腹腔镜完全腹膜外疝囊高位结扎术治疗小儿腹股沟斜疝的方法与疗效。 方法 2015 年 3 月至2016年9月本院实施单孔腹腔镜完全腹膜外疝囊高位结扎术360 例。单孔经脐5 mm 腹腔镜辅助,采用双钩疝针将爱惜邦00#聚酯编织线从斜疝内环体表投影处穿刺导入与牵出,完全腹膜外高位双重结扎疝囊。 结果 全部病例手术过程顺利,单侧斜疝249例,双侧斜疝111例,其中109 例术前诊断为单侧腹股沟斜疝,术中发现对侧鞘状突未闭(或隐性疝),均予以同期处理。手术时间:单侧5～9 min,双侧10～15 min,平均11 min。术中出血量0～1 mL。术后恢复平稳,术后1～3 d出院。无精索血管、输精管损伤,无术后阴囊血肿、睾丸萎缩、医源性隐睾等。360例术后随访3～9 个月,平均6个月,复发2例,经再次腹腔镜手术治愈。 结论 单孔腹腔镜下完全腹膜外疝囊高位结扎术治疗小儿腹股沟斜疝复发率低,创伤小,恢复快,无明显瘢痕,可发现并同期治疗对侧鞘状突未闭(或隐性疝)。
Objective To explore the method and efficacy of single-incision laparoscopic totally extraperitoneal hernia sac ligation for pediatric inguinal hernia. Methods From March 2015 to September 2016, 360 cases of total laparoscopic extraperitoneal hernia sac ligation were performed via a single 5-mm hole through umbilicus. A double hernia needle with Ethibond 00# polyester braided wire was introduced and pulled from hernial ring surface projection for total extraperitoneal high-position and double-ligation of hernial sac. Results All procedures were successfully performed. Among those with a preoperative diagnosis of unilateral hernia, 109 cases of contralateral non-closure of processus vaginalis(latent hernia)were operated. Operative duration:unilateral hernia 5-9 min, bilateral hernia 10-15 min and intraoperative blood loss of 0-1 ml. Postoperative recovery was stable and discharge occurred within 1-3 days. Neither spermatic vessel nor vas deferens was damaged. There were no postoperative complications of scrotal hematoma, testicular atrophy or iatrogenic cryptorchidism. The average follow-up period was 6(3-9)months. Two recurrent cases were cured by a second laparoscopy. Conclusion Single-incision laparoscopic total extraperitoneal hernia sac ligation for pediatric inguinal hernia has a low recurrence rate, small trauma, quick recovery and minimal scar. And simultaneously contralateral non-closure of processus vaginalis may be detected and treated.
